phha 430 final
You are meeting a group of new associates joining your well-managed HCO. You show them the mission on the HCO's website and say, "Our mission is very real to us. It's..."
"...a public declaration of intentions—why we're here."
Pursuing the nurse's complaint in the previous question, you look up the lab's patient waiting time results and goals on its scorecard. It's not there, but patient satisfaction is lower than nursing or most other CSS. You talk to the lab manager, who says that delays happen sometimes, and they're not avoidable. He adds that the EHR records arrival and service times by patient.
You complete the actions described in option b and thank the nurse manager for identifying an OFI.
You're the nonclinical service line administrator for a group of nursing units. You monitor the clinical results by scanning the scorecards for goal achievement in outcomes quality, HCAHPS, NDNQI, cost, turnover, and associate satisfaction.
You review the whole scorecard with the nurse managers of each unit.
Orienting a group of new associates on the HCO's values, you want them to take away all of the following points. Which one should you start with?
The values make the HCO a great place to give care.
You're an intern at a high-performing HCO with a community health mission. Your preceptor says, "We're about to start our annual review process. We need to put together the book for the board retreat. Here's last year's. Look it over. It was organized into 'Customers/Market,' 'Med Staff and Associates,' 'Insurance Trends,' and 'Financials.' I wonder if we can organize it better?" You think about it and look back at exhibit 3.2. It's clear this isn't an amateur effort, so you'll start with something like, "Last year's arrangement was certainly strong. Do you think we should add a section about..."
"...community health needs?"
You're starting a campaign to "brand" your ACO, population health mission, and community health coalition. A professional promotional firm will help you. They ask you for a central theme statement. Which of the following is best? "Our new ACO will..."
"...expand our award-winning, high-quality, patient-sensitive care. We're proud to be part of a community-wide effort toward good health."
A trustee says, "We're asked to invest big sums of money based on forecasts of demand. How do we know those forecasts are accurate?" You reply, "That's a great question. We use a sophisticated planning model that..." What's your strongest point?
"...has a good track record, not just here but among other clients."
Orienting a group of new patient care assistants, you explain that functional protocols or "standard work"...
"...help us guard against errors and omissions. You can always access the protocol, and sometimes a video, on our computers."
As you start your internship at North Mississippi Health Services (NMHS), you know that they emphasize "service excellence" (see exhibit 2.2). Your preceptor asks, "Do you know why this is important?" Your best reply is, "It's because..."
"...it shows that, if all the parts of NMHS support each other, we will thrive."
The CIO comments in a senior leadership meeting, "We're implementing best practice from Memorial Sugar Land (see exhibit 10.5). It does not address disaster planning, though. I'd like to form a PIT to consider implications of long-term power loss, protection of data against theft, how to coordinate transfer of data if patients must be moved and our system is down, and issues like that." The COO says, "Sure, but..."
"...maybe we should dedicate a senior leadership meeting to thinking through the charge."
You're recruiting a physician to join your HCO. She says, "The story you tell, of what you call empowerment and continuous improvement, sounds good, and I contacted some people I know on your clinical staff. They say very complimentary things, that your HCO delivers, and they like practicing there. My concern is this: I'm making basically a lifetime commitment. How do I know the HCO will continue to be cutting-edge?" You begin, "Well, nobody can foresee the future, but..." What's the best way to complete the sentence?
"...our record is our best argument. We've got growing market share, delighted patients, and enthusiastic associates."
In your internship, one of the younger people on the senior leadership team reflects, "You know that, when you're a leader, any associate or patient comment should get a constructive response. When I started, I had a lot of trouble understanding what 'constructive response' means. What do you think that term means?" You reply, "I think it means..."
"...solving the problem raised if you can and accepting it as an OFI if you can't."
A curious associate asks, "Who owns our HCO?" It's a nonreligious not-for-profit that is a subsidiary of a larger system with many HCOs (like Sharp, Henry Ford, or Sutter Health). You respond, "The individual HCOs are owned by..."
