Pharmacy Practice Management Exam #2

Describe in depth Covey habit 2:

MANAGING PRIORITIES: 1. Quadrant 1: -Important/Urgent e.g. crises pressing problems deadline-driven projects 2. Quadrant 2: -Important/Non-urgent e.g. preparation/planning leisure time relationship building empowerment 3. Quadrant 3: -Not Important/Urgent e.g. interruptions some phone calls some meetings 4. Quadrant 4: -Not Important/Non-urgent e.g. trivia, busywork some phone calls irrelevant mail excessive TV

Describe the Law of the Slight Edge

"The slight edge is about doing simple things consistently over time." "Small changes over time make a big difference" process of continual improvement 3-4 weeks to make a habit?

What is the Peter Principle?

"in a hierarachy, every employee rises to his/her level of incompetence" - keep getting promoted until they are incompetent, just because someone has technical skills does not mean they are competent as a supvervisor or manager

Describe Organizational culture

1. "The system of shared meanings held by members that distinguishes one organization from another" 2. "How things are done around here" - norms Affects climate (psychological atmosphere of the organization)

Describe RCA of medication errors

1. Analytically identifies critical underlying reasons for the occurrence of an adverse event or close call (near miss) 2. Any event has multiple root causes 3. Can be applied to one event or a series of events 4. Involves: - Presenting data clearly - Generating practical recommendations - Implementing appropriate corrective action - Establishing systemic controls to avoid recurrence

What are 3 Newer Approaches to Organizational Design?

1. Contingency Approach—Five Forms -do not have to know for exam 2. Boundaryless Organization 3. Organizational Teams -Teams versus workgroups

Why do FMEA?

1. FMEA proactively identifies ways in which products or processes can fail, why they might fail, how they can be made safer 2. The Joint Commission requires a proactive risk assessment tool and many organizations have chosen FMEA

What are a pharmacy manager's "two hats"?

1. Functional specialist (e.g. unique to pharmacy) -based on your skills as a pharmacist 2. Managerial generalist (e.g. general management) -must have working knowledge of management and how to deal with people

What are four theory Y assumptions?

1. The expenditure of physical and mental effort in work is as natural as play or rest, if the conditions are favorable. 2. The average person learns, under proper conditions not only to accept, but to seek responsibility. 3. Self-control is often indispensable in achieving organizational goals/objectives. 4. Commitment to objectives is a function of the rewards associated with their achievement.

1. The action statement should be _____ and ______. 2. Actions should be ______ and _______, not ________ and ________.

1. specific and concrete 2. Actions should be permanent and physical, not temporary and procedural

Root Cause Analysis is used _____ (before, after) a problem

AFTER (de facto)

What is the history of FMEA?

Begun in the 1940s by the U.S. military, FMEA was further developed by the aerospace and automotive industries. Several industries maintain formal FMEA standards i.e.Healthcare

According to the DHHS the # 1 root cause of medical errors is ___________

COMMUNICATION FAILURES!

Describe Clinical Leadership Skills

Communication among colleagues Develop project plan Advocate Lead team Evaluate program Collect data Implement pilot program Gain interdisciplinary support Sell in terms of cost, quality, service, and outcomes

How can you prevent errors from being accidents?

Designing Error Traps Can Prevent Errors From Becoming Accidents

Describe General Leadership Skills

Time management Organization Persuasion Influencing change Team building Public speaking and presenting Communication Coaching Teaching Mentoring Decision making

Describe what is meant by "Clash of Cultures"

corporate culture e.g. nonpharmacists in upper level management positions for pharmacy which clashes because they can't understand pharmacy to evaluate your performance and other things so they usually rely on assessing you by your technical skills e.g. filling prescriptions

Describe Carousel Inventory System

feeds the automated dispensing machine

What does Covey say about priorities for Covey habit 2?

"Don't prioritize your schedule, schedule your priorities" - Covey

What is the premise for theory X/Y?

"Most managers do what they do for/to workers because of what they believe about workers."

What kind of questions does an RCA for medication errors answer?

- What happened? - Why did it happen? - What usually happens? - What should have happened according to policies and procedures? - What will prevent it from happening again? - What actions need to be taken? - How will outcomes be measured?

How are supervisors evaluated?

