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ITIL 4 CI study materials
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ITIL 4 CI practice questions

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Question 1Continual improvement concepts and principles

In ITIL 4, which statement best defines continual improvement?

  1. A recurring activity performed to identify and implement improvements to products, services, and practices Correct answer.
  2. A budgeting cycle that allocates funds to service delivery teams
  3. A one-off project that replaces legacy tooling after a major incident
  4. A compliance audit that confirms processes follow documented procedures

Explanation

Continual improvement is a recurring, ongoing activity aligned to the ITIL 4 continual improvement model, not a single event. It deliberately seeks out improvements across products, services, and practices, and it is supported by the continual improvement practice.

Question 2Continual improvement concepts and principles

Which ITIL 4 component is directly responsible for aligning an organization's practices and services with changing business needs through ongoing improvement?

  1. The supplier management practice
  2. The service desk practice
  3. The incident management practice
  4. The continual improvement practice Correct answer.

Explanation

The continual improvement practice is the practice purpose-built to align practices and services with changing business needs. Other practices may improve their own work, but the dedicated practice owns this alignment outcome.

Question 3Continual improvement concepts and principles

In the ITIL 4 continual improvement model, which step immediately follows 'Where are we now?'

  1. Where do we want to be? Correct answer.
  2. Did we get there?
  3. Take action
  4. How do we get there?

Explanation

The model's sequence starts with the vision and current state, then defines the target state with 'Where do we want to be?'. Understanding the current position only matters because it is compared against a desired future state.

Question 4Continual improvement concepts and principles

What is the first step of the ITIL 4 continual improvement model?

  1. Did we get there?
  2. What is the vision? Correct answer.
  3. Take action
  4. Where are we now?

Explanation

The model begins with 'What is the vision?', which establishes the overall direction and purpose the improvement must serve. Every later step, including assessing the current state, is judged against that vision.

Question 5Continual improvement concepts and principles

Which guiding principle of ITIL 4 suggests that improvement should be approached in small, manageable increments rather than one large change?

  1. Start where you are
  2. Collaborate and promote visibility
  3. Progress iteratively with feedback Correct answer.
  4. Focus on value

Explanation

'Progress iteratively with feedback' advises organizing work into smaller iterations so that feedback can be gathered and used to adjust direction. This reduces risk and keeps effort aligned to value as conditions change.

Question 6Continual improvement concepts and principles

A team wants to improve a service but insists on designing everything from scratch, ignoring existing tools and knowledge. Which ITIL 4 guiding principle is being violated most directly?

  1. Focus on value
  2. Optimize and automate
  3. Start where you are Correct answer.
  4. Keep it simple and practical

Explanation

'Start where you are' encourages assessing what already exists and building on it rather than discarding it. Ignoring existing tools and knowledge wastes capability that could be reused.

Question 7Continual improvement concepts and principles

Which statement accurately describes the relationship between the ITIL 4 guiding principles and continual improvement?

  1. Guiding principles apply only to the continual improvement practice and no other area
  2. Guiding principles are recommendations that can guide improvement decisions across all practices Correct answer.
  3. Guiding principles are mandatory rules that override customer requirements
  4. Guiding principles replace the need for the continual improvement model

Explanation

The guiding principles are universal recommendations intended to guide decisions and actions in all circumstances, including improvement work. They complement rather than replace the continual improvement model.

Question 8Continual improvement concepts and principles

Why does ITIL 4 emphasize measuring improvement outcomes rather than only improvement activity?

  1. Because activity metrics are always inaccurate
  2. Because outcomes demonstrate whether the improvement actually delivered value Correct answer.
  3. Because measuring outcomes removes the need for feedback
  4. Because activity metrics are prohibited in continual improvement

Explanation

The 'Did we get there?' step requires evidence that the intended value was realized. Measuring outcomes shows whether the improvement achieved its goal, whereas activity measures only show that effort occurred.

Question 9Continual improvement concepts and principles

An organization runs a large improvement program but skips defining a vision, moving straight to assessing the current state. What is the most significant consequence according to the continual improvement model?

  1. The organization will automatically progress faster through the model
  2. The current-state assessment will be more accurate than usual
  3. Feedback collection becomes unnecessary in later steps
  4. Improvement efforts may lack direction and be judged against no agreed goal Correct answer.

