Quality management final

CMS has developed programs like pay for reporting that remit financial rewards for practitioners who submit data for certain metrics considered important for patient care quality and safety. Use of the data for determining reimbursement rates was not implemented until 2008, but CMS has begun to tighten rules for paying providers for complications that shouldn't occur like pressure ulcers and catheter-related bloodstream infections. CMS refers to these complications of care as:

"never events"

Res ipsa liquitor

"the thing speaks for itself" typical cases involves foreign body left in patient and burns

The approaches to choosing projects (i.e., clinical processes) that could be considered for lean process management include Goldratt's Theory of Constraints and the Pareto Principle, but in clinical setting the _____?_____may also be used as criteria.

"three highs" (i.e., high cost, high risk, high volume processes)

Over the long term, processes usually do not perform as reliably as in the short term. To account for this real-life increase in process variation over time, an empirically based _____?_____ was introduced into the Six Sigma calculation.

1.5 sigma shift

Six sigma limits are often termed:

3 DPMO

In terms of process efficiency, a sigma level of 2 indicates:

69.2% efficiency

RBRVS

A standardized physician payment schedule in which the cost for each service is divided into three componenets: physician work, expected practice expense (e.g., overhead), and professional liability insurance (e.g., malpractice insurance)

MDS

A standardized, primary health status screening tool used to assess physical, psychological, and psychosocial factors for all residents in a Medicare and/or Medicaid-certified long-term care facility. This data set contains extensive health status information for this patient population.

An approach to assigning actual costs to process steps is called:

ABC

Customer satisfaction measures are of increasing importance to many healthcare organizations, and most of these metrics are collected after a healthcare service is delivered (e.g., after patient discharge). Which of the following organizations developed a new approach called the Consumer Assessment of Healthcare Performance Survey (CAHPS) that divides health care quality into the two major components of clinical aspects and consumers' experiences:

AHRQ

Risk Control

An organizations response to areas assessed as having significant risk as well as its response to limit the liability

This tool is usually applied when a significant change is implemented and the extent of of the "buy-in" is unclear, or when the change is encountering resistance from individuals or groups within the organization.

Benefits and barriers exercise (BBE)

If you wish to generate a number of new ideas on a particular subject or ways to solve a problem, which CQI tool would you use?

Brainstorming

Also known as the "group passing technique," this CQI tool is an approach that stimulates a group of reticent individuals within the team to contribute to the brainstorming process. It can is used when the facilitator is having trouble gaining input from all participants because it requires people to participate (i.e., each person in a circle writes down one idea and the piece of paper is passed to the next person who adds some thoughts until everyone gets his or her original piece back).

Brainwriting

According to Deming, which of the following encourages employees to follow QI?

Break down barriers between staff areas

The DMAIC approach is the foundation of Six Sigma today used to improve existing processes. This approach consists of all of the following stages EXCEPT:

Capitalize - on your investments as your team moves forward

A__________ is a tool for identifying and organizing the possible causes of a problem in a structured format (Hint: also called a Fishbone or Ishikawa diagram).

Cause-and-Effect Diagram

W. Edwards Deming proposed the Theory of Profound Knowledge, which serves as the basis for the concept of statistical thinking. Which of the following IS NOT one of the four parts of Deming's Theory of Profound Knowledge?

Company slogans

According to Philip Crosby, quality should be defined as:

Conformance to requirements

While the DMAIC approach is the foundation of Six Sigma used to improve existing processes, what is the mnemonic that describes the Six Sigma approach used proactively to ensure that a particular process is created for high performance (i.e., design for Six Sigma - DFSS)?

DMADV

DOE

Developed as a strategy for planning research to conduct valid experiment is the presence of naturally fluctuating

Effective

Emphasizes the importance of using evidence-based guidelines to provide high-quality care

Respondent superior

Employer is vicariously liable for an employee (i.e., let the employer answer for the actions of the employee).

QI may help improve patient care but also:

Enhances performance and processes, Prioritizes departmental activities, Saves money; reduces waste

six sigma champions

Ensure that resources are available for six sigma initiatives; set the vision for the company's performance

safe

Ensures correct diagnoses, avoidance of unnecessary risks, and ensuring patients give informed consent for

Risk analysis

Evaluation of current and past experiences to determine the effect risk will have on the hospital, and which risk are

Hold harmless clause

Facility wants other party to accept financial and legal responsibility for its own actions and agree to indemnify the

A higher sigma count means a lower expectation of favorable outcomes.

