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Next Steps: A Practitioner's Guide For Themed Follow-up Visits For Their Patients to Achieve a Healthy Weight
Next Steps: A Practitioner's Guide For Themed Follow-up
Visits For Their Patients to Achieve a Healthy Weight

Monthly QI Quiz

NICHQs QI Quizzes test your knowledge on how to use quality improvement to make sustainable, system-level change. Be sure to come back each month to see how you measure up and learn practical strategies for executing your own quality improvement project.

July 2014


Once you've submitted your best guess, click the button below to see the answer!

C: One doctor in a practice to additional doctors in that practice
Spread in improvement work is defined as adapting change to areas or populations other than your pilot populations.

June 2014

surveys & polls

E: All of the above
All of the answers are examples of things that, when not handled well, can lead to execution failures. Other items to pay close attention to include lack of: focus, priority setting, participation by key players, customer focus, key talent, infrastructure and assessment of front line impact, as well as misalignment of rewards and recognition.

April 2014

C: Implement the change idea
It’s very rare to move to implementation after just one testing cycle. It is important to take your small test of change and expand it by testing under other conditions or settings—be it different people, times of day, locations or other variables. For example, let’s say you want to test whether specific talking points are useful for doctor-patient conversations about healthy eating behaviors. One small test of change could be having one doctor use the talking points with one patient. If that is successful, you wouldn’t skip right to implementation. Rather, you would do additional tests with other doctors and patients, collecting additional feedback and refining the talking points. Only after testing under multiple conditions and adapting and modifying your change idea should you consider implementation.

February 2014

survey software

B: Systems, variation, knowledge and psychology
The four related parts of Deming’s System of Profound Knowledge are:
- Appreciation for a System. An organization is a system with interrelated parts. To optimize performance, a manager needs to optimize the system as a whole, not optimize one part at the expense of another.
- Understanding of Variation. There is variation in every system and every process. The more we understand what is causing variation, the more likely we are to take appropriate managerial action.
- Theory of Knowledge. Management must be able to separate opinion from fact and must continually gain more and better knowledge through a process of continuous learning. The more knowledge we have about a system, the better we are able to predict whether a change will lead to improvement.
- Psychology. Understanding people and what motivates them to do a good job is an essential ingredient to effective management. To have a successful organization, it is critical for managers to understand how different people interact and appreciate the intrinsic factors that motivate each individual.

January 2014

survey service

C. Motivational slide deck
Support from leaders is a must for any project. The closer a project's goals align with an organization's priorities the easier it is to make the case for appropriate resources to support the project's success. And being able to continuously monitor the spread of your work lets you see and share how well your change is being adopted. What's not necessary is a motivational slide deck.

December 2013

surveys & polls

D. All of the above
D. All three conditions should be present before proceeding to full-scale implementation. If even one of these conditions is not fulfilled, the team should continue testing on a small or large scale until that condition is met.

November 2013


E. A, B and C
The "Do" part of a PDSA (Plan-Do-Study-Act) cycle includes carrying out the plan, documenting problems and observations and starting data analysis. Adopting the change is one of the last things you do in the "Act" stage.

October 2013

online surveys

A. Innovation, Pilot, Implementation, Spread
The lifecycle of an improvement project is innovation (come up with new ideas for change), pilot (test the change on a small scale), implementation (make the change in a distinct setting) and spread (apply the new process in several settings).

September 2013

web polls

C: 6-8
The ideal number of measures for an improvement project is 6-8. This range lets you have a variety of measures, including outcome (did we achieve what we set out to achieve?), process (are we going in the right direction?) and balancing measures (are there unintended consequences of improvement?), without being overburdened with data collection.

August 2013

polls & surveys

C: 6-8
The ideal number of measures for an improvement project is 6-8. This range lets you have a variety of measures, including outcome (did we achieve what we set out to achieve?), process (are we going in the right direction?) and balancing measures (are there unintended consequences of improvement?), without being overburdened with data collection.

July 2013

customer survey

B: A run chart does not determines if changes made represent an improvement
Statement B is false. The primary purpose of a run chart is to show whether changes made are an improvement. When interpreting run charts, a shift in progress is indicated by six or more consecutive points above or below the median and a trend is indicated by five or more consecutive points increasing or decreasing.

June 2013

survey services

E: All of the above
All of the statements are basic tenets about testing change in a quality improvement setting. It is important to test small initially to minimize risk. Testing across a wide variety of conditions helps you determine if the change is an improvement. All tests of change should have a question you are trying to answer, a prediction about what will happen and a plan for collecting data. This prepares you to analyze your results and decide if more tests-and what kinds of tests-are still needed before adopting a change. Lastly, quality improvement is all about learning as you go and adjusting your tests of change as you obtain more data.

May 2013


A: Updating policies
Standardization typically includes establishing procedures that help guide the change process. Answer B, testing new job descriptions, is an example of documentation. Answer C, providing staff training, is an example of training. Answer D, purchasing new equipment, is an example of resourcing.

April 2013


D: Answers A, B and C
When it comes to building an effective project team, having leadership personnel on your team (A and C) helps encourage buy-in from others in the system, and having representatives from all levels involved in the change process (B) is essential to the success of a quality improvement project.

March 2013

panel management

F. None
All of the descriptions for the four types of measures are correct. Collectively, the measures help those using quality improvement methods to know if they have been successful.

February 2013

free polls

B. Plan-Do-Study-Act (PDSA)
As part of the Model for Improvement, Plan-Do-Study-Act (PDSA) cycles are used to rapidly test and implement changes in real work settings by planning a change, trying the change, observing the results and acting on what is learned. The PDSA cycle guides the test of a change to determine if the change is an improvement.

January 2013

free polls

Answer: C. Who are we trying to change?
The Model for Improvement is designed to address change at the system-level, not the individual-level. The first part of the model consists of 3 fundamental questions, which can be addressed in any order:

- What are we trying to accomplish? (setting aims)
- How will we know if a change is an improvement? (establishing measures)
- What changes can we make that will result in improvement? (selecting changes to test)

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