-By how well their employees perform -NOT by how well they as individuals perform as functional specialists (pharmacists) For example: -Selection: technical skills & interpersonal/attitudinal characteristics -Development system -Assessment system-feedback: ongoing to shape rather than judge performance -Reward system

What criterion is often used for promoting an employee to supervisor/manager?

-Good technical (pharmacy) skills -People/organizational/managerial skills

Describe Intervention Software

-Intervention software: if pharmacist make recommendation for adjustment another drug or catch a problem and this is all documented - is part of EPIC

1. ___% of pharmacy directors anticipate leaving job within the next 10 years 2. Only ___% of current practitioners considering leadership positions 3. ____% of students surveyed are considering a leadership position

1. 80% 2. 30% 3. 60%

1. About ____% of all the meds are on the unit in the automated dispensing cabinet. 2. How does this work?

1. 80-90% 2. so the order is entered by physician, verified by pharmacist, and then nurse can take it out of machine on the floor (so the stuff from the pharmacy is mainly IV preparations are oddball medications not used that commonly)

Describe the relationship between human error and FMEA

1. An estimated 70% to 90% of all accidents are a result of human error 2. Human failures are often equated with blame, which is more suited to the linear narrative >>The assumption - Human error is unpredictable, therefore the systemic analysis approach is often not utilized to find the source of the problem >>The reality - Human errors are drawn from the limited set of meaningful things that an individual can do in any defined situation 3. Theoretically, human errors are capable of a priori discovery and analysis because the spectrum of errors is limited

What is Organizational Behavior?

1. Basically an inquiry about people groups within organizations 2. "The systematic and scientific analysis of individuals, groups, and organizations." 3. "Its purpose is to understand, predict, and affect human behavior to improve the performance of individuals, which ultimately affects the functioning and success of the organization in which they work."

What are the 5 steps in RCA?

1. Charter the team: put together a multidisciplinary team to look and review the processes 2. Document and research 3. Identify root causes 4. Develop actions 5. Establish outcome measures (to measure improvements)

What properties turn a group into an effective team?

1. Clear goals 2. Defined roles 3. Open/clear communication 4. Consensus decision-making 5. Balanced participation 6. Valued diversity 7. Managed conflict 8. Positive atmosphere 9. Cooperative relationships 10. Participative leadership

Fill in the medication safety technologies 1. C 2. B 3. A 4. C

1. Computerized, Physician Order Entry (CPOE) 2. Bedside Bar Code Scanning 3. Automated Dispensing Cabinets (PYXIS) -Controlled Substances -Floor stock -Cartless System 4. Carousel Inventory System

Describe the step in RCA: identify root causes

1. Create a diagram of the flow of events - Trace the chronology of events that led to the adverse event or close call - Examine the process to find weaknesses: • Include what really happened, not what was supposed to happen • At each step of the event flow ask "Why?" - Write a concise cause-and-effect statement based on the findings in the diagram, include safety recommendation for preventing a future occurence

Describe the HFMEA step: Graphically Describing the Process

1. Develop the process flow diagram and verify it 2. Number the process and subprocess steps on the flow diagram

Fill in the types of technology used in hospital to ensure medication safety 1. D 2. E 3. E 4. I

1. Dose Edge - Sterile Products Review 2. Electronic Medication Administration Record (eMAR) 3. Electronic References (e.g. lexicomp) 4. Intervention Software

1. What does the CPOE system run under at Maine Med? 2. What does the eMAR system run under at Maine Med? 3. What does the smart pumps run under at Maine Med? 4. What does the Intervention Software run under at Maine Med?

1. EPIC 2. EPIC 3. Hospira 4. EPIC

1. What does the Bedside Bar Code Scanning run under at Maine Med? 2. What does the Narcotic usage surveillance run under at Maine Med? 3. What does the Carousel Inventory System run under at Maine Med?

1. EPIC 2. Pandora 3. PhACTs

Organizational Design is: 1. Effective if: 2. Efficient if:

1. Effective if it facilitates attaining org. objectives/goals 2. Efficient if objectives are attained w/ minimal resources

How does FMEA relate to medication error prevention?

