1. You are reducing patient wait time in the Emergency Department. Which of these does not directly relate to Lean?

A. Increasing patient throughput

B. Evaluating acceptable wait times according to the customer

C. Reducing variation of lab tests between providers

D. Reducing duplication of documentation between the nurse and provider

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

2. To reduce patient wait times, what is the advantage of Lean Six Sigma (LSS) over other process improvement methodologies?

A. LSS is more data driven

B. LSS uses DMAIC as a structured problem solving approach

C. LSS engages front-line staff and benefits cross-functional teams through collaboration

D. LSS focuses on the VOC as the key directional driver for the VOP

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

3. In your effort to reduce patient wait times, which of the following is/are representative of a PICK chart's "C" solution?

A. Adding a new provider to the practice

B. Implementing a software program to enable patients to register all insurance and personal information prior to arriving for their appointment

C. Requesting patients arrive 15 minutes early

D. Eliminate unproductive staff

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

4. Which of the following represents application of Six Sigma concepts?

A. Eliminating unnecessary printing in the patient registration process

B. Standardizing clinical utilization of CT testing among providers

C. Adding Advanced Practice Providers (APP) to maximize physician capacity and skillsets

D. Increasing patient throughput in a practice by reducing average visit time

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

5. Your new clinic received marketing surveys back from the community. What is the significance of VOC?

A. Evaluates the consumer's needs, balancing value and cost

B. Ensures the process meets the business' expectations for success

C. Aligns the business' goals with the customer's needs and desires to identify what can be profitably provided

D. Confirms pre-set business goals are aligned with the customer's expectations

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

6. In a patient visit, what is the example of a non-value added step?

A. Verifying the patient's billing information

B. Receiving treatment from a nurse/provider

C. Waiting for discharge instructions

D. Transporting a patient to X-ray

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

7. You are conducting a Gemba activity for your kaizen improvement project. Which of the following is not an example of waste?

A. Redrawing blood due to a labeling error

B. Stocking extra medications in case of a volume surge

C. Avoiding a process change because it is too time consuming

D. Deleting an email thread that does not pertain to you

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

8. During one of your first project meetings, you have the team fill out a project charter. What is the value of the charter?

A. Identifies the solution the team should work to implement

B. Provides the team with a view into quick hit opportunities for the process

C. Provides bylaws and operating procedures for the project team

D. Creates a shared understanding of the purpose of the project and the process being evaluated

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

9. You are working to reduce biohazard waste removal cost as it costs $2,000 per month. When should you use a root cause analysis?

A. Only on complex or large problems

B. When you receive your quarterly data about the costly financial error

C. Before you brainstorm and implement solutions

D. When the causes are known but you need to validate implemented solutions

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

10. During your project to reduce biohazard waste removal costs, when should you use statistical process control?

A. When you need to understand the variation within a process

B. When you need to evaluate the reasons for failure or not meeting project goals

C. When you are ready to implement and/or sustain process changes

D. When you have less than 8 data points

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

11. You manage the hospital's bistro, which is consistently losing money. Which of the following is/are true related to a Kano analysis?

A. It allows you to better understand the customer's perception of waste

B. It enables you to identify and distinguish Dissatisfiers from Satisfiers, Delighters, and Indifferences

C. It allows you to move Indifferences to Satisfiers

D. It analyzes your products or services to ensure they are competitive

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

12. When creating a process map for your project, you should:

A. Go and observe the process to ensure you understand what is really taking place

B. Identify unclear processes and go fix those first

C. Review and possibly re-scope your problem statement

D. Ask for the manager of the process' perspective and to provide input

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

13. Think about the inpatient room turnover process (i.e., Environmental Services cleaning and preparing a room for a patient). Which statement(s) is/are not correct regarding metrics?

A. The patient's illness is an example of an input metric

B. Years of experience of the Environmental Services technician is an example of an input metric

C. The incoming patient's satisfaction with the cleanliness of the room is an example output metric

D. Overall time to clean the room is a process metric

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

14. How can variation impact the inpatient room turnover process?

A. Create unnecessary transportation due to non-standard room layouts

B. Create confusion around when to act on the data

C. Result in inconsistent infection rates and quality scores

D. Potentially reduce the predictability of room turnover time

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

15. Your inpatient room turnover project is running behind schedule. How can you ensure you get back on track to avoid being scolded by the executive sponsor?