False

According to Lighter, having the proper infrastructure in place (structure indicators) is a guarantee that quality care will follow.

False

According to Lighter, physicians have been quick to adopt EHRs; thus, the penetration of EHR systems into medical practice has been extremely high.

False

Counted medical errors are almost always in outpatient settings, leaving the hospital setting, where the bulk of care in the United States is provided, largely unmonitored.

False

From the Nan: A Six Sigma Mystery book, Poka Yoke means prevention of advertent error.

False

From the Nan: A Six Sigma Mystery book, Six Sigma is about incremental change and starts with a numerical goal, working backward to insist that each stage of the operation get into conformance.

False

From the Nan: A Six Sigma Mystery book, people that are qualified to train Six Sigma Black Belts are called Master Gold Belts.

False

In Nan's words, Six Sigma is a system that was developed as a better way of getting manufacturing to get average yields.

False

In the past few years, the healthcare industry has discovered that teams only play a minor role in improving performance and ensuring safe and high-quality care.

False

Nan suggested that the nurses be retrained on routine tasks such as CPR, following the airline model of putting pilots through simulation every year.

False

Six Sigma was created by GE and was soon adopted by Motorola, IBM, and other first class manufacturing companies.

False

The area of highest risk is in the non-clinical areas:

False

True or false: In the NEJM article "What is Value in Health Care," the author describes that for any medical condition, only a single outcome measure is needed to capture the results of care.

False

Walter A. Shewhart defined the state of statistical control of a process as one in which all data points fell within plus or minus 2 sigma limits, which defines common cause variation, or variation that is 99.73% likely to be due to chance variation in the process.

False

Generally, the vertical y-axis of a histogram measures ____?____; and the horizontal x-axis measures ____?____.

Frequency of the occurences; chart time intervals

Risk Financing

Funding your organization for real or potential losses

Depositions

Given under oath, recorded word for word, can be used in all or in part during trial proceedings

Many enterprise systems evolve using "best in class" software for each application, and the interoperability, or communication and ability to exchange information, becomes a major undertaking. Data-sharing standards have been established for some applications, like the _____?_____ standard for data interchange in electronic health record (EHR) systems.

HL7

After gathering data using a check sheet, what CQI tool(s) can be used to illustrate the data?

Histogram, Pareto chart, and Run chart

corporate liability

Holds organizations responsible for monitoring the activities of the people who function within their facilities, whether employees or independent contractors such as physicians

This agency/organization published a report in 2000 titled "To Err is Human" that estimated that there were 98,000 deaths a year from medical errors, to which physicians and consumers were "appalled, angered, and skeptical."

IOM

A lean six sigma project often relies on the "theory of constraints." When a process has a resource constraint, which of the following rules should be followed?

Identify the system's constraint(s) (e.g., bottlenecks) and Decide how to exploit the system's constraint(s) (e.g., reduce setup time, eliminate waste and rework, optimize run time)

Implementing a QI program in the patient registration department will:

Identify ways to better satisfy the customers (both internal and external) of the department

Risk identification

Identifying areas of potential or existing loss

The standard of care is established by:

Introduction of expert testimony

How does Nominal Group Technique (NGT) differ from brainstorming?

It determines the importance of responses through a rating system

From the Nan: A Six Sigma Mystery book, elimination or reducing inadvertent errors requires that work tasks be designed with which of the following rules in mind?

It should be easier to do the task right than do it wrong and Errors should be immediately obvious

Why is it important to establish a complaint tracking system?

Its existence will make it easier for employees and customers to discuss their complaints, It provides a mechanism for a department to generate useful ideas to improve processes and identify opportunities for change, and It proves to customers that the department is committed to CQI

Is a crucial element of lean process management that ensures that required process items and resources are available at the right place and at the right time.

JIT

The science of medical informatics has been evolving since the 1950s, when physicians and computer scientists at the Massachusetts General Hospital developed a computing language for medical applications called:

MUMPS

Subpoena

Means by which courts request and required attendance of witnesses

What is defined as a relatively new healthcare discipline that deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of data in health and biomedicine.

Medical Informatics

Although medical insurance claims data provide the most widely used sources of information for analyzing utilization and quality of care, the most robust source of data is the _____?_____.

