Performance and Process Improvement
What improvement content the exam tests
Know the Model for Improvement's three questions: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? PDSA cycles should run small and fast before spread. Know DMAIC for Six Sigma, Lean concepts (waste, value stream mapping, flow, pull, standard work, 5S), and the classic quality tools: flowchart, check sheet, Pareto chart, cause-and-effect diagram, histogram, run chart, control chart, and scatter diagram. Know when to use FMEA (prospective) versus RCA (retrospective), and where 5 Whys and fishbones fit.
Understand project infrastructure: charter, sponsor, team roles, an aim statement with a numeric target and date, a family of measures (outcome, process, balancing), and sustainability through standard work, training, and monitoring. Expect questions on prioritization using Pareto's 80/20 and impact/effort grids, and on spread and scale.
Traps
- Confusing FMEA with RCA. FMEA is proactive risk assessment; RCA reacts to an event.
- Writing an aim with no target or timeframe.
- Running one large PDSA instead of iterative small tests.
- Omitting balancing measures, so improvement in one area harms another.
Rule of thumb
If you cannot describe the process, you cannot improve it: flowchart first, then locate where delay or defects originate. Worked example: an emergency department wants door-to-provider time cut from 45 to 30 minutes in 90 days. Flowcharting shows triage waits on registration. A PDSA tests parallel registration for one shift, tracking the outcome (median time), process (percent registered in parallel), and balancing measure (registration errors). Spread only after the test holds.