Explanation

Without a vision, there is no reference point for deciding which gaps matter or whether results are acceptable. The model places 'What is the vision?' first precisely so later steps have a purpose to serve.

Question 10Continual improvement concepts and principles

During an improvement initiative, a team defines the target state and then immediately begins executing changes without agreeing an approach. Which step of the continual improvement model did they skip?

  1. Where are we now?
  2. Did we get there?
  3. How do we get there? Correct answer.
  4. What is the vision?

Explanation

'How do we get there?' is the planning step where the approach, actions, and responsibilities are agreed before execution. Jumping from target state to action omits that planning discipline.

Question 11Continual improvement concepts and principles

A service manager wants to apply 'Keep it simple and practical' to an improvement effort. Which action best reflects this principle?

  1. Eliminate steps in the improvement workflow that add no value Correct answer.
  2. Automate every manual task regardless of cost
  3. Expand the improvement scope to cover all departments at once
  4. Add approval gates for every improvement idea to ensure control

Explanation

'Keep it simple and practical' encourages removing complexity that does not contribute to the objective. Eliminating non-value-adding steps keeps the improvement effort lean and effective.

Question 12Continual improvement concepts and principles

Which activity is a valid input to the 'Where are we now?' step of the continual improvement model?

  1. The list of corrective actions already completed
  2. The final results of the improvement after implementation
  3. The post-implementation review conclusions
  4. The agreed vision statement and measurable baseline data on current performance Correct answer.

Explanation

Assessing the current state requires the vision as context plus objective data describing present performance. Baseline measurements allow meaningful comparison with the target state later.

Question 13Continual improvement concepts and principles

An improvement team collects feedback after each small release and adjusts the plan accordingly. Which guiding principle does this behavior best illustrate?

  1. Focus on value
  2. Progress iteratively with feedback Correct answer.
  3. Start where you are
  4. Optimize and automate

Explanation

Releasing in small increments and using feedback to adjust direction is the essence of 'Progress iteratively with feedback'. It allows course correction before large commitments are made.

Question 14Continual improvement concepts and principles

Which statement about the ITIL 4 continual improvement model is correct?

  1. It applies only to technology-focused improvements
  2. It must be applied strictly sequentially with no return to earlier steps
  3. It replaces the need for guiding principles
  4. It is a high-level model that can be applied iteratively, with steps revisited as understanding grows Correct answer.

Explanation

The model provides a structured but flexible sequence; teams commonly loop back as new information emerges. It is a high-level aid, not a rigid waterfall, and it works alongside the guiding principles.

Question 15Continual improvement concepts and principles

A team is deciding whether to improve an existing manual process or replace it with a new system. Which pair of guiding principles is most relevant to this decision?

  1. Collaborate and promote visibility and Focus on value
  2. Start where you are and Optimize and automate Correct answer.
  3. Focus on value and Start where you are
  4. Keep it simple and practical and Progress iteratively with feedback

Explanation

'Start where you are' prompts examining whether the existing process can be improved before replacement, while 'Optimize and automate' addresses making the process efficient and considering automation. Together they frame the improve-versus-replace decision.

Question 16Continual improvement concepts and principles

In the continual improvement model, what is the primary purpose of the 'Did we get there?' step?

  1. To identify which stakeholders should be consulted
  2. To define the target state in measurable terms
  3. To verify that the improvement achieved its intended outcomes and to capture lessons Correct answer.
  4. To decide whether the vision should be abandoned

Explanation

'Did we get there?' evaluates results against the target state and records what was learned. It closes the loop by confirming value delivery and feeding insights into future iterations.

Question 17Continual improvement concepts and principles

Which practice is most directly supported by the continual improvement practice when an organization wants to embed improvement into daily work?

  1. All value chain activities and practices, since continual improvement is embedded across the organization Correct answer.
  2. Only the change enablement practice
  3. Only the service desk practice
  4. Only the problem management practice

Explanation

Continual improvement is not confined to one practice; it supports and is embedded across value chain activities and practices. Embedding improvement into daily work requires it to be a pervasive capability.

Question 18Continual improvement concepts and principles

A manager argues that because improvement is everyone's responsibility, no dedicated roles or structures are needed. How should this be assessed against ITIL 4 guidance?