Medical Record

CQI/Performance improvement goals should be focused on:

Meeting customers' needs

U-chart

Monitors process information due to fluctuations in defects per item or group of items and is useful to determine

Established by the Agency for Healthcare Research and Quality (AHRQ) to serve as a primary source of clinical practice guidelines from many organizations in the United States and throughout the world.

National guideline clearinghouse

According to the Lighter book, there are three major categories of quality measures. Which measure would be applied to this statement -- "The percentage of elderly patients in a practice diagnosed and treated for influenza"?

Outcome measure

As a traditional approach to project selection, this principle states that 80% of the problems in a process are caused by 20% of the possible sources (i.e., by addressing 20% of the causes, you can remove 80% of the problems). Therefore, using this analysis tool, you can set priorities as it clearly indicates what upstream processes are the most likely "culprits for intervention."

Pareto analysis (or principle) and 80-20 rule

A bar graph that uses data to determine priorities in problem solving is called a ____?____. This type of bar graph plots the causes of a problem and its frequency showing results in descending order from left to right with the largest category on the left.

Pareto chart

Interrogatories

Part of discovery process in which there is an exchange of questions between the defendant and plaintiff parties

Clinical practice guidelines (CPGs) have assumed increasing importance in health care as the industry tries to reach the STEEEP aims set by the Institute of Medicine (IOM). Which of the following is NOT one of the STEEEP aims?

Physician-centered

All of the following are sources of input for developing clinical practice guidelines (CPGs) EXCEPT:

Physicians on the hospital medical staff only

A ____?____ is a graphic representation of data elements that are part of a whole. The total seqments must add up to 100%.

Pie chart

Ostensible agency

Purports to hold the hospital legally liable for negligence, if it can be substantiated that the hospital represented, ot "held out" to the claimant that the independently contracted professional waas an employee of the hospital (e.g., commercial that states "visit our friendly physicians").

Displays "before and after data." Shows how the strengths and weaknesses of certain variables change over time.

Radar chart

P-chart

Relies on binomial distribution; used when dealing with ratios, proportions, or percentages of conforming or

NP-chart

Relies on the binomial distribution but the sample size must be constant; use of control charts for diagnosis

Collection and analysis of data about patient incidents that occur in a hospital is a job responsibility of the:

Risk manager

Examples of CMS measures from the Physicians Quality Reporting Initiative (PQRI) include all the following EXCEPT:

Screening for anorexia nervosa

Quality Improvement in healthcare improves the processes of delivering care thereby increasing customer satisfaction with:

Service outcomes, Clinical outcomes, Reducing costs (i.e., cost outcomes)

The assessment of quality was identified with what approach(es) according to Dr. Avedis Donabedian?

Structure (inputs), Process (steps in organizational activities and tasks), and Outcome (outputs or results)

According to Brian Joiner, what is the key to success for any organization that wants to implement quality improvement?

Teamwork

A widely accepted definition of quality, as given by ______________, is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

The Institute of Medicine (IOM)

Answer

The defendants legal complaint to the allegations of negligence.

A team size of with greater than seven or eight members usually require additional facilitation and often require subgroups to allow the team to operate efficiently; and, larger teams of more than eight members often have an "executive group" or core leadership subgroup to oversee the overall project and subgroups.

True

Although it may seem intuitive for a quality professional, healthcare practitioners often have a hard time recognizing that all work in health care can be evaluated using the same process analysis tools that have been applied in the industrial sector for decades. An important aspect of this recognition is the need to concede that all work in health care is based on processes, all of which are subject to the tools of process analysis applied daily in industries throughout the world.

True

Bigger systems (macrosystems) are made of smaller systems; smaller systems (microsystems) produce quality, safety, and cost outcomes at the front line of care; and, ultimately, the outcomes from macrosystems can be no better than the microsystems of which they are formed - this suggests that it is necessary to intervene within each microsystem in the organization if the organization as a whole wants to improve. This statement is:

True

Compliance measures are important to ensure that an organization has performed all the necessary process steps to comply with the multitude of regulations for healthcare organizations (e.g., local and state health departments, OSHA, CMS).

True

From the Nan: A Six Sigma Mystery book, "If one team makes a design error, it's pretty likely that the other teams will make the same goof"; this is called common mode failure.

True

From the Nan: A Six Sigma Mystery book, Six Sigma is a management method for achieving very high goals for correct outcomes.