1. FMEA asks what will happen if a health care provider: - Mistakes one medication for another because of the packaging - Administers the wrong drug or dose - Gives a drug to the wrong patient - Administers a drug by the wrong route or at the wrong rate - Omits a dose - Gives a drug at the wrong time - Takes any action that may produce a medication error 2. FMEA may reveal in some cases that: - The patient can tolerate the error - The error will be intercepted by the checks and balances built into the health system's quality improvement processes - Specific steps must be put in place to address potential errors that are intolerable

Describe FMEA

1. Failure modes and effects analysis (FMEA) is a step-by-step approach for identifying all possible failures in a design, a manufacturing or assembly process, or a product or service. 2. "Failure modes" means the ways, or modes, in which something might fail. Failures are any errors or defects, especially ones that affect the customer (patient), and can be potential or actual. 3. "Effects analysis" refers to studying the consequences of those failures

Describe producer vs. manager for work input and output

1. For producer: input=output 2. For manager: input << output because delegation is the key to being more productive

What are the 3 types of Leadership Skills?

1. General Leadership Skills 2. Clinical Leadership Skills 3. Administrative Leadership Skills

Describe briefly habits 1 & 2 of "Covey's 7 Habits"

1. Habit 1: Begin w/ the end in mind -Called the First Creation (Determining priorities/goals) -Where we want to be/go -Planning for results/change and setting performance expectations 2. Habit 2: Put First Things First -Called the Second Creation (How to allocate resources to achieve our priorities) -How to get there -Time/priority management

Describe the step in RCA: establish outcome measures

1. Include measures for evaluating whether the actions prevent future events 2. Outcome measures should: -Not only measure whether the action was completed but whether the action was effective -Be quantifiable and, when appropriate, include clear numerators and denominators -Clearly define the strategies and include the frequency and time frame for monitoring -Include a threshold or goal, and ensure it is realistic -A simulation might be a good tool to rehearse the proposed improvement

What three major things should you know in order to better your time management?

1. Know how you spend your time (so you can eliminate waste) 2. Know your priorities 3. Know your prime time (when you work best/are most energized)

What are 5 Internal Time Wasters?

1. Lack of Priorities 2. Paperwork 3. Personal Disorganization 4. Trying to do too much - inability to say "NO" 5. Lack of Self-Discipline - Procrastination

Describe in depth Covey habit 1: What are long range goals? What are short range goals? What are daily/weekly tasks?

1. Long Range Goals -Create the vision of where you want to be --> support vision & values of organization & individual 2. Short Range Goals -Create the roadmap of how to get to your vision --> should be set & shared with others 3. Daily/Weekly Tasks -Functions that support the achievement of short & long range goals --> daily/weekly "to do" lists --> Can sometimes be delegated

What are the implications of our perceptions influencing our behavior?

1. Never assume 2. We struggle to manage others when we don't manage ourselves first 3. High expectations are the key to everything 4.

1. Define Paradigm 2. Define Paradigm shift

1. Paradigm: way that you view the world 2. Paradigm shift: change in the way you view the world which leads to a different level of understanding and to changes in how you behave -via experience (formal and informal) -via self-assessment and self-talk

Describe the step in RCA: charter the team

1. People - Multidisciplinary - Include those versed in the process but not directly involved with the incident 2. Places, tools, and time - Provide adequate meeting space, computer access, and time 3. Management support - Brief (let them know what's going on) management - Obtain written consent for the allocation of assets necessary to complete the RCA

List two Organizational Structure Models and give examples of each

1. Professional Model e.g. Universities 3. Corporate Model e.g. Chain Pharmacy—Walgreens, CVS, Rite Aid

What are the 5 HFMEA Steps?

1. Select a topic 2. Assemble the team 3. Graphically describe the process 4. Conduct a hazard analysis 5. Develop actions and outcome measures

What are 5 External Time Wasters?