  1. Correct, because only the service desk should own improvement
  2. Correct, because continual improvement requires no ownership
  3. Incorrect, because only external auditors can drive improvement
  4. Incorrect, because effective continual improvement needs clear accountability and supporting structures alongside broad participation Correct answer.

Explanation

ITIL 4 expects improvement to be broadly owned, but broad participation does not remove the need for accountability and enabling structures. Clear ownership ensures improvement is prioritized, resourced, and tracked.

Question 19Continual improvement concepts and principles

Which statement best captures how the guiding principle 'Collaborate and promote visibility' supports continual improvement?

  1. It requires all improvement data to be hidden to protect confidentiality
  2. It ensures improvement decisions are made only by senior management
  3. It replaces the need for feedback with formal reporting
  4. It encourages involving stakeholders and sharing information so improvement is informed and supported Correct answer.

Explanation

Collaboration brings diverse perspectives and builds buy-in, while visibility ensures decisions are based on shared information. Together they make improvement more informed and more likely to be adopted.

Question 20Continual improvement concepts and principles

An organization completes an improvement but never records what worked and what did not. Which aspect of continual improvement is most weakened?

  1. The ability to obtain budget approval
  2. The ability to reuse lessons and inform future improvement iterations Correct answer.
  3. The ability to measure the current state before starting
  4. The ability to define the original vision

Explanation

Capturing lessons is how improvement becomes cumulative rather than repetitive. Without records, the organization loses the knowledge that would make future iterations faster and more effective.

Question 21Continual improvement concepts and principles

A team sets a target state but defines no measurable success criteria. Which step of the continual improvement model will be hardest to perform credibly?

  1. Where do we want to be?
  2. Did we get there? Correct answer.
  3. Where are we now?
  4. What is the vision?

Explanation

'Did we get there?' requires comparing actual results with the intended target. Without measurable success criteria, the team cannot objectively confirm whether the improvement succeeded.

Question 22Continual improvement concepts and principles

Two improvements are proposed: one reduces cost by 2 percent with high disruption, another improves customer satisfaction measurably with low disruption. Applying 'Focus on value', how should the team reason?

  1. Defer the decision indefinitely to avoid risk
  2. Prioritize based on which improvement delivers the greatest value to stakeholders, considering both benefit and disruption Correct answer.
  3. Choose the cost reduction because financial metrics always dominate
  4. Choose neither until a third option with no disruption appears

Explanation

'Focus on value' directs decisions toward what stakeholders perceive as valuable, weighing benefits against costs and disruption. A small cost saving with high disruption may deliver less value than a clear satisfaction gain.

Question 23Continual improvement concepts and principles

An improvement program repeatedly restarts from scratch whenever leadership changes, discarding prior assessments. Which combination of model steps and principles is most clearly undermined?

  1. 'What is the vision?' and 'Optimize and automate'
  2. 'Did we get there?' and 'Keep it simple and practical'
  3. 'Where are we now?' and 'Start where you are' Correct answer.
  4. 'How do we get there?' and 'Collaborate and promote visibility'

Explanation

Discarding prior assessments undermines the current-state step, which builds on existing knowledge, and violates 'Start where you are' by ignoring what has already been learned. Continuity of understanding is essential for cumulative improvement.

Question 24Continual improvement concepts and principles

Which scenario best demonstrates the continual improvement model being applied appropriately rather than superficially?

  1. A team measures the current state but never defines a target
  2. A team takes action first and writes the vision afterward to match results
  3. A team documents a vision and files it without further action
  4. A team defines a vision, measures the current state, sets a measurable target, plans, acts, and then reviews outcomes to inform the next cycle Correct answer.

Explanation

Appropriate application follows the model's logic end to end and loops back with lessons learned. Each step informs the next, and evaluation feeds the following improvement cycle.

Question 25Continual improvement concepts and principles

An organization wants improvement to be sustainable rather than dependent on occasional projects. Which approach aligns best with ITIL 4 continual improvement concepts?

  1. Restrict improvement to an annual project with a fixed end date
  2. Rely on ad hoc suggestions without tracking or review
  3. Treat improvement as a recurring activity embedded in normal work with clear ownership and feedback loops Correct answer.
  4. Assign improvement solely to an external consultancy

Explanation

Continual improvement is recurring and should be embedded in everyday work, supported by ownership and feedback. This makes improvement a durable capability rather than an episodic event.

