Leadership Exam 1
patient classification system
*Patient needs and requirements for nursing care are predicted*. Patients are grouped according to acuity of illness and complexity of nursing activities necessary to care for the patients. Cons include lack of standardization, lack of credibility among nurse leaders and managers (the people filling out the forms may want more staff on their unit), and no consideration of patient flow. - some people may need more emotional support staffing load is increased or decreased based on this
Medicaid
50-83% paid by government State Level Program Medically indigent, blind, or disabled Children with disabilities
2. Please review EMTALA from an online source and describe how hospitals must respond and care for patients.
EMTALA demands that hospitals must provide care to patients who have urgent medical conditions even if the patients cannot pay for it. Patients must be stabilized or transferred to a facility that has the ability to stabilize them. ("Overview" 2012)
responsibility accounting
Each of an organization's revenues, expenses, assets, and liabilities is someone's responsibility
The QI Process
Involves setting standards of care, taking measures according to standards of care, evaluating care, recommending improvements, ensuring improvements are implemented, and evaluating the improvements Nurse leaders and managers Are integral in the QI process because they are responsible for ensuring the safety and quality of nursing care Can improve patient safety by applying the QI principles using a patient-centered approach
Steps of the QI process
Monitor and Improve performance form and interprofessional team to implement the QI process- include nurses at all levels and promote teamwork and collaboration Foster staff involvement and QI processes to begin changing the processes, attitudes, and behaviors of staff
patient focused care
Multi-skilled team approach Goals of patient-focused care are coordinated, includes the case manager OT, PT, RT more individualized
disease management
Population based healthcare- maybe everyone has CHF, COPD clinics, rehab Continuous improvement Pays particular attention to cost-driving diseases...high risk, high dollar, high frequency
no for profit
Possible sources of funding include public and/or government funding, grants, and private donations Typically services a large number of nonpaying patients May have to cut services or make other changes to ensure a positive cash flow
standarization
Process of developing and implementing uniform criteria, methods, processes, designs, or practices Improves clinical outcomes, reduces inefficiencies, and decreases costs
3. Provide 2 pros and 2 cons about the Affordable Care Act (use online sources that are cited within your response).
Pros: 1. Health insurers must cover birth control. 2. Patients with pre-existing conditions can get health insurance. Cons: 1. Long-term health insurance is not offered. 2. Not everyone could keep the insurance they already had.
Medicaid
Provides health care primarily for children (through CHIP), nondisabled adults, and pregnant women state funded started in WW2- was supposed to be to get people through
patient acuity
represents how patients are categorized according to an assessment of their nursing care needs, total care? are they confused? some patients take more time and attention than others
measuring productivity
required staff hours/ provided staff hours x 100
cost containment
effective and efficient delivery of services while generating needed revenues for continued organizational productivity
FTE
equivalent of one full-time employee working for 1 year; can be combination of employees working part-time to equal one full-time employee *1 employee working 8 hours per day x 5 days x 52 weeks= 2080 hours/year
self-regulation
examining one's practices for strengths and weakness in critical thinking and promoting continuous improvement
error of omission
results when an action that is a standard of care is not taken or omitted
error of comission
results when the wrong action is taken or committed
strategic foresight
seeing the relevant opportunities that could emerge from the future and strategizing how to make the most of them
decision making
selecting the best alternatives to achieve individual and organizational objectives two types - patient care decisions (those that affect patient care) - condition-of-work decisions (those that effect the work environment)
DRG
Third-party payer decides in advance what will be paid for a service/episode of care. In 1983 Medicare implemented PPS for hospital care using diagnosis-related groups (DRGs). If the actual cost is more, the provider takes a loss If the actual cost is less, the provider make a profit
5.) What is DNV GL
This organization was created from an alliance between international organizations of Norway and Germany. It is the organization that provides accreditation.
two avenues to healthcare
Through a physician or care provider practice or clinic Through a hospital emergency department (most expensive)
philosophy
states the organization's beliefs, values, concepts, and principles that reflect its ideas, convictions, and attitudes
halo effect
a person may be incorrectly judged positively based on one positive aspect that they have
budget
a plan that uses numerical data to predict the activities of an organization over a period of time - maximal use of resources to meet short and long term needs
HCAHPS
all about being reimbursed from patient satisfaction survey **Hospital Consumer Assessment of Healthcare Providers and Systems** pay for performance
variable expenses
fluctuate depending on patient volume acuity or activity level
Transactional Leadership
focuses on goals of the organization uses motivation with reward the leader is focused on getting the job done the team member is motivated by the reward
formal communication
follows the line of authority in an organizational hierarchy and reflects the culture of the organization is planned, does not occur randomly
unity of command
suggests that each individual employee is accountable to only one manager, with expectations clearly defined and well understood
all nurses are managers...
