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1. Using the three questions from the Model for Improvement, address a challenge in your organization that needs to be improved: • What are we trying to accomplish? • How will we know that a change is an improvement? • What change can we make that will result in improvement? 2. List three concepts used in your organization every day that might need an operational definition to improve shared meaning. Examples might be: What do we mean by Length of Stay (LOS)? What do we mean by a fall for a patient? Test these definitions with your colleagues; is there shared meaning?

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Bruce is a 69 year old retired gentleman. He lives at home with his wife Betty, and together they have three adult children. Bruce is a Vietnam veteran, and as a consequence of his active duty during the war he has developed severe post-traumatic stress disorder and depression. He suffers with hypertension and hypercholesterolemia, but has repeatedly declined any treatment for any of these conditions. Bruce also has a lump on the right underside of his chin that is about the size of a golf ball. Bruce’s wife reports that this lump had been present for many months but despite the fact that it has turned into an open wound with an offensive exudate, Bruce had refuses to seek treatment for it. In recent weeks Bruce has developed symptoms suggestive of an infective illness. He has complained of generalised malaise, muscle aches and pains and an elevated temperature with occasional rigors. Despite the best efforts of Betty and the children, Bruce has refused to seek medical attention for these symptoms even as his condition deteriorated. Eventually Bruce became so weak and dehydrated that he was no longer able to refuse Betty’s efforts to have him see a doctor; with the assistance of their children Betty manoeuvred him into the car and took him to hospital. On admission to the hospital Bruce was noted to be hypotensive, tachycardic and febrile. His level of consciousness fluctuated, and was often only minimally responsive. Concerned that he may not be able to adequately protect his airway, Bruce was transferred to the high dependency unit where he could be closely monitored. Bruce was diagnosed with septicaemia resulting from the open wound under his chin

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