MCQ Quiz: Quality Improvement

Quality Improvement (QI) is a systematic, data-driven approach to improving the processes of healthcare to achieve better patient outcomes and enhance system performance. For pharmacists, QI principles are essential for advancing patient safety, optimizing the medication-use process, and demonstrating value. This quiz covers the fundamental concepts, methodologies, and applications of Quality Improvement in a healthcare setting

1. The fundamental principle of Quality Improvement is a focus on:

• a. Punishing individuals for mistakes.
• b. Maintaining the status quo.
• c. Improving systems and processes.
• d. Reducing staff numbers.

Answer: c. Improving systems and processes.

2. The most common, cyclical model for implementing and testing changes in Quality Improvement is known as:

• a. The SBAR model
• b. The SWOT analysis
• c. The Plan-Do-Study-Act (PDSA) cycle
• d. The Root Cause Analysis (RCA)

Answer: c. The Plan-Do-Study-Act (PDSA) cycle

3. In the PDSA cycle, what occurs during the “Plan” stage?

• a. The change is implemented on a large scale.
• b. Data is analyzed to see if the change was effective.
• c. A specific objective is defined and a plan to test a change is developed.
• d. The change is carried out on a small scale.

Answer: c. A specific objective is defined and a plan to test a change is developed.

4. A Root Cause Analysis (RCA) is what type of QI tool?

• a. A proactive tool to predict future failures.
• b. A reactive tool used to understand the underlying causes of an adverse event that has already happened.
• c. A tool for brainstorming new ideas.
• d. A tool for financial analysis.

Answer: b. A reactive tool used to understand the underlying causes of an adverse event that has already happened.

5. A “SMART” goal, often used in QI projects, is Specific, Measurable, Achievable, Relevant, and:

• a. Time-bound
• b. Terrific
• c. Theoretical
• d. Tested

Answer: a. Time-bound

6. A “near-miss” medication error is an important data point for QI because:

• a. It indicates a system flaw that could lead to patient harm in the future.
• b. It must be reported to the patient’s insurance company.
• c. It is not important because no harm occurred.
• d. It is used to punish the employee involved.

Answer: a. It indicates a system flaw that could lead to patient harm in the future.

7. “The percentage of patients with diabetes who received an annual foot exam” is an example of what type of quality measure?

• a. An outcome measure
• b. A process measure
• c. A balancing measure
• d. A structural measure

Answer: b. A process measure

8. “The average A1c level of patients in a diabetes clinic” is an example of what type of quality measure?

• a. An outcome measure
• b. A process measure
• c. A balancing measure
• d. A structural measure

Answer: a. An outcome measure

9. The “Swiss cheese model” of accident causation suggests that errors occur when:

• a. A single person makes a grievous error.
• b. The system has too many safety checks.
• c. Holes in multiple layers of system defenses line up.
• d. The system is perfect.

Answer: c. Holes in multiple layers of system defenses line up.

10. What is the purpose of the “Study” phase in a PDSA cycle?

• a. To implement the change.
• b. To analyze the collected data and compare it to the predictions.
• c. To decide on the next steps.
• d. To plan the initial test.

Answer: b. To analyze the collected data and compare it to the predictions.

11. A “forcing function” is a QI intervention that:

• a. Reminds a person to do the right thing.
• b. Makes it impossible to do the wrong thing.
• c. Educates the staff on a new policy.
• d. Is considered a weak intervention.

Answer: b. Makes it impossible to do the wrong thing.

12. A pharmacist creating a checklist for verifying chemotherapy orders is engaging in:

• a. A quality improvement activity.
• b. A waste of time.
• c. A purely administrative task.
• d. A research project.

Answer: a. A quality improvement activity.

13. A key principle of a “Just Culture” is:

• a. Blaming individuals for systems-based errors.
• b. Differentiating between human error, at-risk behavior, and reckless conduct.
• c. A zero-tolerance policy for any error.
• d. Ignoring all errors.

Answer: b. Differentiating between human error, at-risk behavior, and reckless conduct.

14. A pharmacist’s role in quality improvement includes:

• a. Reporting medication errors and near-misses.
• b. Participating in Root Cause Analyses.
• c. Developing and implementing safer medication-use processes.
• d. All of the above.

Answer: d. All of the above.

15. A “balancing measure” in a QI project is used to:

• a. Ensure the project is successful.
• b. Measure the primary outcome.
• c. See if a change in one part of the system caused unintended negative consequences elsewhere.
• d. Calculate the budget for the project.

Answer: c. See if a change in one part of the system caused unintended negative consequences elsewhere.

