Decision Making in Healthcare
When prioritizing activities for overhead cost reduction, one should consider which of the following?
Activity cost vs. its importance to operations
Which of the following focuses more on operational goals than strategic objectives
Dashboards
The use of all the cost management tools contained in this book will have the largest financial impact for which type of payment?
global budget
Tasks in a work breakdown should be
no more than three weeks long
Jose is measuring the time it takes a technician to do a new test. He expects the test to take no more than 5 minutes and no less than 3 minutes. After observing a number of tests, he calculates the standard deviation of the test as 0.3 minutes. What is the process capability of the test?
1.1
What is the next number in this forecasting series: 2.5, 4.5, 6.5, 8.5, 10.5, 12.5, 14.5, 16.5?
18.5
The term "Six Sigma" is derived from which of the following?
3.4 defects per million opportunities
What it is the next number in this forecasting series: 3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7?
3.7
Tiffany decides she can improve operations in her department by sorting, labeling, and cleaning the storage area. What Lean tool is she using?
5S
Which of the following statements is true of descriptive analytics?
All of the above
Which of the following is not a valid method for scheduling appointments in a clinic?
Appointments based on source of payment
Which of the following is not a current trend in vendor supply chain relationships?
Bidding strictly on cost
Which of the following is not a predictive tool?
Data mining
What is the correct project cycle for a Six Sigma project
Define, measure, analyze, improve, control
Which of the following goals is not part of inventory management?
Having a variety of clinical device available for physicians
Which of the following is not an important cost management approach for an organization taking full capitation risk?
High patient copays and deductibles
Which of the following is not a reason for the increasing popularity of analytics in healthcare?
Increasing demand from customers for public analytic reports
Which of the following is not included in a basic discrete event simulation model?
Management team
Which of the following measures is not used in the customer perspective?
Number of new products introduced
Which of the following is not a measure of innovation?
Product profitibility
Which public reporting strategy is the most effective in improving quality?
Rewarding Providers who have high scores or improvements
What is the most important characteristic of advanced access scheduling?
Same-day scheduling
The VVH hospital has separated emergency department cases into two streams of patients—those with severe problems and those with relatively minor problems. This is an example of what type of scheduling?`
Shortest processing time
Tiffany works with radiologists in her department to develop a protocol that will to be used to sterilize each instrument used in a procedure in exactly the same manner. What Lean tool is she using?
Standard work
Vincent Valley Hospital is
a fictional, but realistic, healthcare system used to illustrate the effective use of operations management tools and techniques.
Crashing a project can be accomplished by
shortening the duration of tasks on the critical path
Agile project management should be used when
the exact performance characteristics are unknown at the beginning of the project
What is the capacity of a process
The maximum possible output (goods or services) that a process or resource can produce or transform
Which of the following is not a principal assumption about linear regression?
There is no autocorrelation in the sample
In general a decision tree is used for what purpose?
To examine and evaluate decisions in a structured manner
Rough-cut hospital capacity planning is used for what purpose?
To plan staffing resources for each day of the month using a mix of permanent and contractor staff
Tom is watching a football game he prerecorded, and he is fast-forwarding to only watch the plays. What is he doing?
Using only the value-added time
Which of the following is an example of balancing feedback?
Using real-time physiological monitoring to control dru dosage
which is not a characteristic of big data?
Very searchable
Tom Stinson is the COO of Memorial Hospital. He is receiving complaints about waiting times in the emergency department. What services other than emergency should be a priority for analysis?
Scheduled surgery
The Memorial Hospital emergency department averages 30 patients in their department at any one time, and 20 patients arrive per hour. What is the average throughput time for each patient?
1.5 hours
A project team has estimated the number of days a task will take. The four estimates are 3 days, 7 days, 3 days, and 2 days. What is the PERT estimate for the duration of the task?
3.5
A patient enters the MRI scanning suite at 1:00 pm and leaves at 3:30 pm. The MRI test takes 50 minutes. What is the percentage of value-added time?
