PATIENT SAFETY & QUALITY IMPROVEMENT
EXAMINATION |Summer Series |June/July 2026
|questions and correct answers
1. A quality improvement team is using the Model for Improvement.
After developing their aim statement, what is the NEXT step they
should take according to this model?
A. Implement the change on a large scale to test its effectiveness
B. Conduct a root cause analysis to identify all potential failures
C. Select measures to determine if the change leads to
improvement
D. Perform a cost-benefit analysis to justify the project
Correct Answer: C
Explanation: The Model for Improvement uses three core
questions: 1) What are we trying to accomplish? (Aim), 2) How will
we know a change is an improvement? (Measures), and 3) What
changes can we make that will result in improvement? (Changes).
Selecting measures is the logical second step after establishing the
aim.
2. A hospital is implementing a new electronic health record (EHR)
system. Which of the following represents the HIGHEST risk for a
technology-induced error?
A. Inadequate training on the new system for all staff
B. Mismatch between the EHR's clinical workflow and the actual
, workflow
C. Autopilot errors where clinicians rely on default selections
without review
D. Increased time spent on data entry during patient encounters
Correct Answer: C
Explanation: While all are risks, autopilot errors represent a
cognitive trap where clinicians unconsciously accept default values
or alerts. This can lead to serious medication or treatment errors.
It is a specific type of technology-induced error where the system
design fosters complacency and reduces active decision-making.
3. Which of the following tools is MOST appropriate for analyzing a
series of events that led to a critical patient safety incident,
focusing on system failures rather than individual blame?
A. Fishbone (Ishikawa) Diagram
B. Pareto Chart
C. Run Chart
D. Root Cause Analysis (RCA)
Correct Answer: D
Explanation: Root Cause Analysis (RCA) is a structured method
used to analyze serious adverse events. Its primary purpose is to
identify the underlying systems and processes that failed, moving
beyond individual blame to improve the system and prevent
recurrence. A Fishbone Diagram is a tool often used within an RCA
but is not the overall methodology.
,4. A team is implementing a new checklist to reduce central line-
associated bloodstream infections (CLABSI). After one month, the
infection rate has not decreased. What is the MOST appropriate
first step in assessing the intervention's effectiveness?
A. Abandon the checklist as it is clearly ineffective
B. Conduct an audit to measure compliance with the checklist
C. Increase the frequency of in-service training for all staff
D. Revise the checklist to include more steps for safety
Correct Answer: B
Explanation: Before concluding that the intervention is ineffective
(A), the team must first assess if the intervention is being
implemented as intended. This is a fundamental principle of
improvement science known as assessing "fidelity of
implementation." If compliance is low, the focus should be on
improving adherence, not changing the intervention itself.
5. A patient is transferred from the ICU to a general medical floor.
The sending nurse provides a verbal handoff to the receiving
nurse. Which of the following is a HIGH-RISK communication error
that should be avoided during this process?
A. Using a standardized handoff tool like SBAR
B. Asking clarifying questions about the patient's status
C. Making assumptions that the receiving nurse has read the
patient's entire chart
D. Including the patient's family in the handoff process
Correct Answer: C
Explanation: Assumptions are a common communication pitfall.
Critical information may be missed if the verbal handoff relies on
, the receiving nurse having read the chart. Standardized tools like
SBAR (Situation, Background, Assessment, Recommendation) are
designed to mitigate this risk by ensuring all key information is
communicated verbally and explicitly.
6. In high-reliability organizations (HROs), what does the principle of
"preoccupation with failure" primarily involve?
A. A focus on assigning blame when mistakes occur
B. A relentless focus on identifying near-misses and small failures
before they escalate
C. Encouraging staff to work extra hours to prevent errors
D. An emphasis on technological solutions to eliminate all human
error
Correct Answer: B
Explanation: "Preoccupation with failure" is a cornerstone of HRO
theory. It means that organizations are constantly alert to the
possibility of failure and treat near-misses as valuable
opportunities to learn and improve the system, preventing them
from becoming catastrophic events.
7. A hospital is analyzing its medication error reports from the last
six months. The data shows that 60% of errors are related to
prescribing, 20% to administration, and 20% to transcription.
Which quality tool should be used to visually display and prioritize
the focus for improvement?
