QI and Patient Safety

Question 1

What are the three types of measures in a QI study

Answer 1

1. Outcome – what we are trying to change
2. Process – actions needs to achieve change
3. Balancing – potential undesired side effects of change

Question 2

What are 5 key analysis tools of QI

Answer 2

1. Histogram – detect categories having the highest frequency of event or other attribute of interest
2. Scatter diagram – detect if there is association between two variables.
3. Cause and effect diagram (fish bone) – Identify causes of outcome of interest in a range of domains: measurements, materials, personnel, environment, methods, and machines
4. Pareto chart – combination of histogram and cumulative totals to identify the subset of factors that account for 80% of the outcome.
5. Run Chart or Statistical process control chart – identify if average, upper, and lower bounds for an outcome to detect shift over time

Question 3

You are designing a QI project. You want to understand what are the most reasons providers are not ordering a HFNC holiday on their patients. You survey providers to ascertain the extent to which 5 different factors impact their failure to order a HFNC holiday. What type of QI tool will help you visualize the most common factors identified by the survey?

Answer 3

A histogram.

Question 4

Your team wants to understand all the factors related to whether or not providers order a HFNC holiday on their patients. What QI tool will help you identify these factors?

Answer 4

A cause and effect diagram.

Question 5

You want to identify the smallest set of factors related to ordering a HFNC holiday that accounts for 80% of the failures to order a HFNC holiday. What diagram will help you identify these factors?

Answer 5

A Pareto chart.

Question 6

After completing your intervention, you want to know if there has been a change in HFNC ordering. What QI tool will help you determine if your project has succeeded in changing behavior with respect to ordering HFNC holidays?

Answer 6

A process control chart or run chart.

Question 7

Describe Lewin’s change theory

Answer 7

Unfreezing by increasing driving force or decreasing restraining forces, change, refreeze.

Question 8

What are the 5 principles of Lean methodology

Answer 8

Precisely specify value by specific product
Identify the value stream for each product (value stream mapping)
Make value flow without interruptions
Let customer pull value from the producer
Pursue perfection

The key to the Lean methodology is the concept of WASTE. Identify and eliminate waste by understanding what exactly the customer wants, and then efficiently provide that value without interruption or wasted movement or effort.

Question 9

What is the difference between the Six Sigma and Lean methodologies of process improvement?

Answer 9

Lean is focused on eliminating waste (by understanding the customer’s wants and optimizing the flow of materials and effort). Six Sigma is focused on reducing variation (through statistical analysis and controls).

Question 10

What are the three ethical principles that are the foundation for the Belmont Report’s guidance on human subjects research?

Answer 10

1. Respect for persons
2. Beneficence (which has been expanded to add nonmaleficence)
3. Justice

Question 11

What are 4 possible frameworks for distributing scarce resources described by Emanuel?

Answer 11

1. Maximize benefit
2. Treat people equally.
3. Promote instrumental value
4. Sickest first / Youngest first

Question 12

What are the 4 principles for equitable allocation of healthcare resources?

Answer 12

1. Focus on improving health
2. Patients should be informed
3. Patients should give consent
4. Conflict of interest should be minimized.