Question 26Continual improvement concepts and principles

Which ITIL 4 guiding principle advises an organization to observe how services and processes actually work before deciding what to change?

  1. Progress iteratively with feedback
  2. Optimize and automate
  3. Focus on value
  4. Start where you are Correct answer.

Explanation

'Start where you are' means assessing the existing state, including current services, processes, and capabilities, instead of discarding them and beginning again. Observation of the current situation provides the evidence base for later improvement decisions.

Question 27Continual improvement concepts and principles

In the ITIL 4 continual improvement model, which step comes immediately after 'Where do we want to be?'

  1. Take action
  2. How do we get there? Correct answer.
  3. Where are we now?
  4. Did we get there?

Explanation

The model's sequence runs from vision and current state, through the target state, to 'How do we get there?', then action, then evaluation. Planning the route follows once the desired destination has been defined.

Question 28Continual improvement concepts and principles

What is the purpose of the vision step at the start of the continual improvement model?

  1. To state clearly what the improvement is intended to achieve for the organization and its consumers Correct answer.
  2. To record the detailed tasks and owners for each change
  3. To confirm that the improvement has delivered its expected outcomes
  4. To measure the current performance baseline of the service

Explanation

The vision step establishes a clear, shared statement of the intended outcome so that later steps have direction and can be judged against it. It answers what the improvement is for, rather than how it will be executed or verified.

Question 29Continual improvement concepts and principles

Which guiding principle recommends removing steps, reports, or approvals that add no value to the improvement?

  1. Think and work holistically
  2. Collaborate and promote visibility
  3. Start where you are
  4. Keep it simple and practical Correct answer.

Explanation

'Keep it simple and practical' directs teams to eliminate anything that does not produce value and to use the minimum number of steps needed to achieve the outcome. It targets unnecessary complexity rather than the starting position or wider system.

Question 30Continual improvement concepts and principles

What is the role of the 'Did we get there?' step in the continual improvement model?

  1. To document the sequence of activities needed to implement the change
  2. To select which improvement opportunity will be pursued next
  3. To verify that the improvement achieved its intended outcomes and to learn from the result Correct answer.
  4. To define the measurable targets that the improvement should reach

Explanation

The evaluation step checks actual results against the vision and target state, confirming whether the expected value was realized. It also produces learning that feeds the next iteration of improvement.

Question 31Continual improvement concepts and principles

Which statement describes the scope of the continual improvement practice in ITIL 4?

  1. It aligns the organization's practices and services with changing needs through ongoing improvement of products, services, and practices Correct answer.
  2. It ensures that service components are identified and controlled
  3. It manages the full lifecycle of changes with minimal disruption
  4. It restores normal service operation as quickly as possible after an incident

Explanation

The continual improvement practice is concerned with aligning products, services, and practices with evolving business needs across all value streams. It provides the ongoing mechanism for improvement rather than handling incidents, changes, or assets.

Question 32Continual improvement concepts and principles

According to ITIL 4, who is responsible for continual improvement in an organization?

  1. Only the continual improvement practice owner and their team
  2. Only senior leadership, since improvement requires budget authority
  3. Everyone in the organization, supported by dedicated improvement structures where needed Correct answer.
  4. Only external consultants engaged for improvement programmes

Explanation

ITIL 4 treats continual improvement as a shared responsibility embedded in the culture, with every role contributing to identifying and realizing improvement. Dedicated roles and structures support this but do not replace broad participation.

Question 33Continual improvement concepts and principles

Which guiding principle emphasizes understanding how the constituent parts of an organization interact and how improvement in one area affects others?

  1. Focus on value
  2. Think and work holistically Correct answer.
  3. Start where you are
  4. Progress iteratively with feedback

Explanation

'Think and work holistically' requires seeing the organization as a system of interconnected parts, so that improvements are assessed for their wider effects. It guards against optimizing one component at the expense of the whole.

Question 34Continual improvement concepts and principles

A service desk team notices that a manual workaround has been used successfully for months. Before proposing a formal improvement, they investigate why the workaround exists and how the original process was designed. Which guiding principle does this best reflect?

  1. Collaborate and promote visibility
  2. Start where you are Correct answer.
  3. Optimize and automate
  4. Keep it simple and practical

Explanation

The team is examining the existing process and the reasons behind current practice before deciding what to change, which is the essence of 'Start where you are'. Building on what already exists avoids discarding useful knowledge.