16. Which of the following is the STRONGEST intervention to prevent errors?

• a. Educating staff
• b. A double-check policy
• c. Automation and forcing functions
• d. A warning sign

Answer: c. Automation and forcing functions

17. Failure Mode and Effects Analysis (FMEA) is a _____ quality improvement tool.

• a. reactive
• b. retrospective
• c. proactive
• d. subjective

Answer: c. proactive

18. What is the first step in any quality improvement project?

• a. Implementing a solution.
• b. Analyzing data.
• c. Clearly defining the problem.
• d. Writing a final report.

Answer: c. Clearly defining the problem.

19. A fishbone (Ishikawa) diagram is a QI tool used to:

• a. Brainstorm the potential causes of a problem.
• b. Track a process over time.
• c. Compare two sets of data.
• d. Create a project timeline.

Answer: a. Brainstorm the potential causes of a problem.

20. A pharmacist notices that look-alike, sound-alike drugs are stored next to each other. Reporting this is an example of identifying a:

• a. Patient-specific problem.
• b. Latent system error.
• c. Harmless situation.
• d. Personal failure.

Answer: b. Latent system error.

21. The “Act” stage of the PDSA cycle involves:

• a. Planning the test of change.
• b. Carrying out the test.
• c. Analyzing the results.
• d. Adopting, adapting, or abandoning the change based on the results.

Answer: d. Adopting, adapting, or abandoning the change based on the results.

22. A key component of a successful QI culture is:

• a. A top-down, authoritarian approach.
• b. A blame-free environment that encourages reporting.
• c. Focusing on individual performance only.
• d. Infrequent communication.

Answer: b. A blame-free environment that encourages reporting.

23. The use of Barcode Medication Administration (BCMA) is a QI initiative designed to improve:

• a. The speed of dispensing.
• b. The safety of medication administration at the bedside.
• c. The pharmacy’s inventory system.
• d. The drug purchasing process.

Answer: b. The safety of medication administration at the bedside.

24. The principle of continuous quality improvement (CQI) means that:

• a. QI is a one-time project.
• b. QI is an ongoing process of monitoring and improving.
• c. Once a process is fixed, it never needs to be reviewed again.
• d. Only managers are responsible for quality.

Answer: b. QI is an ongoing process of monitoring and improving.

25. A run chart is a simple QI tool used to:

• a. Display data over time to identify trends or patterns.
• b. Show the relationship between two variables.
• c. Brainstorm causes.
• d. Outline a process flow.

Answer: a. Display data over time to identify trends or patterns.

26. Why is data essential for quality improvement?

• a. It helps to understand the current process performance.
• b. It helps to separate what you think is happening from what is actually happening.
• c. It allows you to measure the impact of a change.
• d. All of the above.

Answer: d. All of the above.

27. In an RCA, asking “why” five times is a technique to:

• a. Annoy the person being interviewed.
• b. Move beyond the immediate cause to find the underlying system-level root cause.
• c. Fill time during the meeting.
• d. Assign blame to five different people.

Answer: b. Move beyond the immediate cause to find the underlying system-level root cause.

28. A “structural measure” of quality refers to:

• a. The outcome of care.
• b. The process of care.
• c. The setting in which care is delivered (e.g., use of an EHR, pharmacist-to-technician ratio).
• d. A patient’s satisfaction.

Answer: c. The setting in which care is delivered (e.g., use of an EHR, pharmacist-to-technician ratio).

29. The ultimate goal of all quality improvement activities in pharmacy is to:

• a. Improve patient safety and health outcomes.
• b. Increase profits.
• c. Reduce medication inventory.
• d. Speed up dispensing.

Answer: a. Improve patient safety and health outcomes.

30. A key role for pharmacists on a QI team is to provide expertise on:

• a. The medication-use process.
• b. Financial budgeting.
• c. Surgical techniques.
• d. Human resources policies.

Answer: a. The medication-use process.

31. A flowchart is a QI tool used to:

• a. Track data over time.
• b. Brainstorm ideas.
• c. Visually represent the steps in a process.
• d. Prioritize tasks.

Answer: c. Visually represent the steps in a process.

32. The “Do” stage of the PDSA cycle is when you:

• a. Analyze the data.
• b. Plan the test.
• c. Implement the test of change on a small scale.
• d. Standardize the change across the organization.

Answer: c. Implement the test of change on a small scale.

33. An example of a QI project in a community pharmacy could be:

• a. Reducing dispensing errors.
• b. Improving medication synchronization rates.
• c. Increasing the number of MTM sessions completed.
• d. All of the above.