33 percent
VVH's pediatric clinic has implemented advanced access and is now attempting to work down their backlog. Providers are working extra hours and are able to see ten more patients per day. They have a current backlog of 400 appointments. How many days will it take to work down the backlog?
40 days
For CT scanning, the check-in process takes 3 minutes, the patient waits for 15 minutes, the patient then moves to the scanner (2 minutes), the scan takes 9 minutes, the patient is moved to the waiting room (2 minutes), and the patient then waits 20 minutes to be picked up. What it the throughput time?
51 minutes
What element is not necessary to use optimization tools such as linear programming?
A process map connecting the elements that are impacted by the decision
Who is the project champion?
A senior manager who can help solve high-level problems as the project progresses
Elements of the clinical microsystem include which of the following?
All of the above
Which of the following is not a priority of comparative effectiveness research?
Allocating Medicare payments
Tiffany institutes as new system that indicates the status of the CT scanning suite with a series of lights. Green means the suite is available, yellow means the suite will be available in 3 minutes, and red means the suite is in use. What Lean tool is Tiffany using?
Andon
Which of the following is true when using the EOQ model?
As holding costs increase, the optimal order quantity decreases
Which assumption is not part of the basic EOQ model?
Back orders and stock outs are allowed
Which is not one of Fredrick Taylor's principles of scientific management?
Employee work experiences
John is forecasting daily demand for laundry in the emergency department. He has very limited historical data. What forecasting method should he use?
Exponential smoothing
Which of the following is not an effective cost reduction tool for a cost reduction project?
Finding ineffective employees and reassigning them
Which of the following is not a useful place for gathering text data through text mining?
Hospital financial reports
As Janice observes all the steps in her Medicare billing process, she notes that only one staff member is doing coding reviews and that individual is always behind. She decides to add a staff member to also do coding reviews. What has Janice just done?
Identified and elevated the constraint
What approach should you use to identify bundled payments that are a priority for cost management?
Identify bundles with high volume, high cost compared with benchmarks from other organizations, and high use in bundled payments where costs are highly variable.
Which of the following are included in the five steps of the activity-based costing process?
Identify relevant activities, determine cost drivers, calculate total cost of service
What is the most important message from W. Edwards Deming's work?
Improving quality will reduce expenses while increasing productivity and market share.
Julie enters the storeroom to get a special syringe for her patients, but none of the syringes are there. This is an example of what?
Stock out
To improve the flow of a process, what two key strategies should be employed?
Increase the speed, and decrease the variability of the process
Which of the following is the most important reason to create a process map?
It provides a visual representation of a process that can be used to identify opportunities to make improvements.
What mathematical tool can be used for staff scheduling?
Linear programing
What is the purpose of a strategy map?
Link strategic initiatives with "if-then" statements
Susan Collins is the director of Memorial Hospital's emergency department. She has redefined the triage nurses' role to expand the number of tasks they can perform so that they can assist other staff. Which of the following describes what Susan is doing?
Load balancing
Which of the following is not a major factor in the increasing costs of healthcare in the United States?
Malpractice costs
Susan has increased staffing levels on some evenings (e.g., first of the month, paydays) to reduce patient waiting time. This is an example of what?
Matching capacity to demand
Which of the following activities will not result in a significant increase in revenue?
Measuring revenue per billing employee and replacing the lowest performers every quarter
Tiffany is the day shift supervisor in the imaging department. She has redesigned the patient intake system so that patients are only asked their name and birthdate once. The old system asked the patient this information three times. What type of waste did Tiffany reduce?
Overprocessing
Which of the following is not a method of bundling payments?
Payment for a clinical service (e.g., CT scan)
What is the PCP coverage metric?
Percentage of same day appoints seen by any physician
Once a product has been designed and delivered, what is the last step in an effective organization's operational process?
Post-sales services
Which of the following is not a measure of variability
Process capability
What variables are measured in the measurement phase of a Six Sigma project?
Process input, process output, critical to quality
A system can be subdivided into what elements?
Processes, subprocesses, and tasks
Which of the following is not a key tool for project management?
Quality circles
Which of the following is not a measure of central tendency?
Range
Which of the following approaches is not an effective means to reduce the cost of overhead?