"...the communities they serve."
The therapist in the previous question continues: "What if I think an order for a patient might be wrong—not harmful, but incomplete, or a little off base? What should I do?" You reply: "If it's harmful, of course, never do it. If it's not..."
"...you should try to reach the attending to revise the order. If you can't, you decide what's best for the patient. You might check with your manager."
Your preceptor says, "When I started out, it was 'command and control.' Somebody, usually a doctor, gave an order, and everybody was supposed to jump. Now it's 'encourage, reward, and celebrate.' Does that work as well?" You respond:
"Actually, when it's combined with benchmarks and continuous improvement, it works better than command and control."
An orthopedist on staff says, "My residency hospital in the Intermountain system used some patient recovery measures that aren't on my unit's scorecard. They were helpful, because they focused on improving function." You reply:
"Can you explain them to me? I'll check the literature and draft a proposal for your review. It will have to be reviewed by orthopedics and the KM planning committee."
You've been working for two years at an HCO that works hard at maintaining an environment where all associates are empowered and motivated to meet their customers' needs. A woman you knew in college moves to town. She's now an experienced baccalaureate-prepared nurse, and she asks if she should apply to your HCO or a competitor. You say:
"Come here. It's a great place to give care. I can introduce you to several nurses I know you'll like."
You want to describe evidence-based management (EBM) to a group of civic leaders. Which of the following would you start with?
"EBM replaces authority and opinion with fact."
The board is reviewing the recommendations of the Clinical Staff Executive Committee, which has advised that a certain internist not be reappointed. Ms. Jones, a trustee, says, "Gee, he's my physician!" A physician trustee says, "We have followed procedures in the bylaws related to impairment (substance abuse), and we have an obligation to protect our patients." The CEO looks at the chair, who looks stunned. The CEO says:
"Gee, that's unfortunate. Ms. Jones may need to recuse herself from the discussion and vote. We all need to remember that these discussions are strictly confidential."
Serena Smart, a leader of the African American community, accepts nomination to your governing board. Of course, senior leadership briefs her on how the board works. "Tell me more about the governance committee," she says. "It's a concept I haven't encountered before." Your reply begins:
"It's worked well for us. It systematically monitors board activity, identifies OFIs, and applies continuous improvement to board activities."
In your HCO fellowship, you meet on a biweekly basis with the CEO. Today, she says, "I'm off to a meeting of the board nominating/governance committee. It will be a while before you get to go to one; they are very confidential. But tell me what I should be looking for at the meeting. How do I monitor the committee's functioning?" You reply:
"I think I'd work off exhibit 4.3. Could we make a checklist of how well the board is doing on the ten items and use it as a survey?"
On rounds, the OR supervisor motions you into her office and closes the door. "Yesterday, Dr. Smith showed up late for his afternoon case. I don't know how to put it. The operation went okay, but he dropped some instruments on the floor, and the assistant did a lot of the work. But afterwards, the scrub nurse said she smelled alcohol on his breath." You reply: "Thanks for bringing this up. I know it's tough..."
"I think the chair of the Department of Surgery needs to be notified as soon as possible. Let's call her right now."
You're on a team of senior managers preparing the annual planning data for the board retreat, step 1 of exhibit 3.7. One of the team members says, "Our quality and satisfaction will look good, but our costs don't. I think we should say that the cost benchmarks are not realistic for places like us." Pick the single best reply.
"I think we're obligated to report all the facts, maybe especially the unpleasant ones."
A registered nurse on the HCO's staff says, "The patient care assistant, Mary Smith, doesn't seem to know what she's doing. She takes forever. Yesterday, she took 30 minutes to change an empty bed." The nurse's immediate supervisor should reply:
"I will observe her and see if we can get some better results. Keep me posted."
