IHI QI 105. Leading Quality
Improvement
Which of the following is a mechanism for "hardwiring" an innovation during the
implementation phase?
A) Developing a new process based on emerging technology
B) Training all staff to use a new process
C) Testing a new process that has been successful elsewhere in a new unit
D) All of the aboce - answerB) Training all staff to use a new process
"Hardwiring" helps sustain an idea after it has been tested and implemented. Training
all staff is one way to do this. Other ways include assigning a day-to-day leader for the
new process or having senior leadership remove barriers for staff.
Dr. Gonsalvez, the medical director of the medicine ward, wants to lower the 30-day
readmission rate of the patients on her unit (i.e., the percentage of patients readmitted
to the hospital within 30 days of discharge). She meets with the nurse manager and
other stakeholders, and, together, they develop a process to improve the way the ward
discharges patients and transfers care back to each patient's primary care provider. The
team tests the change on the ward and runs multiple PDSA cycles to improve the
process. The data look promising.
What improvement project stage have Dr. Gonsalvez and her team just completed?
A) Planning
B) Spread
C) Pilot
D) Implementation - answerPilot
The team has just completed the improvement stage that consists of early, rapid-cycle
tests of change: the pilot phase.
Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering
from inadequate pain control. Currently, a patient who needs pain medication must call
the front desk, which then calls the nurse, who then goes to the patient's room to find
out what he or she needs. Sandy finds out that a hospital in the next county has a
simpler process: Patients can send a text message directly to the nurse to request pain
medication. Sandy goes to her manager and suggests that they form a team to work on
improving pain control and test this change to improve care in the cardiac care unit
within the next three months.
, What improvement project phase is Sandy looking to embark on?
A) Set an aim
B) Develop a pilot
C) Spread the new standard
D) Develop an improvement strategy - answerDevelop an improvement strategy
Sandy has identified a aim and is hoping to establish a team and a plan. Piloting
involves trying out the new process in one place and carefully refining the system to
make sure it works. Depending on the success of the pilot, implementation and spread
may come later.
The four steps for testing a change are:
A) Plan-Do-Study-Act
B) Innovation-Pilot-Study-Act
C) Plan-Implement-Pilot-Spread
D) Plan-Pilot-Implementation-Spread - answerPlan-Do-Study-Act
The four steps for testing a change are "Plan-Do-Study-Act." PDSA cycles are tests of
change that improvers conduct during different stages of their improvement projects.
Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering
from inadequate pain control. Currently, a patient who needs pain medication must call
the front desk, which then calls the nurse, who then goes to the patient's room to find
out what he or she needs. Sandy finds out that a hospital in the next county has a
simpler process: Patients can send a text message directly to the nurse to request pain
medication. Sandy goes to her manager and suggests that they form a team to work on
improving pain control and test this change in the cardiac care unit.
After a successful pilot, which of the following should Sandy's improvement team
undertake as a next step?
A) Work on seeing that the change is widely adopted by the unit AND continue to run
PDSA cycles.
B) Spread the change to other hospitals in the network.
C) Continue to run PDSA cycles.
D) Work on seeing that the change is widely adopt - answerWork on seeing that the
change is widely adopted by the unit AND continue to run PDSA cycles.
After a successful pilot, they should move on to the implementation phase. This phase
includes actions to "hardwire" the change, such as making it standard policy and
training new staff on it. In implementing the change, the team will continue to run
PDSAs: making predictions, carrying out the test, collecting data, and refining the
change based on results.(Note that compared to PDSAs in the pilot phase, these tests
will require significantly more people, time, and resources.)
Improvement
Which of the following is a mechanism for "hardwiring" an innovation during the
implementation phase?
A) Developing a new process based on emerging technology
B) Training all staff to use a new process
C) Testing a new process that has been successful elsewhere in a new unit
D) All of the aboce - answerB) Training all staff to use a new process
"Hardwiring" helps sustain an idea after it has been tested and implemented. Training
all staff is one way to do this. Other ways include assigning a day-to-day leader for the
new process or having senior leadership remove barriers for staff.
Dr. Gonsalvez, the medical director of the medicine ward, wants to lower the 30-day
readmission rate of the patients on her unit (i.e., the percentage of patients readmitted
to the hospital within 30 days of discharge). She meets with the nurse manager and
other stakeholders, and, together, they develop a process to improve the way the ward
discharges patients and transfers care back to each patient's primary care provider. The
team tests the change on the ward and runs multiple PDSA cycles to improve the
process. The data look promising.
What improvement project stage have Dr. Gonsalvez and her team just completed?
A) Planning
B) Spread
C) Pilot
D) Implementation - answerPilot
The team has just completed the improvement stage that consists of early, rapid-cycle
tests of change: the pilot phase.
Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering
from inadequate pain control. Currently, a patient who needs pain medication must call
the front desk, which then calls the nurse, who then goes to the patient's room to find
out what he or she needs. Sandy finds out that a hospital in the next county has a
simpler process: Patients can send a text message directly to the nurse to request pain
medication. Sandy goes to her manager and suggests that they form a team to work on
improving pain control and test this change to improve care in the cardiac care unit
within the next three months.
, What improvement project phase is Sandy looking to embark on?
A) Set an aim
B) Develop a pilot
C) Spread the new standard
D) Develop an improvement strategy - answerDevelop an improvement strategy
Sandy has identified a aim and is hoping to establish a team and a plan. Piloting
involves trying out the new process in one place and carefully refining the system to
make sure it works. Depending on the success of the pilot, implementation and spread
may come later.
The four steps for testing a change are:
A) Plan-Do-Study-Act
B) Innovation-Pilot-Study-Act
C) Plan-Implement-Pilot-Spread
D) Plan-Pilot-Implementation-Spread - answerPlan-Do-Study-Act
The four steps for testing a change are "Plan-Do-Study-Act." PDSA cycles are tests of
change that improvers conduct during different stages of their improvement projects.
Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering
from inadequate pain control. Currently, a patient who needs pain medication must call
the front desk, which then calls the nurse, who then goes to the patient's room to find
out what he or she needs. Sandy finds out that a hospital in the next county has a
simpler process: Patients can send a text message directly to the nurse to request pain
medication. Sandy goes to her manager and suggests that they form a team to work on
improving pain control and test this change in the cardiac care unit.
After a successful pilot, which of the following should Sandy's improvement team
undertake as a next step?
A) Work on seeing that the change is widely adopted by the unit AND continue to run
PDSA cycles.
B) Spread the change to other hospitals in the network.
C) Continue to run PDSA cycles.
D) Work on seeing that the change is widely adopt - answerWork on seeing that the
change is widely adopted by the unit AND continue to run PDSA cycles.
After a successful pilot, they should move on to the implementation phase. This phase
includes actions to "hardwire" the change, such as making it standard policy and
training new staff on it. In implementing the change, the team will continue to run
PDSAs: making predictions, carrying out the test, collecting data, and refining the
change based on results.(Note that compared to PDSAs in the pilot phase, these tests
will require significantly more people, time, and resources.)