1. Shifting Priorities 2. Confused Responsibility 3. Incomplete of Delayed Information 4. Meetings 5. Interruptions

Fill in the medication safety technology 1. S 2. N 3. N 4. W 5. W

1. Smart Pumps 2. Narcotic Inventory System (CII Safe) 3. Narcotic usage surveillance 4. Wireless Telephones 5. Wireless Tablet PCs -moving to iPads

List and define the 4 organizational principles:

1. Span of control: There is a limit to the number of people a person can manage effectively 2. Parity: Authority must be commensurate (corresponding in size or degree) with responsibility. - if you are going to ask someone to do something you should make sure they have the authority to do so 3. Unity of command: You should report to and be accountable to only one boss 4. Departmentalization: The grouping of activities/jobs under the authority of a single manager, according to some common, rational basis e.g. function, time, output, product, client, place

Describe the step in RCA: develop actions

1. Team should state the actions members took to address the root cause(s) of the errors - Action statement should be readily understood (specific and concrete) - Conduct a trial of the actions to address the problems, if possible - Action statement should have buy-in from process owners 2. Goal is to prevent a recurrence of the same close call or adverse event or at least to minimize it - Actions should be permanent and physical, not temporary and procedural - Actions should not be asking providers to "pay more attention next time" - Avoid unnecessary training or new policies

Describe the HFMEA Step: Forming a Team

1. The HFMEA team should be multidisciplinary -Ensures multiple viewpoints are considered 2. Including people who do not know the process ensures critical review of the accepted standards and practices and identification of potential vulnerabilities that others might miss -Reduces disciplinary bias 3. Having at least two subject matter experts on the team improves chances that the analysis has technical merit 4. Designate a team leader and a team recorder 5. PSO usually serves as an advisor and consultant

What are 5 tips for performing an HFMEA?

1. Think of failure modes as "what could go wrong" 2. Think of the failure mode cause as "why" the failure would occur 3. Present failure modes as a problem statement that needs to be corrected 4. Ensure that the team diagrams the flow diagram steps that actually occur, not the ideal process 5. Once the team has diagrammed a process, post the flow charts in the work area because staff not serving on the team may have ideas for additional steps that have been forgotten or failure modes that no one has suggested 6. Chronological event flow diagrams used in RCAs are different from process flow diagrams used in HFMEA -RCA event diagrams show what actually happened on the day of the event -HFMEA process diagrams depict the usual activities

Describe the HFMEA step: Selecting a Topic

1. Topic should not be too broad or too narrow 2. Patient safety officer (PSO) or medication safety officer along with the quality or risk manager should select the topic 3. The Joint Commission advises the use of available information about sentinel events known to occur in health care institutions that provide similar care and services 4. Topic should have value to the institution and be justifiable to auditors 5. PSO should complete a rough flow diagram, using topic selected, to outline the primary process steps as used in that hospital 6. PSO should then select five or six steps that will be the narrow focus of the HFMEA

What are 7 Steps to Overcome Procrastination?

1. Use the "one minute focus question" 2. Place yourself in the presence of a top priority at that time 3. Break it down into small pieces, manageable steps ... the "swiss cheese" approach 4. Write out a plan 5. Make your plans public 6. Talk to yourself 7. Force yourself to work on the project for 5 minutes and tell yourself you can quit after that.

Describe the step in RCA: document and research

1. Use the preliminary report to write a description of the event 2. Collect data relevant to the event - Policies, photographs, equipment involved, etc. 3. Interview key participants in the event 4. Gather credible references that may assist in understanding the event 5. Rewrite the event description, adding the new information

What are 5 situations in which to use FMEA?

1. When a process, product or service is being designed or redesigned. 2. When an existing process, product or service is being applied in a new way. 3. Before developing control plans for a new or modified process. (new MTM service, newly implemented anticoag service etc) 4. When analyzing failures of an existing process, product or service. 5. Periodically throughout the life of the process, product or service

What are four theory X assumptions?

1. Work is inherently distasteful to most people. 2. Most people are not ambitious, have little desire for responsibility, and prefer to be directed. 3. Most people have little capacity for creativity in solving organizational problems. 4. Most people must be closely controlled and often coerced to achieve organizational objectives.

What three primary things are required of a manager?

1. develop various managerial skills needed for effective pharmacy practice and for implementing change → beyond technical 2. Necessitates supervisor create an environment for performance 3. Need to be be aware of various factors affecting performance, including your own assumptions about people

Define Management by Exception

1. giving the people who work for you the authority to control their work or particular jobs, projects, etc., unless there is an exception (= an unusual situation) that causes a problem 2. In management by exception all routine work is entirely the responsibility of more junior staff.