at the bedside
reactive thinking
automatic or knee jerk reaction to situations that has consequences leading to vague or inaccurate reasoning, sloppy and superficial thinking, or poor nursing practice
public healthcare
usually provided for people with low socioeconomic status or those who have disabilities. Costs are either free or reduced for these individuals. Individuals must qualify for public health care. Funded by tax dollars
QSEN
funded with the purpose of adapting the IOM competencies for nursing specifically to serve as guides for curricular development in formal nursing ed, transitions to practice, and continuing education. Sets standards for the regulatory bodies that provide licensure, certifications, and accredidation of nursing schools. Incorporates the 5 core competencies in Health Professions Education- plus it's own 6th The main components of the QSEN initiative include patient-centered care, collaboration, EBP, quality improvement, safety, and informatics
steps of decision making
gathering info analyzing info and creating alternatives selecting a preferred alternative implementing following up on implementation
proficient
have 3 or more years of experience and can perceive the situation as a whole
competent
have 6mo or 3 years of experience and can establish a plan of care
Laisse Fare
the leader leads from afar with minimal interaction with others. This type of leader does not lead by example and does not keep track of employee efficiency
cost per unit of service (CPUOS)
total cost divided by units of service *total staff number worked in 24 hours x average hourly rate x hours per shift/ADC*
budgeting process
based on the organization's fiscal year one of the most important jobs of the nurse manager
levels of evidence
highest= Systematic review or meta-analysis of RCTs, or EBP based on systematic reviews of meta-analysis next= evidence from at least well-designed RCT lowest= expert opinions
Authentic leadership
hold firmly to their values, beliefs, and principles and inspire their followers. Steadfast, creates a predictable environment, strong commitment to truth telling, encouraging productivity, etc
Medicare Part A
hospital, hospice, home health, **skilled nursing** *taking care of an immediate issue original dialysis patients
types of healthcare organization
hospitals extended care facilities retirement and assisted living facilities ambulatory care centers substance abuse treatment facilities
two challenge rule
if the team member does not acknowledge the concern being challenged, the nurse takes stronger action or follows the hospital chain of command
human factors for medical errors
include staffing levels, staff education and competency, and staffing shortages
government healthcare
includes health insurance that is provided by the government and health care that is financed by tax payers. Refers to government-provided health insurance, such as Medicare and Medicaid, that is actually provided by the private health-care system Agencies include Department of Veterans Affairs (VA) and Department of Defense (DOD) system
destructive feedback
includes threats and fear to control employee behavior by criticizing the employee and making him or her feel humiliated
*Regulatory requirement
including federal and state and local legislation as well as State Boards of Nursing, example RN in charge of care of patients, also OSHEA health care is a highly regulated industry. Health-care regulatory policies directly and indirectly influence nursing practice and the nature and functioning of the health-care system.
revenues
income from services provided - projected per unit by *ADC* (average daily census) or number of procedures done - affected by grants, donations, gifts, and third party payers
connective leadership
incorporates the needs of diverse stakeholders within the health-care environment through acknowledgement and use of the strengths of members and by including them in the leadership process considering not only WHOM you are guiding but WHERE you are guiding them
call out
informs team members of important info during critical events/situations
gross domestic product
is the broadest measure of the health of the U.S. economy. Real GDP: output of goods and services produced by labor and property located in the United States
explanation
justifying actions with evidence
interpretation
clarifying data and circumstances to determine meaning and significance
check-back
closed loop communication that verifies that the info that is being received is correct
diagonal communication
communication to others in the organization who are not on the same level in the hierarchy staff nurse shares new info with charge nurse on another unit (bypassing own boss)
critical thinking
complicated process that involves skillfully directing the thinking process and imposing intellectual standards on the elements of thought
problem solving
consists of the act of identifying a problem and implementing an active systematic process to solve that problem
private healthcare
consumers pay a predetermined amount for health care. Most private health care is through employment. predominant in US Monetarily compensated health care provided to individuals seeking care Includes companies, for profit and nonprofit, not associated directly with government agencies Predominant form of health care for persons in the United States
span of control
defines a manager's scope of responsibility and reflects the number of employees who report to a given manager
reflective thinking
deliberate thinking and understanding using one's own personal experiences and knowledge takes a step back and assesses
mission statement
describes the organization's overall purpose
evaluation
determining if expected outcomes are met and if outcomes have not been met examining why
analysis
determining problem or issue based on assessment data
variance
deviation from the projected budget *monthly budgeted expense - monthly actual expense=variance in $ Variance in $/monthly budgeted expense = % of variance*
4 stages of appreciative inquiry
discovery, dreaming, design, and destiny
fixed expenses
do not change over the budget period could include the fire estinguishers, heating, cooling, salaries
inference
drawing conclusions/hunch from observations
Medicare Part D
drug benefits plan, cost based on different incomes Medicare prescription plan
recruiting
make hiring decision carefully and to seek and select the best person for the right position
productivity
measure of the input required for the output *output X 100 input*
AONE
mitigating violence in the workplace..............
Failure Modes and Effects Analysis
mode, cause, and effect of failure Useful in determining what aspect of a process needs to change Includes the following goals: To prevent patient safety events by identifying all possible ways a process could result in failure To estimate the probability of failure To estimate the consequences of failure To establish an action plan to prevent potential failures from occurring Steps include failure modes, or what could go wrong; failure causes, or why would the failure happen; and failure effects, or what would be the consequences of each failure.
4.What is Nursing Informatics and how does NI change healthcare to make it safer?
more than using information technology, it includes the development and application of information technology systems to healthcare problems, research, and education. This has resulted in numerous innovations in healthcare including EHR, telehealth, remote monitoring, and education through simulation. Improves safe care and quality through effective communication, management, and documentation
Transformational Leadership
most effective involved an active involvement of both the leader and team members. It is a process in which leaders and team members "motivate each other to attain and achieve levels of success". *All members contribute to meeting the mission of the organization* Al nurses at all levels are involved in decision making This is one of the 5 components of the Magnet Recognition Program
incremental budgeting
multiplying the current year's budget by a predetermined figure based on the cost of living, consumer price index, or inflation rate and then using that number to project for the next fiscal year -very simple and require little expertise look at what has happened in the past problem- priorities may change
novice
no experience
expert
operate from a deep understanding of the total situation
just culture
part of a culture of safety a culture that is fair to those that makes mistakes responsibility for one's own actions
the 3 domains of quality from the IOM
patient safety practice consistent with current medical knowledge meeting customer- specific values and expectations
the 5 core competencies for all healthcare professionals
patient-centered care work in interdisciplinary teams employ EBP apply quality improvement Use informatics (the 6th for QSEN= Safety)
horns effect
people may be incorrectly judged negatively overall based on one negative aspect that they have.
Know Charts!
pg 164
leader vs manager
possible short answer? focus on group process, not part of the formal organization, empower others, gather info, give feedback, have a personality that makes others want to follow them, makes workforce more effective managers are assigned, have power, emphasize control, decision making, analysis, and results, must report to a higher up, follow rules, managing hours,
productive time
refers to the actual hours worked on the unit caring for patients
skill mix
refers to the varying levels of education, licensure, certifications, and experience of the staff
secondary care
Involves emergency care and acute care Focuses on diagnosis, treatment, and limiting disability Examples—hospitals and urgent care centers
When is census of a hospital taken? What might be an implication of the census being taken at that time with regards to nursing care and patients?
Census is taken at midnight. No one is going to be discharged in the middle of the night. It does make sense to take it that time. Managers can base their 7am staff schedules on who is there at midnight because they will most likely still be there at 7am. However, new admits can come at anytime of the night and it is hard to plan for that. Nurses can quickly get an increase in patient load and this can be a detriment for patient care.
With the person approach, organizations
Focus on unsafe acts of health-care professionals and errors as the result of human behaviors. Correct human behavior through naming, blaming, shaming, and retraining.
3. What is "followership" and why is it important?
Followership is the concept of how team members follow their leader. This is important because leadership and followership are closely connected. The best type of follower is the one that is an active team member who respects the leader, expects respect from the leader, takes an active role, takes responsibility for their actions, and is not afraid to suggest new ideas "doing" "standing by" "resisting"
decision-making grid analysis
List options and factors on a table or grid and assign a numeric score to each option to indicate poor to very good for options
Primary care
Serves as first line of defense Focuses on health education and health screening Examples—health-care providers' offices and wellness centers
9.) Describe the Institute for Healthcare Improvement and its purpose.
The IHI leads the health care industry in ideas for health promotion and improving healthcare. It is a global foundation. Because of the IHI the 100,000 Lives Campaign and the 5 Million Lives Campaign were both started. These campaign seek to reduce illness and death in healthcare.
3.) Explain the relationship between nursing process, critical thinking and decision making
The nursing process (ADPIE) uses assessment, diagnosis, planning, implementation, and evaluation. Critical thinking is especially important in the assessment, diagnosis and planning phases. Connecting symptoms and coming up with a nursing diagnosis requires critical thinking. Planning patient interventions requires critical thinking. Thinking critically about why a patients is experiencing their health alteration and deciding what to do about it can help ensure positive patient outcomes.
automatic actions
When cognitive adaptive mechanisms kick in, resulting in "auto-pilot" Can negatively impact patient safety because nurses pay less attention to details
3. Differentiate between centralized and decentralized staffing, explaining the advantages and disadvantages of each.
With centralized staffing the manager or a group of higher-ups makes the staff schedule. Advantages include the ability to ensure a adequately staffed unit and effective skill mix. Disadvantages include staff discontentment. Decentralized staffing allows for staff to make their own schedule. This can boost morale and staff satisfaction, however, it can lead to poor skill mix.
personnel workforce budget
accounts for the majority of the health care organizations expense
Mediare Part C
cost and deductible varies, coverage type changes each year it's Medicare A+B have private insurance benefits Medicare Advantage plan
direct expenses
costs of providing patient care supplies, staff
number one strategy to retain nurses
creating and sustaining a healthy work environment
retaining employees
critical to finding a solution to the long-term nursing shortage inadequate staffing leads to burnout, turnover, and jeopardizes quality patient care
Capital budget
purchasing *major items*: equipment, technology, furniture, rennovations differs from operating budget by cost of item requires staff input to identify needed items Capital expense items are depreciated annually: over the useful life of the equipment, a portion of its cost is allocated to the operating budget as an expense Process occurs separately from the operating and personnel budget processes Capital budgets plan for purchase of buildings or major equipment that has a long life (greater than 5 to 7 years)...>$1000 items that are not used in direct patient care but are needed for the facility. This includes renovations. These items normally cost more than $1,000. can be depreciated in the books
SWOT analysis
rate factors by Strenghts, weaknesses, opportunities, and threats
emotional intelligence- 5 components
self-awareness self-regulation motivation empathy social skills - Social skills- the ability to interact with others and build relationships - Self- awareness- being able step back and know why you did what you did, where your feelings are coming from, how you can improve, and how you may be perceived by others. - Self-regulation- being able to control one's actions and feelings in an acceptable way. Incorporating discipline and the ability to change. - Motivation- the desire to change and become better. - Empathy- putting yourself in someone else's shoes to try to understand what they are going through.
The Communication Process
sender encoding- the process the sender uses to transmit the message message- the info the sender is seeking to transfer sensory channel- the manner in which the message is sent receiver decoding- interpret feedback- determines if the message was received as intended
upward communication
sending of information up the hierarchal chain
organizational structure
who is responsible for what
shared decision making
with whatever team members involved
how many deaths annually did the IOM report say were preventable?
98,000
Full Time Equivalent
A unit that measures the work of one full-time employee for 1 year (or 52 weeks) based on a 40-hour workweek. It may be comprised of one person working full time or several people sharing the full-time hours
for profit
Are owned by stockholders, shareholders, or corporate owners Must reinvest into the organization to keep it running and to develop new services May not always be readily available for certain purposes that can affect nurses and patient care
peer review
Assessing, monitoring, and making judgments about the quality of nursing care provided by a peer Fosters accountability and supports self-regulation
nonverbal communication
Nonverbal communication can completely changed the intended message. For example, nonverbal communication can cause an urgent message to be translated as nonurgent. This is a safety risk.
Operating budget
Overall plan that accounts for expenses and revenues related to the **day-to-day** operation of a unit for a fiscal year Includes all unit expenses (e.g., costs related to providing care to patients) and revenues (e.g., income from providing such services) Monitoring the operating budget is the most time consuming for nurse managers Includes personnel, the largest part of the budget the money budgeted for a department in a fiscal year. It includes costs and income.
1. Why do you suppose budgeting is important for staff nurses to understand?
Staff nurses need to understand budgeting to understand scheduling and management of resources. Wasting even a small amount of resources can really add up at the end of the year. It also may help them understand why managers make certain decisions. If staff know what they budget goals are and why they can assist in meeting those goals.
ANA indicators
Structure indicators—relate to the care environment Process indicators—relate to how nursing care is provided Outcome indicators—relate to the results of nursing care
10.) What role does the TJC play in quality standards?
The Joint Commission gives agency accreditation and certification. The also monitor safety, quality, and value in healthcare.
calculating FTE
Total hours worked/ 2080
What is the difference between value-added care and non-value added care?
Value-added care is firsthand care that proves to be an advantage for patients. example- vital signs, assessment, etc Non-value added care activities are not provided on a firsthand basis and do not directly promote the welfare of patients. example- waiting on patient transport, searching for equipment or people
democratic
a style of leadership that encourages the department to make decisions as a whole, considering team members' ideas
advanced beginners
can demonstrate marginally acceptable performance of tasks
appreciative inquiry
forms a problem-solving strategy that capitalizes on the **positive** characteristics of an outcome by valuing and building on them example- patient satisfaction scores are good- find out what the people with good scores are doing
performance budgeting
*emphasizes outcomes and results* rather than activities and outputs. provides a picture of where resources are used and their relationship with the goals of the nursing unit and organization measures multiple outcomes of the nursing unit *Emphasis is on results and outcomes* Goals, Safety, Quality Nursing Care takes staff and patient satisfaction into consideration. It does not just measure the bottom line of the whole unit. It dives deeper into where resources are being used, goals of the department, and quality of nursing care.
*accrediting agencies
*ensures that health-care organizations meet certain national quality standards*. THe organization has met Medicare and Medicaid certification standards. TJC for hospitals Board of Nursing accredits the school of nursing higher learning commission accredits the whole university
2. Your book mentions interviewing for employment. Look at Table 10-1 on p. 215. Choose 5 of the illegal questions and explain why they might be discriminatory (not the actual violated law, but in your own words—state why they would be illegal?)
1. How old are you? Applicants may be passed over because they are older and may not work there as long as someone younger 2. Do you have a disability? Applicants may be discriminated against because of a disability that may not interfere their job. You cannot discriminate against someone because of a disability. 3. When did you graduate from college? An applicant may be turned down once the interviewer learns of their age. 4. Are you a US citizen? An applicant may be turned down because of race. 5. Have you ever been arrested? Applicants may not have been convicted of a crime just because they were arrested for something.
qualifying days
3 days in hospital at least to be eligible for Medicare then sent for rehabilitation
For profit vs not for profit
A difference between For Profit (FP) and Not For Profit (NFP) refer to tax status of the organization and how the profits can be used. FP pays taxes and NFP does not. Profit is the excess income left after all expenses have been paid. FP profits can be distributed to investors and managers. NFP must reinvest any profits also called net income or income above expense.
Root Cause Analysis
A problem-solving approach to identifying and understanding the underlying causes of an event, focusing on system factors Completed after a patient safety event and includes the sequence of events that led up to the event, possible causal factors and root cause, and an action plan that identifies specific strategies to reduce the risk of a similar incident occurring in the future *Often used to get to the root cause of an error and to implement a change aimed at improving or alleviating the cause*
using corrective action
A progressive process used to improve poor performance in which deficiencies and substandard performance are addressed immediately to avoid escalation of the behavior
Six Sigma Model
A rigorous method that encompasses five steps: *define, measure, analyze, improve, and control* Used in QI to define the number of acceptable errors produced by a process Involves improving, designing, and monitoring processes to minimize or reduce waste
Explain the difference between a Union strike and a Collective Bargaining event.
A union strike uses the power of the union to join forces and implement change. Union strikes many times involve employees not working until their voices are heard. Collective bargaining occurs when employees work with employers to negotiate changes in processes of work and pay
Steps to budgeting a forecast
ADPIE Assessment Gather data and assess the needs for the upcoming fiscal year. Examine the present nursing activities as well as those planned for the future. Diagnosis Determine the nursing productivity goal for the upcoming fiscal year. Evaluate unit goals from the previous year to ensure they are in alignment with the organization's current mission and philosophy. Revise or develop new goals for the future year if necessary. Panning Determine effective use of human and material resources, nursing services, and the management of the environment. Consider the needs of the unit as well as the organization, and place available resources in the appropriate places. Use budget worksheets and perform break- even analysis. Implementation Keep the unit functioning within the budget plan. Engage all staff in the process and motivate them to work within the constraints of the budget. Meet with staff early to explain the budget and discuss variances. Encourage input regarding any deviations. Evaluation Address any deviations in the budget. Perform variance analysis, including staff variances. Analyze the causes of variances and determine strategies to avoid them in the future. Monitor trends in variances to assist in addressing workload issues.
RN responsibilites
ADPIE Education planning discharge assignment, supervision, delegation makes decision
The Joint Commission
Accredits and certifies health-care organizations in the United States based on established standards and reviews agency activities in response to sentinel events Established the Speak Up programs, with the goal of urging patients to take an active role in preventing medical errors by becoming informed participants in their care Established the National Patient Safety Goals (NPSGs) program to assist health-care organizations in addressing patient safety concerns
with the system approach, organization
Acknowledge that errors happen because humans are not perfect. Focus less on the individual making the error and more on system processes that led to the error. Concentrate on changing the work environment by establishing barriers and safeguards against the errors.
AHRQ
Agency for Healthcare Research and Quality - established the PSNet --Patient Safety Network
team nursing
Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. Requires extensive communication and team planning conferences the RNA delegates to LPN and PCA required more communication, more coordinatned, not just "you do this and you do this"
primary care nursing
As originally designed, it generally requires an all-RN nursing staff. Relationship building is required. Primary RN assumes *24-hour* responsibility for planning care of one or more patients from admission to discharge. During work hours, the primary nurse provides direct care for those patients.- can delegate
Lean Model
Assumes that all processes contain waste and involves the thought process of doing more with less Builds on four basic principles *All work processes are highly specified. All customer and supplier relationships are clear. Pathways between people and process steps are specific and consistent. Improvements are made based on scientific methods and at the lowest level of the organization*. Empowers staff to identify problems and make improvements at the point of care
centralized structure
Authority for decision making is held by a few individuals at the top level of management, typically the chief executive officer and administrators. This allows for minimal innovation or creativity. The flow of communication is from top to bottom and is tightly controlled
decentralized structure
Authority for decision making is shared by a number of individuals across the organization. This fosters autonomy at all levels. The flow of communication is bottom up and between units
General Systems Theory
Based on an open and a closed system A closed system -Has little or no interaction with systems outside -Is overly focused on internal functions An open system, such as a health-care organization -Interacts with systems inside and outside -Is composed of interrelated elements including inputs, throughputs, and outputs
Institute for Healthcare Improvement
Collaborates with the health-care improvement community to remove improvement roadblocks and launch innovations that dramatically improve patient care Developed the 100,000 Lives Campaign to significantly reduce morbidity and mortality in the U.S. health-care system Developed the 5 Million Lives Campaign to significantly reduce illness or medical harm
Case management nursing
Coordinates care throughout an episode of illness. Focus is on individual clients, not populations of clients. Initiates critical pathways, nursing care plans that are followed
case management
Coordinates care throughout an episode of illness. Focus is on individual clients, not populations of clients. Initiates critical pathways, nursing care plans that are followed, conferences occur, insurance needs
2. What is a "cost center" and why are "line items" part of a budget? (may need the Internet for this one.)
Cost centers divide company costs into different areas. They may be divided into different departments or units. This allows a better understanding of what each department or unit needs budget-wise. Line items are a part of a budget because they show the total cost of each item being used, no matter how small. Even things that cost 25 cents can really add up if they are being wasted
DECIDE model
Define problem Establish Criteria Consider the alternatives Identify the best alternatives Develop and implement a plan of action Evaluate and monitor the solution - similar to ADPIE
complexity theory
Derives from the general systems theory as well as physics Suggests that relationships are the key to everything Includes key concepts—attractors, patterns, nonlinearity, self-organization, and emergence Nurse leaders and managers must Embrace the complexity of health care to promote a relationship-oriented structure. Constantly monitor the balance between stability and complete chaos to maximize variety and creativity within the system. Focus on outcomes, develop fluid roles, and be able to act with speed and adaptability through chaos.
4.) Describe the 4 steps of Appreciative Inquiry
Discovery- finding what processes are working in other areas Dreaming- dream about the future when these positive processes that are working in other areas are implemented in your area Design- decide what processes and supports need to be used for success Destiny- deciding how to make this positive processes come alive and keep them going
QI Models
Donabedian Model Lean Model Six Sigma Model IHI Model of Improvement Failure Modes and Effect Analysis (FMEA) Root Cause Analysis
accreditation
Ensures that health-care organizations meet certain national quality standards Means that an accrediting agency has conferred deeming status on an organization and an organization has met Medicare and Medicaid certification standards Required by Medicare, Medicaid, and most insurance companies through accreditors including The Joint Commission and the DNV GL
World Health Organization
Established the High 5s Project, which Addresses major concerns about patient safety globally Uses *standardization* across multicountry settings and a multipronged approach to evaluating the standard operating protocols
functional nursing
Evolved as a result of World War II. Uses unskilled workers (OJT) (on the job training) to complete certain tasks. Care is assigned by task rather than by patient 1 medical staff completing only certain tasks- PCAs, LPNs
1.) Distinguish between a for-profit and a not-for-profit organization.
For- profit organizations are possessed by people who have stocks and shares in the company. These organizations run on money from investments and services. Not-for-profit organizations receive funding from other organizations like the government, grants, and donations from the public or other companies. These organizations do not have shareholders.
partnership nursing
In partnership nursing a RN is paired with a UAP and they always work together on the same schedule. The UAP is an extension of the RN. Depending on the model the nurse may hire the UAP or be assigned the UAP. The RN hold ultimate responsibility for the patient dyads and tryds always scheduled together
What are the potential complications of an inadequately staffed unit and/or poor skill mix?
Inadequately staffed units open opportunities for errors to occur. This can lead to medication errors, higher infection rates, nurse burnout, and even patient discontentment. Poor skill mix can also lead to poor patient care. Nurse managers must ensure the appropriate mix of RNs, LPNs, and UAPs. Managers must also consider the level of expertise that each person brings during a shift.
coaching
Involves assisting a person in achieving his or her goals by helping him or her develop, prioritize, and act on viable solutions Results in significant changes in an individual that motivate him or her to find fulfillment in the workplace
tertiary care
Involves restoration and rehabilitations Focuses on maintaining and improving current state of health Examples—rehabilitation centers and assisted living centers
360 degree feedback
Is constructive: nurses receive feedback from everyone around them Provides specific opportunities for the employee to use in his or her development plan
Annual performance appraisals are part of a nurse's employment. In your own words, what would you expect a manager to do to prepare and conduct your performance appraisal in an objective, productive manner
Keeping an organized filing system including employee information and notes regarding employee performance. Recording updated employee information. Schedule the appraisal a time when full attention can be given by both the manager and the employee. Ask the employee to evaluate their own performance. Inquire about previous and future goals. Explore improvement plans with the input of the employee. Encourage feedback discussion from the employee.
11.) What goals (protocols) does the WHO most recently list for patient safety?
Medication accuracy at transitions in care correct procedure at the correct body site use of concentrated injectable medicines communication during hand-off health-care-associated infections
effective communication
Nurse must communicate effectively with patients, other staff members, and physicians. Miscommunication can lead to misunderstanding, missed tasks, and errors which impair patient safety. Patients will also feel more satisfied with their experience if they feel that staff are listening and communicating with them. patients should have a say in their own care
Describe the many roles a nurse plays in regards to helping a unit meet the budget.
Nurses have to many roles that help the unit stay on budget. Nurse productivity, use of resources, efficiency in care, reducing infection risk, educating patients so that they are not readmitted within 30 days, and patient satisfaction are just to name a few.
Total Patient care
Oldest mode of organizing patient care. Nurses assume sole and total responsibility for meeting the needs of all assigned patients during their time on duty. All RN staff goes back to florence nightengale
Quality Improvement
Originated in other industries and developed into total quality management (TQM) Used by health-care organizations through the implementation of QI programs Entails a systematic and continuous series of actions that leads to measurable improvement in health care Incorporates four key principles QI works as systems and processes. There is a focus on patients. There is a focus on being part of the team. There is a focus on the use of data.
key points of an effective performance appraisal
Promotes successful work relationships, enhances employee development, and motivates staff to improve performance and productivity Ensures that feedback is based on facts Is conducted in a formal but relaxed atmosphere and in such a manner as to encourage productive exchange of ideas and joint problem solving Provides the employee feedback on his or her achievements Seeks input from the employee regarding plans for improvement and career plans Assists the employee in developing new goals and objectives for the upcoming year
Donabedian Model
Provides a framework for examining and evaluating the quality of health care by looking at three categories of information that can be collected to draw inferences about the quality of health care *Structure*—the conditions under which care is provided *Process*—the activities that encompass health care *Outcomes*—the desirable or undesirable changes in individuals as a result of health care Provides a starting point for any QI activity
Medicare
Provides health insurance for disabled persons and persons over the age of 65 To be eligible without a disability, must have worked a minimum of 10 years and paid into the Medicare Trust Fund federally funded covers dialysis
2.) Explain the importance of critical thinking skills in providing safe, high quality care.
Providing safe, high quality care of patients requires critical thinking that goes beyond the present. It considers what may happen in the future as well as past information, what information is still needed, and interactions that may occur.
staffing mix
Refers to the appropriate numbers of RNs, LPNs/LVNs, and UAPs needed on a unit Is based on the type of care required for specific patients and who is qualified to provide such care
self-appraisal
Reflecting on one's own personal actions and professional performance May include feedback from peers as well as patients and their families
nursing hours per patient day (NHPPD)
Represents the nursing care hours provided to patients by nursing personnel over a 24-hour period Usually based on unit census at midnight and reflects only nursing staff productive time
6 Aims for Health Care in the 21st century
Safe- avoid injuries to patients from care that is intended to help them Effective- providing services based on scientific knowledge, avoiding overuse, underuse, and misuse of care Patient-centered- provide care that is respectful of and responsive to individual patients' preferences, needs, and values, and ensuing that patients' values guide all decisions Timely- reducing waits and sometimes harmful delays for both those who receive and those who give care Efficient- avoiding waste, in particular of equipment, supplies, ideas, and energy Equitable- provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic locations, and socioeconomic status
3 stages for culture of safety
Safety management is based on rules and regulations. Good safety performance becomes an organizational goal. Safety performance is seen as dynamic and continuously improving
National Quality Forum
Sets standards for health-care measurements Identifies and accelerates quality improvement priorities Advances electronic measurement to capture necessary data needed to measure performance Provides information and tools to help health-care decision makers Aims to reduce preventable hospital admissions and readmissions, the incidence of adverse health-care-associated conditions, and harm from inappropriate or unnecessary care Establishes its own set of nursing-sensitive quality indicators
3.) What does SWOT stand for and what does a SWOT Analysis entail? Why is this done?
Strengths, weaknesses, opportunities, threats It start with gathering data and then categorizing the data in to one of the 4 areas above. Strengths and weaknesses come from people and systems within the organization. Opportunities and threats come from outside the organization. This analysis aids leaders in pinpointing areas that are succeeding, areas that could improve, and way to change for the better.
constructive feedback
Supports and motivates the employee to succeed and grow Involves showing respect and praising the employee for a job well done
7.) Explain the acronym for TRUST as to how you would represent each letter.
T- treatment- there are some things you just cannot help- like system errors. This is not an excuse, but a caution to be extra diligent. R- respect- people who make errors still deserve respect. Everyone makes mistakes. U- understanding- nurses who make mistakes need empathy and support, not judgement. S- support- nurses who make mistakes definitely need support from colleagues and may even need some sort of counseling to work through their feelings T- transparency- mistakes should always be brought to light right away. Mistakes should also open up more discussion about what can be done better
Team STEPPS
Team Strategies and Tools to Enhance Performance and Patient Safety Aimed at optimizing patient safety outcomes by *improving communication* and teamwork skills Focused on concise information exchange techniques, including the two-challenge rule, call out, and check-back *concise info exchange*
8.) What is the AHRQ? What role does the AHRQ play in quality?
The AHRQ is The Agency for Healthcare Research and Quality. The AHRQ built the Patient Safety Network which makes patient safety and quality care resources available to nurses and nurse managers.
12.) What role does PDSA play?
The PDSA is the actual plan that needs accomplished. It stands for plan, do, study, act. A plan is developed, carried out, assessed, and then implemented, changed, or thrown out.