Reducing executives salaries
Which of the following statements describes the scheduling rule of shortest processing time (SPT)?
The job that takes the least amount of time to complete is first, followed by the job that will take the next least amount time, and so on.
Which of the following is not a part of evidence-based medicine?
Total quality management groups
John is the emergency department manager, and he wants to order supplies for his growing department. He knows his ED patient demand is stronger in the summer than in any other season. What forecasting method(s) should he use?
Trend and seasonal
A network diagram connects tasks in order of precedence.
True
Many changes in a healthcare system will be resisted and reinforced by feedback mechanisms, many of which are not clearly visible
True
Reinforcing feedback prompts change that builds on itself and amplifies the outcome of a process.
True
Which of the following approaches reflects the Bailey-Welch scheduling rule?
Two patients at the beginning of a clinic session, followed by equally spaced appointments
Which of the following is the best example of custom care?
Type II diabetes care
Which of the following issues will be a part of implementing advanced access?
Working down the backlog of appointments
Jose, the lab manager, wants to improve the quality in his laboratory with a Six Sigma program. He wants Sandy, his chemistry supervisor, to attend a Six Sigma training program so that she can oversee all Six Sigma projects that will occur in the lab. Sandy will be trained as a ______________.
black belt
The most accurate way to determine current inventory is to
do a physical inventory count
A RASIC diagram is used to
identify the role and responsibility of each team member for each task
Cross-functional (swim lane) process maps are used for which of the following?
identifying the tasks that are accomplished by each individual or department in a process
A change control policy is important because
no project is ever completed exactly as it was initially planned
To find the confidence intervals for small samples (less than 30). you need to use which of the following?
t-distribution
A type I error in hypothesis testing is
the probability of rejecting the null hypothesis when it is true
The demand for chest X-rays is 4 per hour. It takes 12 minutes to take a chest X-ray. What is the takt time?
15 minutes
Approximately what portion of the US GDP will be consumed by healthcare in 2025?
20 percent
Ivan Gonksi is the IT director at Memorial Hospital. He conducts an experiment to determine the error rate for data entry of diagnostic codes. He notes that five errors were made for every 100 entries. What is the observed probability of an error?
5 percent
Jose has a new test that has three steps. He calculates that in each step some of the sample must be discarded. Step 1 has a discard rate of 2 percent, step 2 has a discard rate of 5 percent, and step 3 has a discard rate of 1 percent. How much of the sample is available after step 3?
86.5 percent
Which of the following healthcare aims is included in the Institute of Medicine's Crossing the Quality Chasm?
All of the above
Which of the following is a reason that evidence-based medicine (EBM) has not been widely used in the past?
All of the above
which of the following describes process mapping?
All of the above
Ivan Gonski is interested in replacing the servers in his electronic health records system. He gathers 1,000 response time samples from two server vendors. Electro server's mean time is 1.01 seconds, and SuperFast server's time is 1.00 seconds. Using a t-test, Ivan found that the time differences were statistically significant. Electro servers cost 10 percent less than SuperFast. How should Ivan decide?
Although Electro servers are slightly slower, the difference is not practically significant, and he should buy the lowest-cost server.
Jose is the supervisor of the laboratory. One of his testing machines seems to be giving different results for the same sample. To make sure he is delivering correct results, Jose uses a second machine to check the results of the first. This action represents which cost of quality type?
Appraisal
Which of the following is not a good meeting behavior as a member of project team?
Challenge poor ideas
Which strategy is not considered part of "evidence-based medicine"?
Correct coding of procedures and diagnoses
Which of the following is not a quality certification or award?
Coventry Award
Janice has decided she wants to take a more detailed look at her Medicare billing process, and she asks her team to create a process map. After the team members are assembled, their first step would be which of the following?
Determine process boundaries and desired level of detail
Janice has decided to make significant changes in her Medicare billing process. She employs force field analysis to help her decide if these changes can be implemented successfully. Which two factors has she considered in this analysis?
Driving forces and restraining forces
Janice keeps finding errors in her Medicare billing process. Which root cause tool would not be useful in helping her reach her goal of improving the system?