Define Scope of Authority

1. limits by nature of position in organization (reflecting the chain of command) 2. can be "Centralized" or "Decentralized" organizational decision-making

What does Organizing as a Management Function entail?

1. the need for coordination/ cooperation 2. Building, developing, maintaining formal working relationships, i.e., structure, that will achieve the organizational objectives -Grouping of activities & assignment to work units (e.g., departments, committees, teams) -Establishes authority & responsibility relationships among departments and people within them, e.g., "chain of command" within a hierarchy -Establishes formal communication channels

Describe the self-fulfilling prophecy

1. when you treat people (self) based upon your perceptions/assumptions of them (self), they (you) eventually start behaving according to your expectations...thus validating your assumptions/perceptions -Perceptions/beliefs --> Your behaviors --> Others' reactions to your behaviors --> Reinforce your perceptions -Can be positive or negative

What percentages of all hospitalized patients use EPIC?

25-30%

Failure Mode and Effects Analysis is used ______ (before, after) a problem

BEFORE (a priori)

How do beliefs and assumptions affect what you perceive?

Beliefs and assumptions filter what you see and then you make assumptions based on what you perceive -this is not the best thing for you regarding people

Why do a RCA?

Evaluating root causes can lead to changes that will break the chain of events and avoid the final breakdown

What are qualities of Leaders?

Focus on people Does the right thing Innovates Develops Investigates reality Challenges status quo Long-range perspective Eye on horizon Is ladder on the right wall

What are qualities of Managers?

Focus on systems Does things right Administers Maintains Accepts reality Accepts status quo Short-range view Eye on bottom Line Climb ladder fast

Define Formal Authority

Formal (line) authority...is the ability/right to command and expend resources necessary to achieve objectives/results (make decisions). It flows through the chain of command.

What is a potential challenge to Pharmacists being managers?

It is easy to focus on technical skills which are emphasized as important, but as a manager you should not be focusing on the technical tasks

What happens to SoA as one moves up the chain of command/hierarchy?

It is larger

Describe Administrative Leadership Skills

Prioritization Delegation Personnel management Strategic thinking Vision setting Political Savvy Change management Staff development Program development Financial acumen

What is a smart goal?

S - Specific (practice juggling 3 balls) M - Measurable (1 hour each week until end of semester) A - Achievable / Attainable (1 hour each week) R - Results-oriented T - Time-bound/based (until end of semester)

Productivity is working _______ not ________

SMARTER NOT HARDER

What is strong organizational culture?

Strong culture—values are intensely held and widely accepted

TRUE OR FALSE: FMEAs are useful in the design stage as well as in the post hoc analysis

TRUE

TRUE OR FALSE: event flow diagrams used in RCAs are different from event flow diagrams used in HFMEAs

TRUE: 1. RCAs use chronological event flow diagrams: show what actually happened on the day of the event 2. FMEAs use event flow diagrams which depict the usual activities

Define the halo and horn effects

Tendency of forming a positive (halo) or negative (horn) first impression or judgment of a person based on a particular characteristic...to be influenced by a general positive or negative impression of him/her

What is weak organizational culture?

Weak culture—vagueness, ambiguity, and inconsistency , i.e., not aligned

What is an example of a violation of the organizational management function "establish formal communication channels"

a violation of this would be if you have a problem and you take it to the store manager instead of to your immediate supervisor - you must go through appropriate channels

Describe Narcotic Inventory System

all scheduled meds are done through this sytem c5-cII

Describe dose edge

done in IV room; when technician makes preparation it is all filmed so pharmacist can check it and view all that was done

Describe the Levels of Organizational Design

groups of organizations --> organizations --> clusters of work groups (e.g. departments) --> work groups --> individual

What kind of team approach does FMEA use?

interdisciplinary

Describe Narcotic usage surveillance

nurses are scored on what does average nurse give for narcotics and any deviation is looked into

Describe smart pumps

prevents wrong drip rate and other things from being input to increase safety for patient

Self-fulfilling prophecy a.k.a. __________

pygmalion effect

"The health care manager's entire purpose is simply _________ to provide their services in the most effective way possible both to serve the patient and to provide some return to the provider organization."

to enable his people

Define stereotyping

when we attribute behavior or attitudes to a person on the basis of the group to which the person belongs Can be positive or negative