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You would like to conduct a quality improvement project to reduce the wait time for patients to register in your clinic. Before assembling your improvement team, you believe the best way to reduce the wait time is to change the registration process. What is the best approach to ensure that the change is an improvement?

A. Test the new registration process on a small number of patients

B. Change the registration process for all patients

C. Form a team that understands the registration process from various perspectives

D. Develop an electronic monitoring system to track wait times

E. Observe the current registration process yourself

Answer: C

It is important that the project team is certain that a change they make is an improvement in the system. The Institute for Healthcare Improvement (IHI) developed the Model for Improvement (Figure 6-2) that outlines an approach that is analogous to the scientific method.

Figure 6-2

The Plan-Do-Study-Act cycle. (Reproduced with permission from Langley GJ, Moen RD, Nolan KM, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd ed. San Francisco, CA: Jossey-Bass; 2009.)

The first question to ask is “What are we trying to accomplish?” This question provides direction for the improvement team that is further clarified by the question, “How will we know that a change is an improvement?” These 2 critical questions are best answered by an interprofessional team that understands the system to be improved from various perspectives (IHI; Taylor et al, 2014). The power of an interprofessional team should not be underestimated as it frequently leads to more rapid and sustained improvement. Each member of the team involved in the system to be improved will serve as a subject matter expert that will help build the collective knowledge of the system. One should also consider adding a patient and family advisor when conducting improvement projects.

The third question is “What change can we make that will result in improvement?” This question leads into the classic Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle or small test of change should occur after a team answers the 3 crucial questions that establish the goals, measurement strategy, and hypothesis development that lead to successful PDSA cycles.

In this vignette, answer choice C is the best answer because the improvement team has not yet been formed to answer the 3 questions in the Model for Improvement and ...

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