Question 35Continual improvement concepts and principles

An improvement team has defined its vision and target state. What should it do next in the continual improvement model?

  1. Reassess the current state to confirm the vision is still valid
  2. Begin taking action immediately to save time
  3. Evaluate whether the improvement has already delivered value
  4. Determine how to reach the target state, including the actions and resources required Correct answer.

Explanation

Once the destination is known, the model requires planning the route: the actions, resources, and sequence needed to move from the current state to the target. Action follows that plan rather than replacing it.

Question 36Continual improvement concepts and principles

An organization wants to make improvement continuous rather than episodic. Which approach best aligns with ITIL 4 continual improvement?

  1. Wait for major incidents to reveal where improvement is needed
  2. Run a single large improvement programme each year and then pause
  3. Embed improvement into daily work and iterate in small increments with regular feedback Correct answer.
  4. Assign all improvement work to a central team that works in isolation

Explanation

Continual improvement is ongoing and iterative, using feedback from small increments to steer the next steps. Embedding it in normal work makes it sustainable rather than dependent on occasional projects.

Question 37Continual improvement concepts and principles

A team is choosing between two improvement ideas and wants to apply 'Focus on value'. What should guide the decision?

  1. Which idea delivers the greatest benefit to the organization and its consumers relative to its cost and effort Correct answer.
  2. Which idea can be completed fastest regardless of outcome
  3. Which idea was requested by the most senior stakeholder
  4. Which idea uses the most modern technology available

Explanation

'Focus on value' directs decisions toward the outcome experienced by the consumer and the organization, weighing benefit against cost and effort. Technology novelty, speed alone, or seniority of the requester are not measures of value.

Question 38Continual improvement concepts and principles

A team runs a two-week improvement experiment, reviews the results with stakeholders, and adjusts its approach before the next experiment. Which principle is being applied?

  1. Start where you are
  2. Think and work holistically
  3. Keep it simple and practical
  4. Progress iteratively with feedback Correct answer.

Explanation

Small increments coupled with review and adjustment are the hallmark of 'Progress iteratively with feedback'. The feedback loop allows the team to correct direction before committing further effort.

Question 39Continual improvement concepts and principles

Why does the continual improvement model include a step to define measurable target states?

  1. Because measurement is required only for regulatory reporting
  2. Because metrics guarantee that stakeholders will support the change
  3. Because target states replace the need for a vision statement
  4. Because without measurable criteria the team cannot objectively judge whether the improvement succeeded Correct answer.

Explanation

Measurable target states give the team an objective basis for the later evaluation step, turning an aspiration into something that can be verified. Without them, success becomes a matter of opinion.

Question 40Continual improvement concepts and principles

A team wants to improve a service but is unsure where to begin. Which action best reflects 'Start where you are'?

  1. Suspend the service until a perfect solution is designed
  2. Benchmark against an unrelated industry and copy its processes
  3. Assess the current service, its performance data, and existing capabilities to identify a baseline Correct answer.
  4. Commission a complete redesign using unfamiliar technology

Explanation

'Start where you are' means using existing data, capabilities, and knowledge as the foundation for improvement. A baseline assessment reveals what already works and what genuinely needs to change.

Question 41Continual improvement concepts and principles

An improvement initiative is sponsored by leadership but stalls because affected teams were never consulted and do not understand the change. Which principle was most clearly neglected?

  1. Start where you are
  2. Collaborate and promote visibility Correct answer.
  3. Optimize and automate
  4. Focus on value

Explanation

'Collaborate and promote visibility' requires involving the people affected and making information about the change available, which builds understanding and support. Excluding those teams produced resistance and confusion.

Question 42Continual improvement concepts and principles

What distinguishes the continual improvement practice from a one-off improvement project?

  1. The practice is performed only by project managers
  2. The practice applies only to technology components
  3. The practice establishes ongoing, repeatable capability for improvement across the organization Correct answer.
  4. The practice ends when the first improvement is delivered

Explanation

A practice is a repeatable organizational capability, so continual improvement provides sustained structures, methods, and habits rather than a single bounded effort. Projects may deliver individual improvements within that capability.

Question 43Continual improvement concepts and principles

An organization wants to ensure that improvement opportunities are captured from many sources rather than only from formal audits. Which action best supports this?