Employee engagement survery
Which of the following is not a goal of pay-for-performance systems?
Encourage poor providers to leave the system
Data mining explores data based on specific hypotheses
False
The topmost perspective on the standard strategy map is which of the following?
Financial
Which tool is not part of the analyze phase of a Six Sigma project?
Gantt Chart
What are the three steps to build a data framework?
Gather data build information gain actionable insights?
Janice has a problem with her accounts receivable system. She has framed the problem as slow payments from Medicare. What should be her next step?
Generating or determining possible courses of action and evaluating
Radiology technologists in Tiffany's department have specialized their work to a specific class of procedures. To improve the flow of patients in the department, she has instituted a series of in-service educational classes to improve the ability of all of her staff to do all of the procedures. What Lean tool is she using?
Heijunka (load balancing)
which of the following is one of the seven ways predictive analytics can improve healthcare?
Helps with preventive medicine and public health efforts
Which of the following is not a financial strategy used by healthcare organizations?
Increase customer satisfaction and retention
Which of the following is not a trend that provides opportunity for improvement in the US health system?
Individual providers avoiding mergers, partnerships, and acquisitions
The just-in-time inventory system and the Toyota Production System were the foundation for which of the following?
Lean production
A direct numerical measure that represents a piece of business data in relationship with one or more dimensions is called what?
Metric
Which of the following is not a measure of employee satisfaction?
Minimal numbers of requests for salary increases
Which of the following is the best example of standard care?
Minute clinic
Ivan Gonski is concerned about the operator errors in the hospital staff use of the electronic health record system. He runs a number of experiments that track the number of errors by a staff member after different amounts of training. He observes a linear relationship—the more training, the fewer errors. He then runs a linear regression and finds that the r2 is .79. What should he conclude?
More training will reduce the errors
Public reporting of healthcare quality does not measure which of the following?
Patient compliance
What of the following was not a key strategy for successful healthcare organizations in the past?
Reduce costs
Tiffany worked with the radiologists to develop a new system to improve equipment utilization. In this new system, the instruments needed for an interventional procedure are organized outside of the interventional suite and prior to the procedure. What Lean tool is Tiffany using?
SMED
Jose is checking his laboratory equipment using test control samples that are designed to give the same results and are used to calibrate the equipment. When he runs 100 samples ,he gets two results that are greater than 3 standard errors of the mean. These results are called what?
Special variation
What is a necessary element of a system for mass production?
Specialization of tasks
Tiffany wants to continue to make improvements in the imaging department and organized a kaizen event. What will be her first step?
Specify value to the patient
Electronic health records allow for data collection from patients, which offer insights and capability to improve decision making.
True
One of the most expensive aspects of all healthcare systems is the care of patients with chronic disease.
True
Supply chain management encompasses the planning and management of all activities involved in sourcing and procurement, conversion, and all logistics management activities.
True
The balanced scorecard with strategy mapping is quantitatively based, providing a vehicle for ongoing strategy analysis and improvement.
True
The supplying organization's perspective on quality includes performance quality and conformance quality
True
Once a strategy map has been constructed, which action is not critical to the effective use of the balanced scorecard?
Use a variety of graphics to display the monthly results
Which of the following is not a common theme found in successful Six Sigma programs?
Use of Taguchi methods
Which of the following is not an element of Wagner's chronic care model?
Use of generic medications
Which of the following is not a key step for creating effective disruptive innovations in healthcare?
Utilize agile project management in innovation projects
Which is the most useful level of the knowledge hierarchy for making management decisions?
Wisdom
The central limit theorem states that
as a sample size becomes sufficiently large, sampling distribution approaches normality
The metrics on the balanced scorecard are used to
display current performance and predict future results
A data point is an outlier in a bell-shaped distribution if
it is greater than 3 standard deviations above the mean
Janice's new system to improve her Medicare accounts receivable system does not perform as expected. Janice's team had applied system changes that they had copied from their Medicaid billing system. This type of failure is known as __________________.
shortsighted shortcuts