Answer: d. All of the above.

34. The main difference between QI and traditional research is that:

• a. QI uses data, while research does not.
• b. QI is typically designed to implement and evaluate changes in a specific local setting, not to generate generalizable new knowledge.
• c. Research does not require ethical approval.
• d. There is no difference.

Answer: b. QI is typically designed to implement and evaluate changes in a specific local setting, not to generate generalizable new knowledge.

35. A pharmacist notices that several patients have received the wrong strength of lisinopril. A QI approach would be to:

• a. Blame the technicians who filled the prescriptions.
• b. Investigate the system to see if the different strengths are stored next to each other, leading to selection errors.
• c. Do nothing.
• d. Tell the patients to be more careful.

Answer: b. Investigate the system to see if the different strengths are stored next to each other, leading to selection errors.

36. “Lean” and “Six Sigma” are:

• a. Types of medication.
• b. Formal quality improvement methodologies.
• c. Pharmacy software systems.
• d. Government regulatory agencies.

Answer: b. Formal quality improvement methodologies.

37. Which of the following is a barrier to successful quality improvement?

• a. A culture of blame.
• b. Lack of leadership support.
• c. Failure to use data.
• d. All of the above.

Answer: d. All of the above.

38. The Institute for Healthcare Improvement (IHI) is a major organization focused on:

• a. Drug manufacturing.
• b. Pharmacy law.
• c. Healthcare quality and patient safety.
• d. Medical education.

Answer: c. Healthcare quality and patient safety.

39. A Pareto chart is a QI tool used to:

• a. Show process steps.
• b. Track data over time.
• c. Identify the “vital few” causes that are responsible for the majority of problems.
• d. Brainstorm solutions.

Answer: c. Identify the “vital few” causes that are responsible for the majority of problems.

40. The first step in an FMEA (Failure Mode and Effects Analysis) is to:

• a. Implement solutions.
• b. Map out the steps of a process to identify potential failure points.
• c. Analyze an error that already happened.
• d. Collect data.

Answer: b. Map out the steps of a process to identify potential failure points.

41. Why is it important to test a change on a small scale first in a PDSA cycle?

• a. To minimize disruption and risk if the change does not work as intended.
• b. It is not important; changes should always be implemented system-wide at once.
• c. To make the project take longer.
• d. To save money on data collection.

Answer: a. To minimize disruption and risk if the change does not work as intended.

42. A pharmacist-led medication reconciliation program is a QI initiative designed to:

• a. Increase pharmacy revenue.
• b. Improve the accuracy of patient medication lists and reduce errors at transitions of care.
• c. Speed up the discharge process.
• d. Replace the need for physicians.

Answer: b. Improve the accuracy of patient medication lists and reduce errors at transitions of care.

43. A successful QI project requires:

• a. A clear aim statement.
• b. A method to measure improvement.
• c. A team of engaged individuals.
• d. All of the above.

Answer: d. All of the above.

44. What does the “S” in PDSA stand for?

• a. System
• b. Safety
• c. Study
• d. Standard

Answer: c. Study

45. Quality improvement is the sole responsibility of the pharmacy manager.

• a. True
• b. False

Answer: b. False

46. An example of a “balancing measure” for a project aimed at reducing length of stay might be:

• a. The average length of stay.
• b. The hospital readmission rate.
• c. The number of patients discharged per day.
• d. The cost per day.

Answer: b. The hospital readmission rate.

47. The primary audience for the results of a QI project is:

• a. A peer-reviewed journal.
• b. The local team and leadership responsible for the process being improved.
• c. The national news media.
• d. The FDA.

Answer: b. The local team and leadership responsible for the process being improved.

48. The QI mindset focuses on:

• a. “Who made the error?”
• b. “How can we improve the process to prevent this error from happening again?”
• c. “This is how we’ve always done it.”
• d. “This was a one-time event that won’t recur.”

Answer: b. “How can we improve the process to prevent this error from happening again?”

49. The overall management of a pharmacy requires a commitment to:

• a. The status quo.
• b. Continuous Quality Improvement.
• c. Individual performance only.
• d. Cost-cutting above all else.

Answer: b. Continuous Quality Improvement.

50. The ultimate reason for a pharmacist to be skilled in quality improvement is to:

• a. Systematically improve the medication-use process to make care safer and more effective for patients.
• b. Add a new skill to their resume.
• c. Be able to lead meetings effectively.
• d. Fulfill a requirement of their job description.

Answer: a. Systematically improve the medication-use process to make care safer and more effective for patient