  1. Restrict improvement suggestions to the quality assurance function
  2. Collect ideas only during the annual audit cycle
  3. Provide accessible channels for staff, users, and partners to raise improvement ideas and feed them into a managed backlog Correct answer.
  4. Require every suggestion to be approved by the executive board before recording

Explanation

Continual improvement benefits from broad input, so accessible channels and a managed backlog allow ideas from many sources to be captured and prioritized. Restricting sources or adding heavy gates suppresses the flow of opportunities.

Question 44Continual improvement concepts and principles

A team applies 'Optimize and automate' by automating a process exactly as it currently operates, including several redundant approval steps. What is the weakness in this approach?

  1. Automation is inappropriate for any approval-based process
  2. Automation should follow optimization, so redundant steps should be removed before automating Correct answer.
  3. Automation should always precede any analysis of the process
  4. Automation should be avoided until all staff are retrained

Explanation

The principle pairs optimization with automation: work should first be made effective and efficient, then automated where appropriate. Automating waste simply makes the waste faster and harder to remove.

Question 45Continual improvement concepts and principles

How do the ITIL 4 guiding principles relate to the continual improvement model?

  1. The principles are used only after the model's final step is complete
  2. The principles apply only to the vision step of the model
  3. The principles replace the model and make its steps unnecessary
  4. The principles inform how each step of the model is carried out, providing guidance on decisions and behavior throughout Correct answer.

Explanation

The guiding principles are general recommendations that shape decisions and behavior at every stage, including within each step of the continual improvement model. They complement the model rather than substituting for it.

Question 46Continual improvement concepts and principles

An improvement team wants to reduce the risk of a large change failing. Which combination of ITIL 4 principles best addresses this?

  1. Start where you are, combined with optimize and automate
  2. Progress iteratively with feedback, combined with collaborate and promote visibility Correct answer.
  3. Think and work holistically, combined with focus on value
  4. Focus on value, combined with keep it simple and practical

Explanation

Delivering in small increments with feedback limits the impact of any single failure, while collaboration and visibility keep stakeholders informed and engaged. Together they reduce the risk that a large change fails unnoticed or unsupported.

Question 47Continual improvement concepts and principles

A team completes an improvement and records that the target was met, but it never captures why the approach worked or what should be done differently next time. Which aspect of continual improvement is missing?

  1. The selection of which improvement to pursue
  2. The definition of a vision for the improvement
  3. The assessment of the current state before the change
  4. The learning and knowledge capture that turns an improvement outcome into reusable organizational capability Correct answer.

Explanation

Continual improvement depends on capturing lessons so that knowledge is retained and reused, not lost when a project ends. Without that capture, the organization repeats mistakes and cannot build on successes.

Question 48Continual improvement concepts and principles

A team is asked to justify why its improvement should proceed. It presents only a list of activities it plans to perform. Why is this insufficient under ITIL 4 continual improvement?

  1. Improvement should be justified by the value and outcomes it will deliver, with activities being a means to that end Correct answer.
  2. Improvement should be justified only by the number of staff assigned
  3. Activity lists are insufficient because they are always too long
  4. Activity lists are insufficient because they omit the budget

Explanation

Continual improvement is oriented toward outcomes and value, so a proposal must show the benefit expected for consumers and the organization. Activities describe effort, not the value that effort is meant to produce.

Question 49Continual improvement concepts and principles

An improvement team finds that a change will benefit one department while degrading service for another. Which principle should guide its next step?

  1. Keep it simple and practical, proceeding because the change is easy to implement
  2. Think and work holistically, assessing the effect on the wider system before proceeding Correct answer.
  3. Progress iteratively with feedback, proceeding because the change is small
  4. Optimize and automate, proceeding because the change uses new tooling

Explanation

'Think and work holistically' requires considering how a change affects interconnected parts of the organization rather than optimizing one area in isolation. The team should evaluate the wider impact and adjust before proceeding.

Question 50Continual improvement concepts and principles

An organization has a mature improvement practice but its improvements rarely address the outcomes consumers care about. Which principle is being applied least effectively?

  1. Focus on value Correct answer.
  2. Start where you are
  3. Progress iteratively with feedback
  4. Collaborate and promote visibility

Explanation

'Focus on value' requires that improvement be directed at what the consumer and organization actually perceive as valuable. A well-run practice that misses consumer outcomes is efficient but misdirected.