Your interview at Memorial Hermann has gone well. As the day draws to a close, a member of the search committee asks, "What are you looking for from us? What do you think Hermann can offer you?" You respond:
"I'd like a chance to learn by doing, with guidance from people who know best practice. I hope I can win promotion. I'd like a plan for my personal development. If my partner can get a position where we live, Hermann is my first choice."
A young patient care assistant, Sally Jones, tells her nurse manager, "Dr. Baker asked me to meet him for a drink in his office after work. When I said no, he said, "I can make life a lot better for you." The nurse manager should reply:
"I'll call Human Resources for you. They will want you to meet with a counselor. What you say will be confidential, and it won't be used against you."
At many excellent HCOs, the CEO reviews the mission with all new hires. When you're hired as a young manager, you attend with all the other hires. At the coffee break, you hear one new hire say, "The boss really put emphasis on the mission and stuff. I wonder if he really means it." What is your best comment?
"I'm pretty sure he does. You could ask coworkers on your team."
A few days after the systemwide planning retreat (May-Aug., #4, in exhibit 3.7), a first-line manager says to a rounding senior manager, "The PIC did not fund any of our OFIs. I don't think we can improve any scorecard goals next year." What is the best response?
"I'm sorry. Can you and I meet with your manager, to plan what to do?"
Your aunt Sarah, who lives in another city, is selecting a care provider. She says, "I've looked up two cardiologists in my insurance panel. Each is privileged at a different hospital. Does the hospital make any difference?" You reply: "It might make a difference. I'll look up the record of each on WhyNotTheBest.org..."
"If you go to one that takes quality seriously, you'll know not only that your cardiologist is competent but also that other specialists you might need are competent."
Meeting with a small group of newly hired therapists, you tell them the HCO is committed to excellence and gets there through continuous improvement, with measures, benchmarks, OFIs, PITs, and goals. One of the therapists asks, "What does that mean for therapists?" You reply:
"It means doing your best job with every patient, helping meet your team's scorecard goals, following protocols, and speaking up when you see an OFI."
The PIT (from the previous question) is formed, and extensive discussions occur in and around it. Several of the radiologists now approach the HCO with a proposal to purchase equipment for advanced computer-aided mammography. (See Zhang and Xiao, "Diagnostic Value of Nineteen Different Imaging Methods for Patients with Breast Cancer: A Network Meta-Analysis," Cellular Physiology & Biochemistry 46 (5): 2041-55, 2018.) The COO asks your opinion. You reply:
"It's complicated, and probably high risk, but we ought to negotiate. "
During rounding, a recently employed nurse says he is happy to be here, but at Mass General, the nursing care plans for his service were more thorough. The nurses took several steps that his colleagues here don't always do. The CNO replies:
"It's great you worked at Mass General. Could you discuss the differences in our practice council?"
At a senior leadership meeting, the COO says, "We need to know how to make nursing more effective. What can we do collectively to improve nursing unit scorecards?" The CNO replies, "I'm not sure what we could do collectively. I think the only way to improve our scores is to work in each service line, which we're doing." What should the COO say next?
"Let's form a small PIT to check for new options. We could look over the OFIs collectively, to see if they share any themes."
Newcomers are often impressed at the complexity of the measurement system for individual work teams (see exhibits 3.3, 3.4, and 3.5). Explaining the measures to them, which of the following statements is least useful?
"Many of the measures are reported by Medicare."
While you're lunching with a group of young nurses, one of them says, "On my unit, we seem to have had an increase in catheter-associated urinary tract infections (CAUTIs), but the rate on monthly report does not show it. My nurse manager says not to worry about it. Do you think she's right?" You respond:
"Maybe not. Do you have any idea why it's changing?"
Rounding in the doctors' lounge, you hear Sam, an older physician, say, "I don't understand this Magnet nursing stuff. I guess it's just a recruitment gimmick." A younger doctor, Jane, replies, "Well, nursing has a big role." She's interrupted by George, who says, "Nursing's got too big for itself. There's no such thing as a nursing diagnosis." You might just let them ventilate, but if you join in, what is your best line?
"Nursing makes a proven contribution to shorter stays, better recovery, and better patient satisfaction."
Your HCO is part of a large not-for-profit system. You are recruiting a prominent local citizen to join the local governing board. "Let's be candid," the citizen says. "This is just an honorific post. All the real decisions are made by your corporate office." "I'm glad you brought that up," you reply. "Our system wants strong local input. The central office expects its local boards to initiate all local actions." You continue:
"Our system wants local board members who will help us achieve our mission here in this community. It's a working board, about a day a month of your time."
The board is considering changing from an excellence-in-care mission to a population health mission. One member says, "Why should we do this? We will be jack of all trades, master of none." The CEO should say: "Our scorecard shows we are masters of acute care..."
"Population health will help control health insurance costs. We think we can move toward it without endangering our care."
A colleague at the HCO where you are a manager says, "Rounding takes a lot of time. I wonder why the senior leadership team wants us to spend five hours a week at it." You think before you answer, and conclude that your strongest response is:
"Rounding encourages workers and first-line managers to raise questions and get answers."
Your internship preceptor asks, "I want to know if we have everything we need in our knowledge management system. Do you think you could start a review? You reply:
"Sure, I'd start with the Poudre Valley summary in my textbook from class."
On rounds with the nursing supervisor, a nurse manager says, "We've had a lot of problems with laundry. Deliveries are coming too late for our bed changing, and it's complicating our day." What's your best response?
"Tell me more about that. Is this a recent problem? What time does the linen arrive, and what time do you need it?"
A nurse manager complains to a rounding senior leader: "My mom had to wait an hour in the lab yesterday to get her blood drawn, and I could have done it for her. The lab is always behind. Why can't they keep up?" The senior leader might reply, "Gee, I'm sorry to hear that..."
"That sounds like an OFI. I'll look into it and keep you posted. How is your mom now?"
As a fellow in a high-performing HCO, you often take time for coffee with the house officers and younger nurses. One of them comments, "Our electronic health record (EHR) is a pain. It's too slow, too complicated." When you reply, "Really?," she says, "It's hard to find critical parts of the history. I was looking for patient advocate and advance directives yesterday, and it took forever." Which of the following should start your reply?
"That sounds like an OFI. I'll see what Info Services says and get back to you."
As an administrative fellow, you are rounding with the CMO, visiting an office of primary care practitioners. The leader of the group complains that committees take a lot of time. She'd like the HCO to pay for the time. You know that the CMO should answer:
"That's not easy to do, but I think we should set up a PIT to consider it."
Several members of your radiology group are in independent practices specializing in mammograms. As the literature reports, the 2009 recommendations of the US Preventive Services Task Force, which cut the recommended frequency of examinations in half, had virtually no impact on their practice. (The recommendations were opposed by the American Cancer Society, the American College of Radiology, and the American College of Obstetricians and Gynecologists.) Now, however, several healthcare insurers drop coverage to the USPSTF level. A radiologist friend of yours asks, "What is the HCO's obligation to help us out?" You reply:
"The HCO could set up a PIT to discuss it. We could limit recruitment of radiologists if the PIT recommends it."
Your HCO's population health strategy is just beginning, but it is going well. Dr. S., a high-volume surgeon, says, "This ACO and community health stuff is a serious mistake. It will reduce the HCO's revenue, eliminate profits, and keep us from maintaining state-of-the-art critical care, which is our real mission." His views are quickly noticed by the board, which asks senior management for a response. The response should be:
"The board reviewed our forecasts of volumes and finances with and without our ACO strategy. They showed that the HCO will continue to generate cash for new technology. We will review these with Dr. S."
You're on the search committee to replace the CIO at a high-performing HCO. The leading candidate asks you, "How can I be sure that your HCO will provide adequate capital investment funds?" You reply:
"The board's policy is (state what the policy is—so much per year earmarked for IT or to judge IT requests with all capital needs). Here's our record in recent years."
As fellow at an HCO like Charleston Area Medical Center, you spend a month with the chief medical officer. She says, "There's a big rhubarb in anesthesia. The anesthesiologists limited the nurse anesthetists (CRNAs) from certain procedures, and now the CRNAs are threatening to strike. I think there are attitude problems, too; some of the older anesthesiologists are quick with the put-downs. What do you think I should do?" You respond, "Let's form a PIT." You go on:
"The charge should be addressing expressed concerns of the CRNAs."
A newly hired nurse wants to know, "What if our nursing care plan conflicts with the clinical management protocol? What if the patient needs something unique that's not in the protocol?" Which of the following do you include in your response?
"The need should be brought up during rounds and the decision entered in the IPOC. If it's recurring, bring it up at your practice council."
You're part of the strategy team at a small NFP HCO with a strong patient-care mission. The question of joining are large system comes up. One of the senior managers asks you, "Just in general, why might we do that?" You reply, "I think the most important reason might be..."
"The system will help us do a better job of supporting patient care."
You're on a PIT that's charged to improve your HCO's strategic scorecard (exhibits 3.3 and 3.5), and a number of additions and deletions have been suggested. It's clear that the PIT will need some criteria for deciding what to include. What will you emphasize when you explain the charge to them?
"The underlying criterion is the sense of importance to mission."
WMHO defines stakeholders as having "a direct interest in an organization's success." A PIT studying a not-for-profit HCO's mission wants to know, "Are some stakeholders more important than others? Can we give priority to the interests of some group of stakeholders at the expense of others shown in exhibit 1.3?" You reply:
"They all have equal rights. If their 'direct interests' are not met, any stakeholder group can close us down."
A new member of the board quality committee wants to know more about "standard work"—that is, functional protocols. You say, "They are guidelines for clinical procedures, like hand-washing and catheterization." You continue:
"They standardize practice to ensure consistent safety and effectiveness."
In midyear, a first-line manager says to a rounding senior manager, "We're not making a couple of our goals for this year." What is the best response?
"We can bring in a team to help you out and make a 90-day plan for recovery. Can you and I meet with your manager, to plan what to do?"
The new urology medical director says, "The trend to fewer prostatectomies is hurting some of our doctors' income. Can we do anything about that?" You reply, "Maybe. We can use our planning model to forecast the number of urology procedures each year, by procedure." You continue:
"We can present the forecasts to the urologists and follow up with a survey of practice intentions. If it shows an oversupply, we can recommend to the board that we close the service to new members."
You are addressing a group of newly hired associates. You will mention all of the following points to help them understand the HCO's continuous improvement philosophy. What's the most critical takeaway?
"We deliver on our promises—that is, we set realistic goals and meet them."
At an associate forum, one associate asks if the HCO can add free parking as an employment benefit. You reply:
"We try to add benefits that are useful to a large number of employees and don't give an advantage to some employees. Many employees car-pool or use public transportation."
The new director of the orthopedics service line says, "Our post-op complications are higher than they could be—can you help me deal with these?" You reply, "Absolutely," and continue...
"We use PITs to work on problems like this. You know how it works; you've served on several."
Your community's population health council was formed as a voluntary association. It has no corporate status, but it has made significant progress, establishing a set of measurable goals and a strategy for each. One goal, "Coordinate our FQHCs, HCOs, and ACOs to provide appropriate care for all citizens," will be measured by hospitalization rates of ambulatory care-sensitive diseases and a household survey administered by the local health department. At the council meeting, the chair, who is the county public health officer, proposes that all three of the county's HCOs meet to discuss how to serve the entire city with ACOs. As the representative of one HCO, you reply:
"We welcome such a discussion. To make sure we're complying with the law, I'll ask our HCO's general counsel to confer with you."
The chief of your new and highly successful ACO says, "Prescription drug costs for some of our outpatients can bankrupt them. They don't fill their scrips, and then they turn up in the ED, where we either get Medicaid or write it off. Can we set up a PIT to find the best solution?" "Sure, doctor," you reply...
"What's your thinking about membership? It sounds like pharmacy, social service, and accounting should be involved."
You give a public talk on your HCO's achievements at the local community college. In the Q&A, a lady asks, "I've heard the electronic records are not really safe, but you said they were a big success. How can we be sure our information is protected?" "I understand your concern," you reply. You continue:
"Whether they are paper or electronic, patient records are subject to various risks. We meet or surpass national privacy standards. Outside auditors have given us a high score. We've met all the auditors' recommendations."
A clinical staff member says he thinks a guideline should be changed. The nurse manager should reply:
"Why? You'll have to explain why to the service line chief, but maybe I can help."
Your lunch friends—young nurses and doctors—complain steadily about the EHR. "Takes forever" and "can't find" are common threads. You should:
Find out if there are EHR OFIs about speed and search, and report back to your friends.
Interviewing for a position at Sharp Healthcare, you are asked, "Are you familiar with our 12 Behavior Standards? We want all our managers, even our beginners, to exemplify them. Do you think you can do that?" Which is the best response?
"Yes, of course. I studied them with my class at __________. I especially like 'All For One, One For All'" (or any other one that you remember).
A registered nurse on the HCO's staff says, "These checklists are nothing but a pain. It takes time to enter them into the record, and they almost never help the patient." His nursing manager should reply:
"Yes, they do take a few minutes, but they prevent really serious problems."
The board is reviewing the strategic scorecard, which is modeled on exhibit 3.4. A member asks, "There are three yellows—weren't they there last month?" The COO, who is a guest at the meeting, gets a nod from the chair. He says.
"Yes, we've instituted 90-day plans for all three." He then briefly summarizes progress and identifies any difficulty that might lead to year end failure.
Your HCO has offered free screening for all comers at health fairs, county fairs, and similar events, with weight and body mass index, blood pressure, diabetes, prostatic cancers, and cholesterol. The health department representative on the newly formed community population health committee says, "That's not population health; it's care promotion. It raises community health costs without noticeably impacting disease. You should redesign the program, drop several of those tests, and make the rest age and sex specific." What is your response?
"You might be right. It will take some study, but let's work out a stronger offering."
You are staffing a PIT to implement an accountable care organization. The PIT's initial list of criteria for success include team care, emphasizing clinical support service professionals; holistic care plans; community support; and an outcomes-oriented scorecard. You consider proposing...
...adding palliative and end-of-life care, because it's a critical element for many patients
Your CEO asks you how to evaluate progress of the local community health group. You say that an effective group should...
...establish quantitative goals for incidence and prevalence of preventable disease
You are orienting a group of newly appointed first-line managers. The takeaway you want them to remember most is that the HCO's not-for-profit governing board...
...is legally responsible for ensuring the quality of care and must monitor quality of care to maintain accreditation.
You're explaining your HCO's approach to a new attending physician. You want to be sure she understands that...
...the attending physician leads the care team that applies evidence-based guidelines to each patient's needs.
Your HCO has several clinical services, and a record of improvement on quality, patient satisfaction, and associate satisfaction in most of them. One service is lagging. Guidelines are not routinely used, and the clinicians argue over guidelines. Outcomes quality and patient satisfaction are the lowest in the HCO, although still better than national medians. Senior leadership debates, and decides...
...to form a PIT of clinicians in the service, chaired by the chief of a similar service with top or near top scores on all the unit scorecard dimensions.
