MSRA Quality Assurance and Improvement 3 — Questions and Answers
Question 1: A GP practice wants to improve diabetic foot care. They use the NHS England guidance as a benchmark and compare their current performance against it. This process is known as:
- Variance analysis
- Benchmarking (Correct answer)
- Significant event analysis
- Process mapping
Correct answer: Benchmarking
Benchmarking involves comparing one's performance metrics to established standards or best-practice data from comparable organisations.
Question 2: Which of the following best describes 'high reliability organisations' (HROs) in healthcare?
- Organisations with the highest patient throughput
- Organisations that consistently minimise failures despite operating in complex, high-risk environments (Correct answer)
- Organisations that rely solely on technology to prevent errors
- Organisations with zero staff turnover
Correct answer: Organisations that consistently minimise failures despite operating in complex, high-risk environments
HROs maintain safe performance over time by fostering a preoccupation with failure, sensitivity to operations, and a culture of continuous vigilance and learning.
Question 3: In the SBAR communication tool, what does the 'R' stand for?
- Rationale
- Risk
- Recommendation (Correct answer)
- Response
Correct answer: Recommendation
In SBAR (Situation, Background, Assessment, Recommendation), the 'R' stands for Recommendation — the specific action requested of the recipient.
Question 4: A clinical team conducts a significant event analysis (SEA) after a patient collapse in the waiting room. Which of the following best describes the purpose of SEA?
- To allocate blame to the responsible clinician
- To systematically learn from events in order to improve patient safety and care (Correct answer)
- To satisfy medico-legal documentation requirements
- To dismiss staff who were on duty during the event
Correct answer: To systematically learn from events in order to improve patient safety and care
SEA is a formative, blame-free reflective process used in primary care to identify learning points and implement improvements following significant events.
Question 5: Which quality improvement model underpins the NHS 'Model for Improvement' framework?
- Six Sigma DMAIC
- Plan-Do-Study-Act (PDSA) cycle (Correct answer)
- Lean 5S methodology
- ISO 9001 standard
Correct answer: Plan-Do-Study-Act (PDSA) cycle
The NHS Model for Improvement is based on the PDSA cycle developed by Deming and Langley, focusing on iterative small tests of change.
Question 6: A surgeon notices that post-operative wound infection rates vary significantly between two hospitals performing the same procedure. The most appropriate first step to investigate this is:
- Immediately retrain all surgeons at the hospital with higher rates
- Conduct a process mapping exercise to compare practices at both sites (Correct answer)
- Close the operating theatres at the underperforming hospital
- Increase antibiotic prophylaxis doses at both hospitals
Correct answer: Conduct a process mapping exercise to compare practices at both sites
Process mapping identifies steps in the workflow at each site to reveal differences in practice that may explain the variation in outcomes.
Question 7: The Donabedian model for evaluating healthcare quality assesses which three dimensions?
- Safety, efficacy, and equity
- Structure, process, and outcome (Correct answer)
- Input, throughput, and output
- Prevention, diagnosis, and treatment
Correct answer: Structure, process, and outcome
Avedis Donabedian proposed that healthcare quality can be evaluated through structure (resources), process (care delivery), and outcome (patient results).
MSRA Quality Assurance and Improvement 3
A GP practice wants to improve diabetic foot care.
They use the NHS England guidance as a benchmark and compare their current performance against it.
This process is known as: