Final Exam HCAD 301
Clinical paths
Care management tools used to organize, sequence, and time major patient care activities and interventions of the entire interdisciplinary team for a particular diagnosis or procedure.
what is common cause vs special cause variation?
Common-cause variation is where no one, or combination of factors is unintentionally affecting the process variation (random variation). Special-cause variation is when one or more factors are affecting the process variation in an intentional way
In what context are pie graphs not ideal?
to many categories look at recording
What group is ultimately responsible for the quality of patient care and services in a healthcare organization?
A) Board of trustees
What are the two factors that influence the decision to start a project?
Timeliness priority tasks and risk management
For noncatastrophic processes, good outcomes depend on having at least 95 percent process reliability.
true
5S Methodology
"The 5Ss are Sort, Simplify, Sweep, Standardize, and Sustain. They are tactical ways of organizing any process and can guide your Kaizan events, helping you find and eliminate the eight wastes. " Example: When delivering food trays, waste less time.
What does DMAIC stand for?
(D) - Define (M) - Measure (A) - Analyze (I) - Improve (C) - Control
Consider the failed improvement project in the chapter 9 case study when answering the following:
- 80- 90%: Standardization and staff education, keeping careful watch for possible danger, Engagement from management and those directly involved with process/procedure - 95%: Add decision aids (stronger interventions like checklists or computer reminders), Advanced failure prevention and failure identification and risk reduction strategies - 99.5%: Process failures closely monitored, Targeted interventions designed and tested, Performance regularly reviewed and feedback provided
briefly discuss the similarities and differences between a line and control chart.
-> Control Chart: -Center line represents the overall process average (monitors process variation over time) - Distinguishes special causes from common causes of variation - Collects data to study outcomes on a regular basis in order to understand the process - Also helps determine stable vs. unstable processes - helps determine common causes (expected) and uncommon causes (unexpected) -> Line: the mean on which causes occur
recognize the role of physicians and nonphysicians in managing the use of healthcare resources:
- Nonphysicians: plan for patient care, make sure not to overuse, underuse, or misuse resources - Physicians: provide care to the best quality, using the best of the resources
What is the pareto principle?
1) Helps a team focus on areas that would have the greatest impact 2) Displays the relative importance of problems in a simple visual format 3) If many factors impact, relatively few have the bulk of the impacts 4) 80/20 rule: 20% of the input (time, resources, money) contributes to 80% of output (results, rewards)
What is the main purpose of LEAN Models?
A performance improvement approach aimed at eliminating waste; also called Lean manufacturing or Lean thinking.
Identify sources of comparative healthcare utilization data:
1.) Hospitals. 2.) Community health centers. 3.) Physician and Group.
With line graphs, you shouldn't include more than ----- many measures?
4 measures
physician advisor
A practicing physician who supports utilization review activities by evaluating appropriateness of admissions and continued stays, judging the efficiency of services in terms of level of care and place of service, and seeking appropriate care alternatives
Value Stream Map
A complex flowchart documenting processes and flows to help a manager determine which processes add value and which do not. EX: emergency evacuation
What individual assists the leader in leading discussions during improvement project team meetings?
A. Sponsor
Your nursing home, where you have been the Director of Quality Management, now has an issue of too many survey citations, including those with a high scope/severity level issued. The administrator at your site has been fired, and you have just been asked to take over that role. As part of accepting the position, the Board of Directors has asked that you develop a plan to decrease the number of F-Tags received and the scope/severity of those tags - thus avoiding severe fines and the potential of your site being put on the Special Focus Facility list. In your response to this question, to get full points, discuss ALL of the following
A.) Call the employees together and develop an fish bone diagram. B.) The employees responsible for the part of the facility, and the immediate supervisor during the shift the citations occur C.) Incident reports that have caused the citations to occur D.) Feedback from the immediate supervisor, resident(s) involved, employees involved, the number of reports filled
Members
All do their part to contribute to the team
What is a component of an organization's quality management infrastructure?
C) Committees
What is a Kaizen event?
a focused, short term project aimed at improving a particular process
What group is responsible for allocating resources necessary to support quality management activities in the organization?
D) Administrative leaders
What is the primary purpose of risk management activities in a healthcare organization?
D) Protect the organization from financial losses
What is the most widely recognized improvement process today?
Do-Study-Act (PDSA) cycle. PDSA (Plan do Study Act Cycle)
What does the dotted line represent on a radar chart, compared to a solid line?
Dotted Line: Expected results Solid lines: actual results
pell out these acronyms (steps): - FOCUS- PDCA - FADE
FOCUS: Find, Organize, Clarify, Understand, Select. PDCA: Plan, Do, Check, Act FADE: Focus, Analyze, Develop, Execute
During what type of improvement project does the team brainstorm what could go wrong in each step of a process.
Failure mode and effects analysis
The Joint Commission requires accredited healthcare organizations to have a quality management plan.
False
The likelihood of human errors causing patient harm can be greatly reduced by disciplining staff for making mistakes.
False
Mistake Proofing
Improving processes to prevent mistakes or to make mistakes obvious at a glance; also called error-proofing. EX: set up instructions on how to check certain residents
What factor makes an improvement team work most effectively?
a. Operates under an agreed-upon set of ground rules
leader
Keeps project on track, coordinates assignments
timekeeper
Keeps track of how much time is left
What are the two most commonly used SPC tools
Key tools used in SPC include run charts, control charts, a focus on continuous improvement, and the design of experiments
Discuss 6 sigma and its relation to the normal distribution in statistics
Lean Six Sigma solves problems where the number of defects is too high. A high number of defects statistically equals high variation in the process. Helps Figure out how significant certain events are
What are the two most common ways to display trend reports?
Line graph and Bar graph
describe how clinical practice guidelines are used for utilization management purposes
Making sure all the employees are where they need to be and know what they need to do.
Assessment asks the question, are we meeting the expectations? If the answer to this is yes, then what is done? If the answer to this is no, what is the step taken?
Met: keep the process, just check for unexpected errors or any small improvements. Not met: Reassess where the process is flowed, and address the flaw, and try to put it back into practice.
Regarding team development, what is the role of the improvement team leader?
a. Recognize development as a natural team progression
Quantitative vs Qualitative data- do you know the difference?
Qualitative Data: non-numerical, Generate ideas, set priorities, maintain direction, determine causes of problems, clarify processes, Quantitative Data: numerical, Measure performance, collect/display data, monitor performance
If you were the team leader of the group described in the following case study, how would you refocus and remotivate the team toward achieving the improvement goal? When members were recruited for the improvement project, they were told that the team's work would be additional to their regular work responsibilities but that they had to treat team activities as a high priority. They were expected to complete team assignments on time and were required to attend meetings. Despite being aware of these clear expectations, by the third week of the project, team members started arriving late to meetings, making excuses for not having completed their assigned tasks, and neglecting to return the leader's phone calls.
Remind them of what we are trying to achieve with our group work. Ask why certain obstacles have occurred that caused them to miss important deadlines. Ask why it's important to meet dead lines and be on time. Say I will reward each of them if they do what has to be done and if they don't. There will be consiquences.
Which of the following methods can be used to improve the effectiveness of meetings?
a. create an agenda and stick to its topics b. evaluate the meeting at the end c. keep within the allotted time for the meeting (all of these)
The sponsor, within an improvement project team, is usually the person who convenes the group to address a particular issue or challenge in a facility.
a. true
SPC- what does this stand for and what does the concept focus on addressing?
Statistical process control, used to make sense of any process or outcome measured over time, usually with the intention of detecting improvement or maintaining a high level of performance
What are the 4 common steps of performance improvement?
Step 1: define the improvement goal Step 2: Analyze current practices Step 3: Design and implement improvements Step 4: Measure success
What is an improvement action considered to be strong - meaning it is more likely to achieve patient safety improvement goals than weak or intermediate action?
Tangible involvement by leadership
Can you define Assessment
The evaluation or estimation of the nature, quality, or ability of someone or something
Preadmission Certification
The practice of reviewing claims for hospital admission before the patient actually enters the hospital. This cost-control mechanism is intended to eliminate unnecessary hospital expenses by denying medically unnecessary admissions.
When are improvement teams helpful?
acquire new skills and gain a gain deeper understanding of problem-solving techniques. Impovement projects shouldn't be done alone
How are fishbone diagrams a helpful way to determine root cause?
They assist in brainstorming root causes for certain problems in health care facilities
There are a range of tools that can help differentiate between common cause and special cause variation. Name three.
Time plots, frequency plots, pareto charts, and scatter plots.
Compare trend reports to snapshot reports and provide an example of each. Can you have an overlap between the two?
Trend Reports: cover over time studies Snapshot: report just a moment in time. Yes because the snapshot can capture a moment within the trend report
Both from one of the guest speakers, and this slide, answer: if you wanted to analyze workflow patterns and where movement/motion occurs, to eliminate or minimize that waste, you might use a spaghetti diagram to show common travel patterns.
True
In a high-performing organization, conflict and disagreement are dealt with openly.
True
What is the first step of a root cause analysis?
Understand what happened
Consider your practicum site (if you haven't been placed yet- refer to your current top choice and/ or the organization you now work in)- what three words or phrases would you use to describe the company or department culture? Does the culture prompt or inhibit quality performance? Why?
Welcoming Friendly Compasion Yes, our training system is strict on how well we learn things, if we mess up or don't do thinks correctly, we will be notified.
List two helpful questions to ask yourself to help prioritize your improvement goals:
What do I want to accomplish? how will i measure my process?
Briefly discuss how rapid cycle improvement works
When an improvement needs to be made and the company has an efficient system in place to make the improvement and put it into practice. They also have a system in place to see if the improvement made is doing what it is intended and no further changes need to be made. PDSA within 6 weeks
Episode-based bundled payments
a fixed, lump-sum payment for a patient's episode of care for a single illness or course of treatment, shared among all caregivers during and after hospitalization
Indicate next to each of the shapes, below, what the particular shape represents if/when it would be used within a flowchart to diagram out a process or procedure within a health care setting
a flowchart is made up of shapes and arrows. The shapes, represent the steps of a process. Arrows are used to connect these shapes to depict the path, or flow, through the process.
Kanban
a manual system that signals the need for parts or materials, ways to show your process. Ex: When new medications need to be ordered, have a system in place to order them on time
In the team development stage known as "storming," group members are at the point where they are highly effective problem solvers and working efficiently to meet the group's charge.
a. False
What is the ideal number of members on an improvement project team?
b. Five to ten
What individual or group creates the written charter for an improvement project?
b. Sponsor
Which of the following improvement actions can help achieve 95% process reliability?
b. Standardize the process steps.
Which of the following developmental stages is normally the first stage a team goes through?
b. forming
Which of the following is the structured form of multi-voting, usually with five steps and a rank voting process to prioritize quality improvement initiatives?
b. nominal group technique
What type of form is used by hospital caregivers to document potential or actual patient safety concerns?
c. Incident report
What is an improvement action considered to be strong—meaning it is more likely to achieve patient safety improvement goals than weak or intermediate actions?
c. Process double-checks Tangible involvement by leadership
In a survey questionnaire, if a question has a dichotomous response, how many potential answers are there to that question?
c. two
In what context are tables not ideal?
categories, too much
The number of actions that achieve intended results divided by the total number of actions is measuring what aspect of performance?
reliability
Prospective review Protocols
review conducted prior to the delivery of the requested medical service
What is the primary purpose of root cause analysis and failure mode and effect analysis?
d. Improve patient safety
Who is the individual responsible for keeping the improvement project focused on the improvement goal?
d. Leader
What federally recognized group maintains a database of adverse patient events?
d. Patient Safety Organization
What technique can be used to minimize cognitive overload for hospital caregivers?
d. Provide staff with adequate off-work intervals.
During what stage of team development do team members often exhibit dissension, irritation over lack of progress, and general impatience?
d. Storming
What is the correct order describing the team development stages advanced by psychologist Tuckman?
d. forming, storming, norming, performing
In a decision matrix
d. the weights represent the relative importance of criteria
describe the purpose of utilization management
designed to make sure that your members get the care that they require, without excessive testing and unnecessary costs associated with care they don't need
Case managers
experienced healthcare professionals who work with patients, providers, and insurers to coordinate medically necessary and appropriate healthcare services
Improvement initiatives are successful when it is expected that people will perfectly execute their job responsibilities.
false
There is no reason to investigate what happened to cause a near miss event because no patient was harmed.
false
Concurrent review
review for medical necessity of tests and procedures ordered during an inpatient hospitalization
facilitator
helps manage discussions, keeps them following
visual control
making current performance and potential problems immediately visually apparent warning lables EX: Set up safety bed heights to help make sure residents don't fall at a dangerous hight
how do each of these terms relate to performance expectations?
opinion: opinions on those who are affected in the organization criteria: professionally defined criteria out there, standard rules/ guidelines you should have performance comparisons: how other organizations are doing define: benchmarking: learning the best practices of other companies
What is the next step after performance assessment?
performance appraisal interview and discuss the points with their superior.
Pay-for-performance systems
performance-based payment arrangements that control costs directly or indirectly by motivating providers to improve quality and reduce inappropriate utilization
discuss utilization management measurement, assessment, and improvement activities:
prior authorization to allow payers, particularly health insurance companies, to manage the cost of health care benefits. This will assess its appropriateness, before it is provided using evidence-based criteria or guidelines.
discharge planning
systematic process of preparing the patient to leave the health care facility and for maintaining continuity of care
Accountable care organizations (ACOs)
the group of physicians, hospitals, and other health care providers come together voluntarily to provide coordinated high-quality care to their Medicare patients.
sponsor
the individuals and groups responsible for a starting a team's ideas
what factors should be considered when displaying measurement data?
time frame, risk factors, people involved, and metrics measured.
Process standardization improves patient safety
true
What does the type of variation associated with your process dictate?
variation is bad in relation to quality, control charts
Recorder
writes and types things, captures things