In your fellowship at a high-performing HCO, the CIO asks, "Is our communication to associates what it should be? Ideally, every associate should know all the general policies related to their job. How could we identify communications OFIs? Give me your thoughts on that, to help me decide whether we should do a more extensive review." You go back to your office and start a list of ways to assess HCO-to-associate communication. Your initial thoughts include the following options: 1—Every PIT could report to KM planning on what they feel are communication OFIs.2—Add questions to the employee satisfaction survey. 3—Study unexpected-event reports to identify cases where communication failed.4—Offer all intranet users a voluntary follow-up survey, "Was this the info you needed?"5—Ask senior management to ask first-line managers on rounds, "What do associates not know but should?"6—Ask for comments in exit interviews of voluntary terminations.Now report the three best back to the CIO. Which do you choose?
1,3, and 5
You are interviewing for an HCO CEO position, and a search committee member asks, "What kinds of reports should the board receive?" You reply, "The board should receive several items at every meeting." Which of the following should be your list?
A "state of the HCO" report by the CEO; the strategic scorecard; any new accreditation, regulations, or legal actions; any changes in clinical staff appointments or bylaws
A couple years after your fellowship at a high-performing HCO, you are offered a seat on the knowledge management planning committee. You accept, knowing that it's a growth opportunity for you personally because the committee...
All of the above
A new board member asks, "How do we know that the board is doing a good job?" You reply, "Good question! The answer isn't easy, but there are several important indicators..."
All of the above
A promising young associate, just promoted to first-line leadership, asks you, "Can you list a few skills I should think about and work on to become a really good transformational leader?" You begin your reply, "I think these are what you should emphasize." Which skills do you include in your list?
All of the above
A trustee says, "You have said that the right diagnosis is critical. How does the HCO help its clinicians make good diagnoses?" You reply, "Our HCO does several things to support reaching the right diagnosis quickly on every patient, including..."
All of the above
As an administrative resident at a Baldrige-winning healthcare system, you report to the COO. She says, "Let's improve improvement. Where do we look for OFIs in our goal-setting and continuous improvement programs?" You reply, "Well, we could..."
All of the above
At your interview to get employed as a manager at Atlanticare, the interviewer presses you. "You've said you admire Atlanticare's worker empowerment. What do our leaders need to do to make sure worker enthusiasm actually improves mission achievement?" You answer: "Leaders need to make sure..."
All of the above
Excellence is defined as "safe, effective, patient-centered, timely, efficient, and equitable." A new associate asks you why "safe" is first. You reply:
All of the above
In a discussion about the ACO, a new trustee asks, "How do nurses impact readmissions and success measures for the ACO?" The CNO should reply, noting:
All of the above
Responsive or "servant" leadership emphasizes listening. Explain to your BFF or your mom why listening by managers at all levels is important.
All of the above
At a PIT discussing improving hospital-initiated infection rates, somebody says, "We have the right protocols. What are the tools we have to improve compliance?" Your reply should address which of the following?
Training, reward, reminders
After several years of strenuous effort, nurse retention is now 90 percent across every unit, and 95 percent in two units. Senior leadership debates what to do about it. Several ideas are proposed, and the CEO asks you which you think should be pursued. You choose:
Both b and c
Your HCO has had a contract with a group of radiologists that expires in nine months. You prepare for negotiations by listing the five most important things to the HCO in the relationship. Safe, effective, and timely care comes first, followed by what?
Continuous improvement, patient satisfaction, credentialed practitioner satisfaction, low cost
As the intern in a large HCO, you are alone in an elevator until two patient care techs and two guests enter. The PCAs are talking about "Ms. Jones," who apparently has some complication to her surgery. As you hear them, you decide:
To tap one on the shoulder and point to a sign that says, "Do not discuss patient matters in public"
Attending a meeting of your HCO's primary care physicians, you hear a lot of complaints. "The EHR's a pain"; "I can't spend the time I should with patients"; "You have to check every box, 'No, this man is not pregnant. Yes, this 80 year old has arthritis. It's a waste of time.'" You decide:
To ask the practitioners if they would serve on a PIT to make the EHR less obtrusive
You staff your HCO's credentialing committee. At a meeting, you hear one older member grumble to another, "Credentialing these nurse practitioners is stupid. They are not as good as doctors, and they cut into our income." What is your response?