True

From the Nan: A Six Sigma Mystery book, a questionnaire was sent out after the Lunchtime Theater to get feedback on whether verbal orders are a matter of concern and if other solutions were known.

True

From the Nan: A Six Sigma Mystery book, in order to evaluate her own performance as a manager, Maggie explained that she sets separate goals for herself beyond the management-by-objective forms regularly used by hospitals.

True

From the Nan: A Six Sigma Mystery book, the quote "...avoid common modes of failure and single points of failure", means to avoid the situation in which one catastrophe can knock out two of the systems or machines at once.

True

Given the idea initially from Sanjar, in order to reduce errors in communication, Nan suggests the hospital try a pilot program following the Navy's way of repeating orders.

True

Hospitals were historically immune from professional liability litigation through the doctrine of charitable immunity until landmark cases (e.g., 1957 Bing v. Thunig; Darling v. Charleston Community Hospitals, 1965 and 1966). This statement is:

True

Statistical process control (SPC) is a mature statistical tool for examining healthcare processes and identifying opportunities for improvement, and control charts are important at several stages of of the improvement process. Perhaps the most common error that leads to inappropriate use of SPC is the selection of the wrong chart. These statements are:

True

The PDCA cycle method provides an overall framework for CQI. This CQI method was developed by Walter Shewhart in the 1920s, a very early pioneer in statistical quality control. However, it is sometimes called the Deming Cycle because W. Edwards Deming popularized its use in Japan. PDCA consists of these steps: plan, do, check, and act. These statements are:

True

The United States has one of the highest rates of diabetes among developed countries. One factor that relates to the increase in diabetes prevalence is the higher rate of obesity in the U.S. population.

True

The best protection against injuries and ensuing financial liability is prevention. Ideally, the Risk Management (RM) program, when integrated with the facility's Quality Improvement (QI) program, focuses on prevention by identifying and monitoring high-risk and problem-prone processes.

True

The run chart is a good way to display departmental statistics because staff can see trends.

True

The sigma level is simply a determination of opportunities for improvement regardless of the type of process that is being reviewed, with lower sigma levels connoting worse performance and greater areas for improvement.

True

True or false: In the NEJM article "What is Value in Health Care," the author recommends aligning provider reimbursement with value, which rewards providers for efficiency in achieving good outcomes, by providing bundled payments covering the full care cycle or, for chronic conditions, covering periods of a year or more (i.e., tracking outcomes and costs longitudinally).

True

Stratification and ANOM

Two strategies that may be useful when larger samples "hide" underlying variation because of the statistical

Which country ranks 37th among developed nations for infant mortality rates:

United States

ANOVA

Used to test hypotheses about differences between two or more means; tests which group means are significantly

Regression Analysis

Used to try to quantify the direction, strength, and magnitude of relationships between variables.

One of the fundamental axioms of quality and performance improvement is stated: "You can't manage what you don't measure." The ability to make improvements in processes requires answering all the following questions EXCEPT:

Who is to blame for the inefficient process

What is an effective QI program?

a continuous cycle of improvement activities

Value stream mapping (VSM)

a lean technique that involves flowcharting the steps, activities, material flows, communications, and other process.

kanban

a simple part-movement system that should only deliver components to the production line when they are needed

All improvement requires change, but not all change results in improvement. The only way to determine if changes have been beneficial is through measurement, which consists of three steps. Which of the following IS NOT one of those steps?

acknowledging the process will always be complicated

Master black belts

act as in-house couches for six sigma teams; in an ideal setting, these experts devote all their time to six sigma

One of the two pillars of the Toyota Production System (TPS) is Jidoka. Which of the following denote the meaning of Jidoka?

any employee can stop the production line if a defect is identified anywhere along the line (e.g., can be applied in healthcare in the surgical suite) and focuses on the need for machines to notify humans when they need to be adjusted or repaired (e.g., optimizes safety and effectiveness of the machine/human interface)

autonomation

automation with a human touch to approve patient safety and efficiency

Norming

begin to discuss constructive approaches to complete the groups work; subgroups based on mutual trust

A simple tool used to determine how often an event occurs (i.e., tally sheet) is called a:

check sheet

MEDPAR

claims data for service provided to beneficiaries admitted to medicare certified inpatient hospital and SNF

In the NEJM article "Medical Malpractice," the authors describe that conventional tort reforms can be divided roughly into three families. Which of the following IS NOT part of the three?