A. Create the project charter on your own to reduce unnecessary group discussion

B. Host a kaizen event to expedite results

C. Merge the Measure and Analyze phase of DMAIC to save time

D. Begin implementing solutions on obvious errors that everyone agrees upon

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

16. A well-formed problem statement

A. Creates a sense of ownership for the team

B. Includes where the problem is occurring and how it is affecting stakeholders

C. Creates a sense of urgency for addressing the problem

D. Includes a timeline connecting the impact to the magnitude and demonstrating how long the problem has occurred

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

17. You are leading an initiative in revenue cycle to increase front-end patient collections. After creating a control chart, you notice a few violations of Shewhart's rules. Which of the following may be (a) "good" example(s) of special cause in a practical sense?

A. After splitting the control chart, the new ("after") mean increased by 15%

B. A single point lies 3 standard deviations below the mean

C. 15 consecutive points lie within ± 1 standard deviation of the new ("after") mean

D. 4 of 5 consecutive data points lie above one standard deviation from the new ("after") median

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

18. Which statement(s) is/are true about types of data?

A. Patient satisfaction is an example of ordinal data

B. Zip codes are an example of nominal data

C. Patient falls can be considered discrete or attribute data

D. Attribute data is the weakest type of numerical data

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

19. In reviewing the rise in patient falls on your unit, identify the appropriate causes to drill into on your Fishbone diagram:

A. Difficult patients should always have a paid staff sitter with them

B. Nurse Sally has the highest fall rate because she is a new hire

C. Patients consistently fall from toileting when nursing staff step away to give privacy

D. Epic

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

20. Select the statement that is not true about LSS tools.

A. A Pareto chart displays occurrences and order of importance of nominal data

B. A Fishbone diagram allows the team to brainstorm potential causes

C. Using 5S shows whose fault it is for not keeping areas organized

D. Control charts always plot data over time

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

21. An oustourced imaging clinic gets paid per completed x-ray. Which of the following is / are true about control charts?

A. A control chart may be able to predict future volumes for the clinic, even with regular add-on appointments scheduled

B. Control charts cannot depict x-rays because they are not continuous data

C. It is recommended to plot a goal line for the target number of x-rays to be completed

D. Control limits are always represented as straight lines ± 3 standard deviations from the mean

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

22. The following statement(s) is/are true related to central tendency:

A. It is acceptable to remove outliers if they skew the data too much

B. Central tendency can be interpreted as measuring accuracy and precision

C. When numerical data are skewed, you should use the median

D. Central tendency can be measured via the mean, median, standard deviation, or mode

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

23. Your sponsor gives you a new project and informs you where to get data. However, he says it's not important to spend the effort to collect it since this initiative is so time-sensitive and everyone knows it's a problem. How can you explain the importance of measuring baseline data to the project sponsor?

A. "I know it may take a little extra time, but it is worth the effort up-front validating the need for change vs. investing time in a project that will not show improvements in the long-run."

B. "Without understanding the current or baseline state, it will be impossible to validate the effectiveness of future improvements."

C. "I'm not denying the significance or urgency of this initiative, but gathering baseline data will enable us to determine the severity of the problem. Sometimes problems feel bigger than they actually are; this allows us to confirm assumptions."

D. "Understanding baseline state enables us to create charts reflecting the current state and gain buy-in from critical stakeholders who may doubt the need for this change."

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

24. Which of the following reflects discrete data?

A. Nurse vacancy rate

B. Total number of meal orders per day

C. Types of patient complaints

D. Number of rejected insurance claim forms

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D

25. Which of these reflect continuous data?

A. Nurse vacancy rate

B. Number of surveys returned

C. Average number of falls per hospital

D. Percent of wrong site surgeries

E. All of the above

F. None of the above

G. Only A and C

H. Only B and D