PBC Quality Control & Process Improvement 3 — Questions and Answers
Question 1: When implementing a new bereavement care protocol, which first step is most aligned with evidence-based QI practice?
- Rolling out the protocol hospital-wide on day one
- Piloting the protocol on one unit, collecting data, then revising before expansion (Correct answer)
- Asking families to co-design the protocol without clinical input
- Waiting until staff request a change before acting
Correct answer: Piloting the protocol on one unit, collecting data, then revising before expansion
Starting with a controlled pilot allows the team to identify implementation barriers and refine the protocol before broader rollout.
Question 2: The National Perinatal Bereavement Standards recommend that a designated bereavement coordinator's role supports QI by:
- Replacing all bedside nurse bereavement responsibilities
- Providing program oversight, tracking outcomes, and leading education initiatives (Correct answer)
- Managing only family bereavement packets without clinical involvement
- Serving purely in a chaplaincy capacity
Correct answer: Providing program oversight, tracking outcomes, and leading education initiatives
A bereavement coordinator provides the infrastructure needed for consistent program oversight, data tracking, and ongoing staff education.
Question 3: A fishbone (Ishikawa) diagram is used in perinatal bereavement QI to:
- Rank satisfaction scores from highest to lowest
- Visually map potential causes contributing to a quality problem (Correct answer)
- Outline a new bereavement protocol step by step
- Track the frequency of memory-making offer compliance
Correct answer: Visually map potential causes contributing to a quality problem
Fishbone diagrams organize brainstormed causes into categories (people, process, environment, etc.) to help teams systematically identify root contributors to a problem.
Question 4: Which quality improvement framework is best suited to reducing variability in bereavement care delivery across shifts?
- Lean methodology focused on waste elimination and standardization (Correct answer)
- Six Sigma aimed at financial cost reduction
- Agile software development sprints
- Balanced Scorecard for executive reporting
Correct answer: Lean methodology focused on waste elimination and standardization
Lean methodology focuses on standardizing processes and eliminating non-value-added variation, making it well-suited to reducing inconsistency in bereavement care across shifts.
Question 5: A 'driver diagram' in perinatal bereavement QI is most useful for:
- Scheduling staff for bereavement shifts
- Linking a high-level improvement aim to the specific changes that will achieve it (Correct answer)
- Auditing individual staff bereavement conversations
- Replacing family grief support plans
Correct answer: Linking a high-level improvement aim to the specific changes that will achieve it
Driver diagrams visually connect the overall aim to primary and secondary drivers, helping teams understand which changes are most likely to produce improvement.
Question 6: When a QI team notices that bereavement memory-making offers drop significantly on night shifts, the most appropriate next step is:
- Disciplining all night-shift nurses
- Conducting a focused analysis of night-shift workflow barriers and then designing targeted solutions (Correct answer)
- Concluding that night-shift families prefer not to be offered memory-making
- Removing the memory-making offer requirement entirely
Correct answer: Conducting a focused analysis of night-shift workflow barriers and then designing targeted solutions
Understanding workflow-specific barriers (e.g., staffing ratios, resource availability) on nights allows the team to design targeted, feasible solutions.
Question 7: In perinatal bereavement QI, 'balancing measures' are tracked to ensure that:
- All staff receive equal numbers of bereavement assignments
- Changes improving one part of the system do not create problems elsewhere (Correct answer)
- Families always receive the same bereavement packet
- Budget expenditures remain within defined limits
Correct answer: Changes improving one part of the system do not create problems elsewhere
Balancing measures detect unintended consequences, such as improving documentation compliance at the cost of increased staff burnout.
PBC Quality Control & Process Improvement 3
When implementing a new bereavement care protocol, which first step is most aligned with evidence-based QI practice?