combining group practice liability insurance

patient-centered

compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient

six sigma green belts

comprise the backbone of six sigma improvement program; serving the role of project management.

muda

connotes a set of "tools" or approaches to efficient and effective management that focus on identifying and

mura

connotes a set of techniques or approaches to eliminate unevenness or lack of uniform to flow in the work system

Deployment flowchart

consist of a sequence of activity steps arranged in a way that allows assignment to specific individuals or groups

Which compelled hospitals to establish a more stringent physician credentialing process:

corporate liability

SMART

defines criteria to implement solutions to remedy underlying causes problems

Statistical thinking implies that application of statistical data provides the best possibility of reducing variation and improving processes. Understanding the difference between common cause variation and special cause variation helps to identify opportunities for improvement. Common cause variation generally occurs within a process because of its _____?_____ and is predictable; whereas, special cause variation is _____?_____ and entirely unpredictable.

design; unanticipated

PERT

developed primarily to organizing planning and scheduling of complex projects; identifies "critical path"

Forming

dialog centers around the goals for the team and what data needs to be collected; "ground rules" are established

Which of the following would NOT be considered a benefit of flowcharting?

diminished respect and teamwork

Voice of Business (VOB)

draws from financial information and data to identify market weaknesses

When looking at a pie chart of the hospital's budget, Nan learned that all of the following are tied to the number of employees within each department, except:

equipment

Sample selection and size is an important part of Six Sigma project design because samples that are too large may waste resources, whereas samples that are too small may not yield results that are statistically significant; therefore, we need to utilize a formula to determine the appropriate sample size. In this formula, the difference between the sample and the population means can be thought of as a(n) _____?_____.

error (E) and margin of error between the observed sample mean and the true value of the population mean

The prestigious Malcolm Baldrige National Quality Award (MBNQA) honors organizations that demonstrate superior performance in seven categories of performance. Which of the following is not one of the seven categories?

focus on low cost products

CQI tool that identifies the driving and restraining forces of a problem.

force-field analysis

From the Nan: A Six Sigma Mystery book, the Six Sigma management attitude encourages management to do all of the following, except:

forget it

An important aspect of Six Sigma is the recognition of the effects of measurement error on performance metrics; therefore, Six Sigma professionals include the evaluation of measurement error in statistical analysis. Applying the ANOVA, the evaluation of measurement variation is termed:

gauge repeatability and reproducibility (gauge R & R)

The brainstorming process is designed to help each team member feel empowered to contribute to the group effort. The basic framework of the procedures includes all the following EXCEPT:

generate constructive criticism

lean spaghetti diagram

helps establish the optimum layout for workspace based on observations of distances traveled by customers

decision matrix

helps support decisions where several complex alternatives exist; includes rows for weights so that several options

Statistical analysis packages (e.g., SPSS, QI Macros) can help by applying techniques like predictive modeling and data mining. Predictive modeling identifies _____?_____; whereas, data mining identifies _____?_____.

high-risk (high-cost) patients from historical utilization data for earlier preventive care; trends within data that may surpass traditional statistical analysis to target opportunities for improvement

What are purchasers looking for to optimize value (i.e., the value proposition)?

higher quality/lowest cost

Performing

highly productive, problem solving unit that can come to consensus over useful solutions; highly cohesive and

Nan suggested some ideas to Maggie for reducing inadvertent errors within the nurse department such as _________.

implementing individual retraining and hiring a clinic receptionist

Many organizations are aligning incentives with physicians who follow CPG recommendations. In addition, payers like the Centers for Medicare and Medicaid Services (CMS) are beginning to penalize providers for not following recommendations and ending up with "never events." All of the following are "never events" EXCEPT:

informed consent given prior to surgical procedure

four-quadrent matrices

intended to describe product or service lines in an organization in a visually appealing and easily understandable

Performance measures are used for quality improvement, accountability, and research. Examples of situations in which metrics are used for accountability include all the following EXCEPT:

layoffs of employees

This team tool follows a process similar to brainstorming, but the goal is not to increase the number of ideas under consideration but to bring the list under more control. It provides a method for making a long list of alternative ideas more useful by removing duplicates and combining similar ideas.

list reduction and multivoting

six sigma black belts

may operate independently to manage multiple six sigma projects, devote 100% of their time to six sigma initiatives

Failure mode and effects analysis (FMEA)

mean of evaluating a process prospectively to prevent errors before the occur; has become a wildly used tool in

Feasibility

measurement data are easy to collect and identify

Voice of process

most often measured on control charts

Voice of employee

most often measured through surveys

The most common theory in a malpractice case is:

negligence

six sigma yellow belts

not an official six sigma designation; provided basic training in performance improvement with emphasis on six sigma.

