Practice and Process Improvement

Question 1

Research process

Answer 1

Identify the problem
Review of literature
Identify conceptual framework
Define concepts and variables
Select design
Identify population and sample
Determine measurement methods
Plan data collection and analysis
Implement: collect, analyse, interpret
Disseminate findings (most important)

Question 2

Qualitative inquiry

Answer 2

Subjective (words)
Inductive
Broad focus
Meaning/discovery

Question 3

Quantitative inquiry

Answer 3

Single, measureable reality
Objective (numbers and statistics)
Deductive
Narrow focus
Cause and Effect

Question 4

Research study critique

Answer 4

Introduction: is problem identified
Problem statement: is it clear
Purpose statement: clearly stated goal or objective?
Review of literature: is the review comprehensive
Theory and conceptual framework; Clearly identified and discussed
REsearch question: clearly stated? Further delineates the problem area of study?
Design/methodology: is the design appropriate to test the study
Ethics: appropriate IRB approval
Data: were collection methods clearly described? Statistics clearly discussed? Demographics?
Findings: are findings presented clearly and objectively? Is each hypothesis addressed separately?
Limitations: any that may have influenced findings?
Implications: suggestions for nursing practice, education or further nursing research

Question 5

Evidence-based Practice steps

Answer 5

Formulate a burning question using PICOT:
Population or patient; interest or intervention; comparison; outcomes; time (optional) it takes to achieve outcome
Search best evidence
Review evidence
Integrate evidence with clinical expertise and patient preferences/values in making practice change
Evaluate effectiveness is of change meeting desired outcomes
Disseminate findings

Question 6

Rapid critical appraisal

Answer 6

Validity: was research study conducted in a rigorous manner
reliability: can others realistically expect to achieve the same results
Applicability: does the study apply to my patients/learners?

Question 7

Levels of evidence

Answer 7

Systematic review or meta-analysis
RCT
Controlled trial without randomization
Case control or cohort study
Systematic review of qualitative or descriptive studies
Qualitative or descriptive study
Expert opinion or consensus

Question 8

Evaluating the evidence: 3 important question

Answer 8

Is the evidence strong enough to implement the findings into practice?
Is the evidence so weak that a research study needs to be conducted?
Should we return to the literature and do a more complete search, widening the sources used?

Question 9

Principles of quality management

Answer 9

Customer focus
Leadership
Involvement of people at all levels of the organization
Process approach
System approach to management of interrelated processes
Continual improvement
Factual approach to decision making
Mutually beneficial supplier relationships

Question 10

6 measures of quality

Answer 10

Safe; timely; effective; efficient; equitable; patient-centered

Question 11

QSEN versus IOM Measures of healthcare quality

Answer 11

QSEN : IOM
Pt centered care : delivering pt centered care
Teamwork and collaboration : working as part of an interdisciplinary team
EBP : Practicing EBP
QI : focusing on QI
Informatics : using information technology
Safety

Question 12

FOCUSPDCA

Answer 12

Find a problem
Organize a team
Clarify the problem
Understand a problem
Select an intervention
Plan
Do 
Check the results
Act

Question 13

Six Sigma Improvement

Answer 13

Near-elimination of defects from every product, process or service; minimizing variances;
Approaches: DMADV, DMAIC

Question 14

six sigma approaches

Answer 14

DMADV (define, measure, analyze, design and verify) :developing a new process
DMAIC (define, measure, analyze, improve and control) improving an existing process

Question 15

Lean thinking

Answer 15

Provide perfect value to the customer through zero waste (time waste, supplies where they need to be, improves efficiency)

Question 16

Rapid cycle improvement

Answer 16

Small, concrete changes that can be implemented and piloted quickly
Set the aim
Define the measures
Make the change
Test changes using PDSA
Repeat cycle if changes or did not work.

Question 17

FMEA. Failure mode and effect analysis

Answer 17

Looking in a future way where is there a potential for errors to occur and the likelihood for that to happen, goal is error prevention, may be used to evaluate new or existing processes

Question 18

Steps in FMEA

Answer 18

Select a process
Select a team
Describe the process
Identify what could go wrong at each step of process
Work on eliminating the problems chosen
Design and implement changes to reduce or prevent problems
Measure the success of the process changes

Question 19

Dashboards

Answer 19

Internal formative assessment of performance and quality care

Question 20

PICOT

Answer 20

P - population or patient - most important characteristics
I - interest or intervention - Issue or intervention to be studied, measure, improve, or affected
C - comparison - Describe the main alternatives
O - outcomes - Describe what is to be accomplished
T - Time it takes for intervention to achieve outcome - describe the timeframe

Question 21

3 components of EBP

Answer 21

Best evidence
Clinician (NPD) Expertise
Patient (learner) values/preferences

Question 22

Quality improvement skills

Answer 22

Using systematic processes and tools to define problems (flowchart, cause effect diagrams)
Recognizing potential causes of problems (RCA)
Planning and implementing change
Using tools and data to measure quality, performance and variation (control chart, run chart)
Selecting appropriate methods for testing possible solutions (PDCA)
Evaluating effects of change to improve care and practice

Question 23

Flowchart

Answer 23

Flow of work through a process including activities, decisions, and measurement points. Oval – beginning and end, rectangle Dash steps in the process, diamond – decision making point

Question 24

Line graph or run chart

Answer 24

Shows data trends over time Y axis shows the time delay, defects or cost and X axis shows the time

Question 25

Pareto chart

Answer 25

Bar graph showing frequency of measures in descending order, focuses on the improvement effort by identifying the 20% of the contributors that create 80% of the time delay, defects, or cost in any process

Question 26

Cause-effect diagram or Fishbone diagram

Answer 26

Begins with major causes and work backward to read causes, five whys; Problem statement and brainstorm to identify potential issues related to specific categories – people, process, materials, management, environment, policy, etc.

Question 27

Control chart

Answer 27

Helps analyze, sustain, and monitor the current levels of process stability and identify key issues for problem-solving or root cause analysis. Looks for variation over time.

Question 28

Histogram

Answer 28

Bar graph showing frequency and pattern of distribution of one variable - numeric data

Question 29

Bar graph

Answer 29

Compares multiple variables – categorical data

Question 30

Matrix

Answer 30

Compares two or more groups of ideas, determines relationships among the elements, and makes decisions. It helps prioritize tasks or issues to a decision making and shows linkages between large groups of characteristics, functions, and tasks.

Question 31

Tree diagram

Answer 31

Systematically links ideas, target, objectives, goals, or activities in greater and greater detail it shows key goals, some goals, measures, and tasks required to accomplish an objective.

Question 32

Scatter diagram

Answer 32

Plotting data on a graph to look for correlations between variables (positive, negative, or no correlation)

Question 33

FADE Methodology

Answer 33

Focus, analyze, develop, execute/evaluate

Question 34

CIPP Model

Answer 34

Model of program evaluation: Context, Input, Process, Product; evaluating to aid in decision making and improve process
Context - goals, needs assessment; Input - planning, Process - action/implementation, Product - evaluate outcomes
provides formative and summative evaluation