DHA Quality Improvement & Audits 5 — Questions and Answers
Question 1: During a DHA infection control audit, a surveyor finds that hand hygiene compliance is 55%. Which improvement strategy is most evidence-based?
- Issue written warnings to non-compliant staff
- Install additional alcohol-based hand rub dispensers at point of care and provide multimodal education (Correct answer)
- Replace all staff with demonstrated non-compliance
- Reduce patient load to allow more time for hand hygiene
Correct answer: Install additional alcohol-based hand rub dispensers at point of care and provide multimodal education
WHO's multimodal hand hygiene improvement strategy — including system change, training, evaluation, reminders, and institutional safety climate — is the gold standard.
Question 2: A 'near miss' in patient safety reporting is defined as:
- An event that caused permanent patient harm
- An unplanned event that did not reach the patient but could have caused harm (Correct answer)
- A complaint filed by a patient's family member
- A medication error discovered after patient discharge
Correct answer: An unplanned event that did not reach the patient but could have caused harm
A near miss is an error or unsafe condition that was caught before reaching the patient, providing a learning opportunity without causing harm.
Question 3: Which of the following BEST describes the purpose of a balanced scorecard in healthcare quality management?
- To rank hospital departments by revenue generation
- To monitor performance across financial, patient, process, and learning dimensions simultaneously (Correct answer)
- To compare individual physician salaries against market benchmarks
- To calculate staffing ratios for each clinical unit
Correct answer: To monitor performance across financial, patient, process, and learning dimensions simultaneously
The balanced scorecard provides a multi-dimensional view of organizational performance across financial, customer (patient), internal process, and learning/growth perspectives.
Question 4: In Lean methodology applied to healthcare, 'waste' (muda) includes all EXCEPT:
- Unnecessary patient transport between units
- Waiting time for diagnostic results
- Evidence-based clinical decision-making (Correct answer)
- Overproduction of redundant laboratory tests
Correct answer: Evidence-based clinical decision-making
Evidence-based clinical decision-making adds value and is never classified as waste; Lean targets non-value-adding activities like unnecessary transport, waiting, and overproduction.
Question 5: A quality indicator shows a hospital's 30-day readmission rate is 18%. This is an example of:
- A structure indicator
- A process indicator
- An outcome indicator (Correct answer)
- A sentinel event indicator
Correct answer: An outcome indicator
Readmission rate measures a result of care delivered, making it an outcome indicator reflecting the quality of treatment and discharge planning.
Question 6: When conducting a failure mode and effects analysis (FMEA) in a DHA facility, the Risk Priority Number (RPN) is calculated as:
- Severity + Occurrence + Detectability
- Severity × Occurrence × Detectability (Correct answer)
- Severity × Occurrence ÷ Detectability
- Probability × Impact only
Correct answer: Severity × Occurrence × Detectability
RPN = Severity × Occurrence × Detectability, with each factor scored 1–10; higher RPN indicates higher priority failure modes requiring immediate intervention.
Question 7: According to DHA quality standards, a 'sentinel event' requires which type of review?
- Quarterly departmental audit
- Root cause analysis (RCA) completed within the required timeframe (Correct answer)
- Anonymous peer survey of clinical staff
- Financial impact assessment only
Correct answer: Root cause analysis (RCA) completed within the required timeframe
Sentinel events — unexpected deaths or serious harm — mandate a thorough root cause analysis to identify system failures and implement preventive actions.
DHA Quality Improvement & Audits 5
During a DHA infection control audit, a surveyor finds that hand hygiene compliance is 55%.
Which improvement strategy is most evidence-based?