IHI Model of Improvement
Three fundamental questions are asked in any order. *What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?* The Plan-Do-Study-Act (PDSA) cycle is implemented. Plan involves developing a plan to initiate a small change. Do is implementing the plan and collecting data about the process. Study includes studying and summarizing the results of the change. Act encompasses three possible actions: adopt the change, adapt the change, or abandon the change.
Key IOM reports
To Err is Human Crossing the Quality Chasm- 6 aims for healthcare improvement Health Professions Education- 5 core competencies for all health-care professions
IOM
To Err is Human report- the first report the IOM brings together experts and stakeholders to provide the nation with unbiased, evidence-based guidance on health-related issues. reports on the state of quality of the US healthcare system
performance appraisals
a formal evaluation of the work performance of an emplyee that is conducted by the nurse leader or manager To assess a new employee at the end of probationary status To provide recognition or constructive feedback For an annual performance review of past goals
managed care
a health plan that brings together the delivery and financing function into an entity goal is to decrease unnecessary services thereby decreasing costs use critical pathways - may have a target schedule for patients
cynfin
a sense-making model framework emerges from the data data preces framework** simple, complicated, complex, chaotic causual differences exist between system types
variance analysis
actual vs planned budget evaluation of the budget performance is usually obtained through variance analysis positive: the budgeted amount was greater than actual spending negative: the budgeted amount was less than actual spending the nurse manager must be able to explain the reasons for alteration from the budget
ACA
affordable care act Enacted into law in 2010, the goal is to reduce the number of uninsured persons in the United States by expanding Medicaid and implementing health-care exchanges. Provisions include Elimination of pre-existing conditions as a means of denial for insurance No annual limits on coverage Mandated coverage by employers with at least 50 full-time employees Extension of coverage to adult children to age 26 with individual and group health policies Inclusion of preventive services without cost sharing
autocratic
an authoritarian style of leadership that makes decisions without considering the input of others
intuitive thinking
an instant understanding of knowledge without supporting evidence. clear grasp of a situation based on background of similar situations
decision making at the unit and organization level
assessment diagnosis (analysis) outcomes identification planning implementation evaluation
average daily census
average number of patients on the unit on any given day over a period of time *total patients on the unit in 1 year/365 days*
average daily census
average total number of patients when census is taken over a given period of time, such as weekly, monthly, or yearly
futures thinking
bringing vision to the planning process, seeing the relevant opportunities that are emerging, and creating a desired future
quantum leadership
focuses on holistic and relational perspectives Looks at the system, the processes, and the relationships between workers and tasks to determine efficiency and job performance Offers nursing a framework in which to develop leadership skills to assist in advancing the goals of their organizations
universal healthcare
health care is funded solely through the government without the involvement of private party insurers
near miss
is a potential error that was discovered before it was carried out
indirect expenses
necessary for daily operations of the organizations but do not affect patients directly nurse manager salary, worker's comp, etc
grapevine communication
negative form of informal communication that flows quickly and haphazardly at all levels of organization and becomes distorted
workload
number of nursing staff required to deliver care for a specific time period; dependent on patient care needs
intraprofessional communication
nurse to nurse
interprofessional communication
nurses talking to doctors, lab, RT, PT, etc
calculating NCH-PPD (HPPD)
nursing hours worked in 24 hours/patient census pg 338
unsafe act
occurs in the presence of a potential hazard, sometimes as the result of a violation, not an error
adverse event
occurs when an injury to a patient is caused by medical management rather than the patient's underlying condition
Medicare Part B
provider, medical equipment, diagnostics pays for physician, nurse practitioner, the equipment they need at home original Medicare dialysis facility
culture of safety
provides a blame-free environment in which staff feel safe reporting errors and near misses
Slips, lapses, and mistakes
refer to actions that do not result in the intended outcome
chain of command
refers to a formal line of authority from the top to the bottom of the organization, with each unit connected to another
sentinel event
refers to a patient safety event that results in death, permanent harm, and severe temporary harm and intervention required to sustain life
nonproductive time
refers to benefit time, such as vacation hours, holiday time, sick hours, education time, and jury duty
unit of service
reflects the basic measure of nursing workload based on different types of patient encounters
downward communication
reflects the hierarchical nature of the organization and includes directives to employees, expectations for employees, and performance feedback from the top to the bottom
vision statement
reflects the image for the future the organization plans to create
zero-based budgeting
start the budget from zero each year as if each item on the program was brand new. managers must prioritize and justify or rejustify requested funds meticulously on an annual basis. what do you THINK will happen? and how much will you need
what is the second biggest cost?
supplies
unit intensity
takes into account the totality of the patients for whom care is provided and the responsibilities of nursing staff, some patients might need more resources than others
Nursing hours per patient-day (NHPPD)
the amount of productive nursing care hours per patient day in a 24-hour period *productive nursing hours worked in 24 hours/ patient census for 24 hours*
break-even quantity
the number of patient needed to break even *fixed costs/variable costs per patient*
productivity
the ratio of output (products and services) to input (resources used)
lateral communication
the sharing of information among nurse leaders and managers or other staff at the same level like-positions share information