Discuss the comment with the chair, encouraging the chair to take a few minutes to reinforce why the HCO needs and credentials nurse practitioners and other nonphysician LIPs.
All of the following statements about empowerment are true. Select the one most important to convey to associates.
Empowerment gives an associate the ability to control his or her work situation in ways consistent with the mission and values.
As fellow, you take your regular rotation on call for senior leadership. One evening, a trustee calls, very upset. He's in your emergency department. His elderly mother has been in the ED for two hours, and nothing seems to be happening. He'd like your help to get her admitted. You go to ED, where the physician managing her case reports that she's been examined and diagnosed, and will be admitted. She's waiting for an appropriate inpatient bed. You thank the emergency physician, and together you explain to the trustee. You call the CEO to alert her. What else should you do?
Go to the floor where the patient will be admitted. Ask the floor charge nurse what the plan is and when a room will be available. Report that back to the trustee.
There's an undercurrent of dissatisfaction with the nursing scheduling system. Senior leadership decides it's an OFI. You will staff a PIT. What's your plan?
Identify by unit the number of shifts where staffing was below standard, at standard, and above standard, and recover comments about scheduling in nursing personnel satisfaction surveys. Review this with the PIT's chair before the first meeting.
In several questions in this quiz, a nurse manager encounters realistic situations and can make some serious errors. How does an excellent HCO make sure he answers correctly?
It trains him, gives him a coach with more seniority, and rounds so that he and his staff can approach senior management directly.
Your ACO is going well, but the primary care chief, who provides critical leadership, decides to retire. The replacement in your succession plan, Dr. A., will be interim chief, but she declines the permanent post, saying she needs to get her kids out of high school, another two years. The senior management team is debating what to do next. What do you recommend?
Meet with the current chief, and Dr. A., to see how to make the job manageable for Dr. A.
Reviewing the scorecards of the clinical support services (CSS) you manage, you know they have several opportunities to increase appropriate demand. Which of the following would you not recommend as a way to increase volume and cut unit cost?
Offering a discount to patients of high-volume attendings
Community health needs assessments (CHNA) are required of all 501c3 hospitals at three-year intervals under the Affordable Care Act (see www.irs.gov/charities-non-profits/charitable-organizations/new-requirements-for-501c3-hospitals-under-the-affordable-care-act). You are preparing the CHNA for your HCO. Following the spirit of the law, you assemble the HCO's demand forecasts for preventable chronic disease and post-acute services. Your assessment should also include information about:
Relations with other agencies committed to community health, and local plans to address health disparities
The senior leadership council is debating a proposal to modify the mission to include population health. The COO notes that, although quality measures are generally well above median, two small service lines have important OFIs. "Should we fix those first?" she asks. In the discussion that follows, you suggest, "We should move forward with population health." You continue:
So long as the work on population health and support for those services don't conflict."
Your membership checklist for a population health advocacy group includes the following: • Local and state health departments • Competing HCOs and the county medical society • K-12 schools, police, and social services departments • United Way, chamber of commerce, and local business groups • Local religious leaders • Disease-specific support groups, such as the cancer society and arthritis foundation The COO says it's unmanageably long. Now what?
Suggest that the HCO start by building support with the health departments, competitors, and the medical society, with plans to expand around that core.
You are part of the staff of the large PIT that has just begun a deliberate effort to reduce readmissions. Checking IHI.org, you note that they have a number of documents on the subject (www.ihi.org/explore/Readmissions/Pages/default.aspx). After reading the supporting documents, how should you proceed?
Talk with the PIT chair about the IHI work and how to use it.
Why is a values statement important? Like the mission, many associates will assume that it's window dressing. What does leadership need to say? "We're serious about our values, and they are important because..."
all of the above
