7.6 Knowledge Check

1. Which of the following best describes a ‘nudge’ in QI?
   1. A top-down directive
   2. A motivational speech by leadership
   3. A subtle environmental or design change that encourages preferred behavior
   4. A type of staff training session

1. Provide an example of how human-centered design could improve a workflow or tool in your pediatric mental health access system.
2. Describe how a strong leadership advocate might influence the sustainability and spread of your improvement efforts.

1. Assess your understanding of culture, change management, sustainability, and spread, and reflect on how these concepts support long-term quality improvement success.
2. In your current or past QI project, how did you — or how could you — adapt your messaging to different audiences?

Knowledge and Awareness

1. C) A subtle environmental or design change that encourages preferred behavior — nudges shape behavior through design (e.g., a default option or a visual cue) rather than a directive or training.

Application

1. Sample answer: Redesigning the referral workflow so the default, easiest path for a clinician is the preferred behavior — for example, making the telepsychiatry consult line the pre-selected option in an EHR order set rather than requiring an extra search step. A strong answer identifies a specific, low-friction design change in the learner's own workflow.
2. A leadership advocate helps sustain and spread improvement by protecting staff time and resources for the work, modeling and reinforcing the new process, removing organizational barriers, and championing the change to other units or leaders so it continues after the initial project team's attention moves elsewhere.

Reflection

1. This is a self-assessment reflection with no single correct answer. A strong response names specific areas of confidence and areas for growth across culture, change management, sustainability, and spread, and connects at least one to a concrete next step.
2. A strong answer gives a concrete example of tailoring the message to the audience — e.g., leading with data and resource impact for hospital leadership, workflow specifics for frontline staff, and patient/family outcomes for community partners — rather than using one generic message for everyone.