7 - Program, Quality, and Care Management - PHN Chapter 26 - Quality Management
ANS: C Traditional quality assurance measures can fit well with the CQI process. The overall goal of specific quality assurance approaches is to monitor the process and outcomes of client care. A utilization review program ensures that care is needed and that the cost is appropriate. Prospective utilization review assesses the necessity of care before the service is provided. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: pp. 580-581
A community health clinic's prospective utilization review program works to ensure which of the following? a. Necessity of care/service and appropriate cost while care is being given b. Necessity of care already received by clients c. Necessity of a care/service before it is given d. Necessity of care before it is given and during the provision of services
ANS: B The general approach to quality improvement protects the public by ensuring an appropriate level of competency among health care professionals. Means of establishing such competency include credentialing, licensure, accreditation, certification, charter, recognition, and conferral of academic degrees. The nurse in this example has obtained voluntary certification as a community health nurse from the professional association, is recognized as a state-licensed RN, and has graduated from an accredited college nursing education program. Cognitive Level: Evaluation Associated Chapter Objective: 6 REF: pp. 574-576
A community health nurse is an American Nurses Credentialing Center--certified registered nurse (RN) with a degree from a National League for Nursing--recognized college of nursing. This nurse can best be described as which of the following? a. Nurse who is nationally certified by an accredited nursing education program b. State-licensed RN who graduated from an accredited nursing education program and obtained professional certification c. State-licensed nurse who completed the certification required for community health nurses from a recognized college d. State-licensed nurse who graduated from an accredited college and is recognized as a community health nurse specialist
ANS: A Model quality assurance and quality improvement programs are comprehensive. To accomplish effective long-term quality improvement in an organization, the program needs to address the structure, process, and outcomes within an organization. The program must include all members of the organization affected by the program. The focus of the program is systems change, not assignment of blame. Cognitive Level: Synthesis Associated Chapter Objective: 6 & 8 REF: p. 582
A community health nurse practitioner has been assigned to revamp the agency's old quality assurance program into a continuous quality improvement (CQI) program. The new program will: a. focus on methods of analysis of the scientific process to look at the structure, process, and outcomes of an organization, with all members of the organization involved in improvement. b. include all members of the organization in problem solving, with a focus on what went wrong and who was responsible for the problem in order to diagnose and fix the problem. c. focus on using external standards and expectations to determine quality measures. d. primarily involve senior management in identifying process improvement opportunities to detect errors and deficiencies.
ANS: A Staff/peer review processes are a specific approach to quality assurance that often use audit tools to determine quality of care. The concurrent audit is an auditing process in which the quality of ongoing care is evaluated by looking at the nursing process. It is often used by Medicare and Medicaid to evaluate the care being received by public health, home health, and hospice clients. A retrospective or outcome audit evaluates quality of care after the discharge of the client. Concurrent audits are time consuming and costly, and cannot provide the total picture of care received. Cognitive Level: Application Associated Chapter Objective: 6 REF: p. 580
A state agency is conducting an audit of all client records at the local hospice to ensure that Medicare criteria for hospice care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: a. concurrent audit. b. outcome audit. c. retrospective audit. d. peer review.
ANS: B Quality assurance has two goals: (1) to ensure the delivery of quality client care and (2) to demonstrate the efforts of health care providers to deliver quality care. CQI is the use of methods of analysis of the scientific process to achieve quality assurance. TQM is a structured management approach to quality assurance. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 579
A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best exemplified by the department's approach is: a. CQI. b. quality assurance. c. risk management. d. TQM.
ANS: A Efforts to strengthen nursing practice in the community have been carried out by several nursing organizations. These include the American Nurses Association, Public Health Nursing Section of the American Public Health Association, Association of State and Territorial Directors of Nursing, and ACHNE, collectively known as the Quad Council for Public Health Nursing. In 2007, the Quad Council reviewed the scope and standards of practice for population-focused (public health), community health, and community-based nursing practice and developed new standards to guide the profession. The major area of concern of ACHNE is the quality of nursing education in preparing nursing students for practice in the community. ACHNE has identified the curriculum content required for the preparation of community health nurses. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: pp. 573-574
Nursing practice in the community has been strengthened through the efforts of professional nursing organizations such as the Quad Council for Public Health Nursing and the Association of Community Health Nursing Educators (ACHNE) to advance the community and public health: a. scope/standards of practice and nursing education curriculum. b. practice guideline clearinghouse, and quality indices. c. voluntary credentialing and mandatory licensing programs. d. mandatory accreditation and certification programs.
ANS: B Deming identified 15 guidelines for ensuring quality using a TQM approach. One major guideline is to drive out fear and create trust, which, in turn, fosters innovation. This allows the organization to integrate quality into the culture "every day in every way." It ensures that employees integrate continuous process improvement to enhance outcomes, productivity, and customer/employer satisfaction. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: pp. 576-577
One specific approach to quality assurance is TQM. A district public health department has adopted this approach and gives much attention to ensuring that studies are used to improve processes, eliminate management by objectives, and promote self-empowerment. The major TQM guideline that summarizes the department's effort is: a. create, publish, and disseminate aims and purposes. b. drive out fear and create trust. c. eliminate barriers to pride of work/performance. d. understand the purpose of inspection.
ANS: A The Omaha system is a comprehensive method for evaluating client care. The components are a classification system for assessing and categorizing client problems, a database, a nursing problem list, and anticipated outcome criteria for the classified problems. This system has the potential to improve the delivery of nursing care, documentation, and the descriptions of client care in a way that will enhance nursing assessment, planning, implementation, and evaluation of client care and will allow the collection of more pertinent client information (relevant, consistent, and measurable) to ensure more effective and efficient communications and improved nurse productivity. Cognitive Level: Application Associated Chapter Objective: 9 & 10 REF: p. 588
The Omaha system is a client classification system developed by the Visiting Nurse Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: a. improving the description of care. b. minimizing the assessment required. c. predicting the outcome. d. decreasing the communication needs.
ANS: D, E Records provide complete information about the client, indicate the extent and quality of services provided, resolve legal issues in malpractice suits, and provide information for education and research. Cognitive Level: Analysis Associated Chapter Objective: 9 REF: p. 587
The purpose of record keeping by a community health agency is to maintain complete information on clients served and the extent and quality of services provided to these clients. Other important uses of these records may include which of the following? (Select all that apply.) a. Determine performance raises for staff b. Explain cost overruns c. Foster independence in clinical practice d. Provide information for education and research e. Resolve legal matters in malpractice suits
ANS: C Organizational structure can support or restrain effective quality improvement programs. The optimal organizational structure for a successful TQM/CQI program is a flat organizational structure with few supervisors between staff and directors. Multidisciplinary teams are optimal because they ensure a broader perspective in problem solving. The presence of a separate but parallel management quality council that monitors quality improvement strategies and implementation helps ensure that quality improvement team strategies are implemented and outcomes are tracked. Teams are empowered to solve problems and identify opportunities for system improvement. Cognitive Level: Analysis Associated Chapter Objective: 1 & 6 REF: p. 577
Total quality management (TQM) works best in organizations with which of the following characteristics? a. Belief that strategies proven effective in the past should be continued, unless long-term data supports change b. Flat organizational structure with supervisor-headed and -supported teams, and combined quality control management c. Flat organizational structure with a multidisciplinary team approach and a separate management for quality control d. Multilevel hierarchy and teams headed by supervisors