Summons and Complaint

notice to the defendant from the court that a legal civil action has been commenced and a judgment will be taken if

AHA

one of the best sources for U.S. hospital information that conducts a yearly survey of hospitals that serves as the

Fill in the blank: In the NEJM article "What is Value in Health Care," the author states: "There is no substitute for measuring actual _____?_____, whose principle purpose is not comparing providers but enabling innovations in care. Without such a feedback loop, providers lack the requisite information for learning and improving."

outcomes

The seven types of waste include:

overproduction, waiting, conveyance, overprocessing, inventory, motion, product defects

The payment system that is characterized by the providers being paid an incentive amount based on their performance on certain quality metrics is called?

pay-for-performance (P4P)

Storming

people are comfortable enough to start disagreeing with one another; strengthens the team to deal with

CMS has put forth a number of measures that are used in its continuing effort to ensure quality care for Medicare and Medicaid beneficiaries. Which one of the following measures for patients aged 18 years and older with stroke and stroke rehabilitation is INCORRECT:

percentage with a diagnosis of ischemic stroke whose time from symptom onset to arrival is less than 6 hours who were considered for t-PA administration.

Timely

prevents customers from experiencing harmful delays in receiving needed diagnostic or therapeutic interventions

Two Institute of Medicine (IOM) studies have demanded provider action about medical errors, clinical quality and patient safety. The first, To Err is Human (1999), emphasized the surprisingly large scale of the ___?___, while the second, Crossing the Quality Chasm, focused more on ___?___.

problems (e.g., medical errors); solutions (e.g., evidence-based guidelines)

L-shaped matrix

produce tables of information that relate two variables to each other; can be use din almost all types of decisions

The techniques used for elimination of mura include:

production leveling, pull production, heijunka

The situations in which teams may be effective include all the following EXCEPT:

projects that must be completed in a very short time

In order for a plaintiff to establish a cause of action alleging negligence, he or she must:

prove four elements (i.e., duty, breach of duty, proximate harm, damages/injuries)

Equitable

provides care that does not vary because of personal characteristics such as gender, ethnicity, geographic location

One way to make bar coding work, as explained by Nan's sister, is to ____

redesign the workspace so it is possible to use them, make it possible to check the screen to see what is being scanned in:, and simplify the correction process

Root-cause analysis (RCA)

represents a "post hoc" approach to evaluating a process deployed in response to a problem or error

efficient

requires maximizing quality and minimizing waste

A subpoena duces tecum differs from a subpoena in that it:

requires the production of documents (e.g., medical records, business records)

In many cases, staff members can be enticed by the lean approach through assurances that "lean" does not equate with "fewer employees" but rather realignment of work and elimination of non-value added work, what we in health care sometimes call "_____?_____."

scut work

a scatter diagram

shows a possible relationship between two variables

From the Nan: A Six Sigma Mystery book, the Japanese follow the belief that if a mistake is made, it is the fault of the ________.

system

kaizen event

the Japanese term for improvement; an organized frame work for implementing lean principles by focusing on

Pearson product-moment correlation coefficient

the commonly used statistical tool that connotes the strength of a linear association between two variable.

Precision

the measure correctly differentiates between different levels of performance or responses

Reliability

the measure is reproducible and consistent

Responsiveness

the measure is sensitive to changes that are important to patients/customers

Validity

the metric measures what it is intended to measure

AHRQ

this government agency maintains the principle clinical practice guideline repository in the U.S.

The Joint Commission (TJC)

this organization provides accreditation to healthcare organizations around the world, require quality improvement

National Committee for quality assurance (NCQA)

this organization was an early adopter of performance metrics for healthcare payers through HEDIS.

takt time

time required for a specific output (specific services)

In the NEJM article "Medical Malpractice," the authors state: "There are three social goals of malpractice litigation..." What one of the following IS NOT one of the three social goals mentioned in the article?

to encourage additional testing during routine health exams

decision tree

uses a graphic representation to model a set of criteria leading to a decision or the consequences of a specific

The tools that can be used for elimination of muda include:

value stream mapping, five S (known in health care as Six S), kanban, poka yoke