A. Scatter Plot
B. Control Chart
EXAMINATION |Summer Series |June/July 2026
|questions and correct answers
1. A quality improvement team is using the Model for Improvement.
After developing their aim statement, what is the NEXT step they
should take according to this model?
A. Implement the change on a large scale to test its effectiveness
B. Conduct a root cause analysis to identify all potential failures
C. Select measures to determine if the change leads to
improvement
D. Perform a cost-benefit analysis to justify the project
Correct Answer: C
Explanation: The Model for Improvement uses three core
questions: 1) What are we trying to accomplish? (Aim), 2) How will
we know a change is an improvement? (Measures), and 3) What
changes can we make that will result in improvement? (Changes).
Selecting measures is the logical second step after establishing the
aim.
2. A hospital is implementing a new electronic health record (EHR)
system. Which of the following represents the HIGHEST risk for a
technology-induced error?
A. Inadequate training on the new system for all staff
B. Mismatch between the EHR's clinical workflow and the actual
, workflow
C. Autopilot errors where clinicians rely on default selections
without review
D. Increased time spent on data entry during patient encounters
Correct Answer: C
Explanation: While all are risks, autopilot errors represent a
cognitive trap where clinicians unconsciously accept default values
or alerts. This can lead to serious medication or treatment errors.
It is a specific type of technology-induced error where the system
design fosters complacency and reduces active decision-making.
3. Which of the following tools is MOST appropriate for analyzing a
series of events that led to a critical patient safety incident,
focusing on system failures rather than individual blame?
A. Fishbone (Ishikawa) Diagram
B. Pareto Chart
C. Run Chart
D. Root Cause Analysis (RCA)
Correct Answer: D
Explanation: Root Cause Analysis (RCA) is a structured method
used to analyze serious adverse events. Its primary purpose is to
identify the underlying systems and processes that failed, moving
beyond individual blame to improve the system and prevent
recurrence. A Fishbone Diagram is a tool often used within an RCA
but is not the overall methodology.
,4. A team is implementing a new checklist to reduce central line-
associated bloodstream infections (CLABSI). After one month, the
infection rate has not decreased. What is the MOST appropriate
first step in assessing the intervention's effectiveness?
A. Abandon the checklist as it is clearly ineffective
B. Conduct an audit to measure compliance with the checklist
C. Increase the frequency of in-service training for all staff
D. Revise the checklist to include more steps for safety
Correct Answer: B
Explanation: Before concluding that the intervention is ineffective
(A), the team must first assess if the intervention is being
implemented as intended. This is a fundamental principle of
improvement science known as assessing "fidelity of
implementation." If compliance is low, the focus should be on
improving adherence, not changing the intervention itself.
5. A patient is transferred from the ICU to a general medical floor.
The sending nurse provides a verbal handoff to the receiving
nurse. Which of the following is a HIGH-RISK communication error
that should be avoided during this process?
A. Using a standardized handoff tool like SBAR
B. Asking clarifying questions about the patient's status
C. Making assumptions that the receiving nurse has read the
patient's entire chart
D. Including the patient's family in the handoff process
Correct Answer: C
Explanation: Assumptions are a common communication pitfall.
Critical information may be missed if the verbal handoff relies on
, the receiving nurse having read the chart. Standardized tools like
SBAR (Situation, Background, Assessment, Recommendation) are
designed to mitigate this risk by ensuring all key information is
communicated verbally and explicitly.
6. In high-reliability organizations (HROs), what does the principle of
"preoccupation with failure" primarily involve?
A. A focus on assigning blame when mistakes occur
B. A relentless focus on identifying near-misses and small failures
before they escalate
C. Encouraging staff to work extra hours to prevent errors
D. An emphasis on technological solutions to eliminate all human
error
Correct Answer: B
Explanation: "Preoccupation with failure" is a cornerstone of HRO
theory. It means that organizations are constantly alert to the
possibility of failure and treat near-misses as valuable
opportunities to learn and improve the system, preventing them
from becoming catastrophic events.
7. A hospital is analyzing its medication error reports from the last
six months. The data shows that 60% of errors are related to
prescribing, 20% to administration, and 20% to transcription.
Which quality tool should be used to visually display and prioritize
the focus for improvement?
A. Scatter Plot
B. Control Chart
