The Model for Improvement begins with three questions designed to clarify the following concepts:
Aims, measures, changes
Applying the Model for Improvement to the clinic’s improvement goal, which of the following is the most reasonable aim statement?
Increase the number of patients reporting they are “very satisfied” with the clinic’s scheduling by 50 percent within six months.
What is the team’s next step?
Test their change plan using the PDSA cycle.
The orthopedic clinic plans the change to improve scheduling, and then it carries out a small test of change with three patients on Tuesday morning. What’s the next thing the clinic’s improvement team should do?
Measure to see if the change led to improvement.
When trying to improve a process, one reason to use PDSA cycles rather than a more traditional version of the scientific method (such as a randomized, controlled trial) is that:
Both C and D
Having a clear aim statement is important in quality improvement work because:
Aim statements provide a clear and specific goal for the organization to reach.
An aim statement should include the following:
Numeric goals, specific time frame, patient population or system affected
Which of the following is the most effective aim statement for this project?
Within three months, the emergency department will administer all pain medications within 45 minutes of order time.
The charge nurse in the emergency room asks Brenda to assemble a team to improve the delivery of pain medication. As she considers who to place on the team, Brenda should:
Review the aim statement to make sure the team includes representatives of all processes affected by the team’s aim.
During Brenda’s first group meeting, the members ask to review the aim statement to make sure they agree it addresses the current problem. With Brenda’s approval, they all decide to rewrite it. However, when they meet to consider what would be a better aim statement, the group loses direction. In order to help them, Brenda might want to:
Remind the team of the Institute of Medicine’s dimensions of health care quality.
What would you identify as the outcome measure for the project?
Percent of patients that are readmitted to the hospital
Which of the following is an example of a process measure that you may collect as part of this improvement effort?
The percent of patients receiving a call within 48 hours of discharge
Why might you consider collecting balancing measures?
To make sure you did not unintentionally damage other aspects of the unit’s work
What else should you add to the graph to best explain the work your unit has done?
Annotations to show when specific changes were tested
Gathering and reviewing data during an improvement project—that is, measuring—helps you answer which of the three questions of the Model for Improvement?
How will we know that a change is an improvement?
You’re a medical assistant at a community health clinic. Sometimes, patients with unresolved problems need to come in for follow-up appointments. However, you notice that it’s a real challenge to schedule these follow-ups within a week of the initial appointments. Which of the following techniques might be most useful as you search for a good idea for change?
Review the process for scheduling these appointments with colleagues to identify opportunities for improvement.
What’s the main benefit of using change concepts to come up with improvement ideas?
Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially.
You notice that it’s very easy to confuse medications at the community health center where you’re working. They are lined up on the shelf and the labels are very similar. You decide that it’s worth a try to highlight parts of drug names on certain labels to reduce confusion. Which change concept are you using?
Design Systems to Prevent Errors
Which of the following changes falls under the heading of “eliminating waste”?
Physicians type all consult responses directly into a computer rather than writing them in a patient’s chart, thus saving paper.
As you recall, the IHI staff member’s change idea involves leaving work by 5:30 PM each workday. Which of the following is an example of using technology to help her do so?
Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, “Leave!”
The care protocol was successful at the other hospital. Why would it be important to test this proven change at your hospital?
Because this change may not be as effective in your hospital.
After several tests, you decide to try implementing a modified version of the protocol at your institution. Which of the following might you do within the “S” portion of your next PDSA cycle?
Analyze information collected.
Based on the recommendations in this lesson, what should you do next?
Work on improving both the schedule and communication at the same time.
Starting with small tests of change:
Improves the likelihood of buy-in from opinion leaders
Which of the following statements is true?
While not all changes lead to improvement, all improvement requires change.