Podcast
Questions and Answers
The "appropriateness" of care is
The "appropriateness" of care is
A medication is ordered for a diabetic patient. Its capacity to improve health status, as a dimension of quality or performance, is its
A medication is ordered for a diabetic patient. Its capacity to improve health status, as a dimension of quality or performance, is its
That dimension of quality/performance that is dependent upon evaluation by the recipients and/or observers of care is
That dimension of quality/performance that is dependent upon evaluation by the recipients and/or observers of care is
If in the continuous quality improvement process, we increase our emphasis on customer satisfaction and outcomes of care, which two dimensions of quality/performance must be incorporated into all quality management activities?
If in the continuous quality improvement process, we increase our emphasis on customer satisfaction and outcomes of care, which two dimensions of quality/performance must be incorporated into all quality management activities?
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Which of the following key healthcare issues is more problematic for ambulatory care than for inpatient care?
Which of the following key healthcare issues is more problematic for ambulatory care than for inpatient care?
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Incorporating TQM key concepts, compartmentalization of QM/QI activities by organizational structure, i.e., by department or discipline, is
Incorporating TQM key concepts, compartmentalization of QM/QI activities by organizational structure, i.e., by department or discipline, is
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One fundamental difference between monitoring product quality and service quality is based upon the fact that
One fundamental difference between monitoring product quality and service quality is based upon the fact that
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The quality professional can best facilitate the development of a “quality culture” in an organization by
The quality professional can best facilitate the development of a “quality culture” in an organization by
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The task of setting up an ambulatory care setting QM/QI program that focuses on "outcomes" as a measure of treatment effectiveness is difficult because
The task of setting up an ambulatory care setting QM/QI program that focuses on "outcomes" as a measure of treatment effectiveness is difficult because
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In developing a program to evaluate the effectiveness of physician care, a primary care clinic would select which one of the following indicators?
In developing a program to evaluate the effectiveness of physician care, a primary care clinic would select which one of the following indicators?
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The Quality Management Cycle, based on Juran's Quality Trilogy (quality planning, quality control, quality improvement)
The Quality Management Cycle, based on Juran's Quality Trilogy (quality planning, quality control, quality improvement)
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The perception of quality by a patient receiving care in an ambulatory healthcare center is influenced most by
The perception of quality by a patient receiving care in an ambulatory healthcare center is influenced most by
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Total quality management philosophy assumes that
Total quality management philosophy assumes that
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Outside the United States, most industrialized nations offer which type of healthcare insurance?
Outside the United States, most industrialized nations offer which type of healthcare insurance?
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That function in the Juran’s Quality Management Cycle that includes the initial analysis of Data / information is
That function in the Juran’s Quality Management Cycle that includes the initial analysis of Data / information is
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A potential conflict between the philosophy of total quality management and quality improvement in healthcare is the challenge in Deming's Principles to
A potential conflict between the philosophy of total quality management and quality improvement in healthcare is the challenge in Deming's Principles to
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The most basic components of managed care include all except
The most basic components of managed care include all except
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What is the most important relationship between structure, process, and outcome as types of indicators of quality?
What is the most important relationship between structure, process, and outcome as types of indicators of quality?
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Physicians working with health maintenance organizations (HMOs) in the U.S. may be organized in any of the following models except [Not for CPHQ Exam]
Physicians working with health maintenance organizations (HMOs) in the U.S. may be organized in any of the following models except [Not for CPHQ Exam]
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Continuous quality improvement efforts find problems in hospital admission .To provide breakthrough ideas in admission , the quality team seeks ideas from :
Continuous quality improvement efforts find problems in hospital admission .To provide breakthrough ideas in admission , the quality team seeks ideas from :
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Which of the following best describes the successful outcome of the quality improvement process?
Which of the following best describes the successful outcome of the quality improvement process?
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Monitoring the specific organization and content requirements of a medical record system is a review of which focus?
Monitoring the specific organization and content requirements of a medical record system is a review of which focus?
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The major difference between traditional "quality assurance" activities and the expanded quality improvement/performance improvement activities is the QI/PI focus on
The major difference between traditional "quality assurance" activities and the expanded quality improvement/performance improvement activities is the QI/PI focus on
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Monitoring phlebitis associated with IV insertions by nurses in the Surgical Intensive Care Unit addresses which focus?
Monitoring phlebitis associated with IV insertions by nurses in the Surgical Intensive Care Unit addresses which focus?
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The centerpiece of "outcomes management" in healthcare is
The centerpiece of "outcomes management" in healthcare is
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Study Notes
Quality Concepts
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Appropriateness of care is primarily a focus of utilization management. It's a key component of quality care, and equivalent to case management. Appropriateness describes the degree to which healthcare services are coherent and unbroken.
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A medication's capacity to improve health status (quality or performance) is its efficacy.
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Respect/caring is the aspect of quality/performance dependent on evaluation by recipients/observers of care.
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For continuous quality improvement, respect/caring and effectiveness are crucial components to incorporate into quality management activities.
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Access to specialty care is more problematic for ambulatory care than inpatient care.
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Compartmentalization of QM/QI activities by organizational structure (department/discipline) is a weakness in implementing quality improvement.
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A fundamental difference between monitoring product and service quality pertains to the fact that services are often more heterogeneous (difficult to measure in advance) than products.
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The quality professional best facilitates a quality culture by encouraging leaders to commit to a culture of excellence.
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Setting up an ambulatory care QM/QI program focused on outcomes is challenging because patients retain control of treatments and expected outcomes are often obvious.
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In evaluating physician care effectiveness, an indicator to use is the rate of control of newly diagnosed hypertensive patients within six months.
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The Quality Management Cycle, using Juran's Trilogy (quality planning, control, improvement), doesn't exclude lab activities for equipment management. Instead, it requires a centralized, or departmentalized approach; and it does incorporate information from strategic planning.
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Patient perception of quality is most influenced by caring staff and physicians.
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Total quality management philosophy emphasizes that issues with service delivery commonly stem from system difficulties, instead of individual employee issues.
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Outside the U.S., most industrialized nations offer universal healthcare coverage.
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The Juran Quality Management Cycle function that involves initial data analysis is quality planning.
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A potential conflict between total quality management and Deming's principles involves eliminating numerical management goals.
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Most basic components of managed care include all except broad choice of providers.
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The most important relationship between structure, process, and outcome of quality indicators is interdependent, where structure directly affects both process and outcome.
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Doctors working with HMOs within the United States utilize organizing models that aren't always the same as broker organizations.
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To receive breakthrough ideas, quality teams might find ideas from other healthcare facilities, previous lectures, and different industries like the automobile industry, hotels and resorts, and other relevant sources.
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The primary outcome of a quality improvement process is customer satisfaction.
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Monitoring medical record system specifics focuses on the structure of care.
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A significant difference between traditional quality assurance and expanded quality improvement is the QI/PI focus on systems/processes.
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Monitoring phlebitis in surgical patients focuses on evaluating elements of the process of care.
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The core of outcomes management in healthcare is measuring patients' functionality and quality of life.
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"Common causes" of process problems refer to chronic/consistent issues, not acute or one-time events.
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Review of the diabetes high-risk screening timeliness focuses on process of care.
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The concept of risk management mostly developed as a result of increased physician malpractice liability costs.
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Under the quality improvement paradigm, the incorrect statement is that the focus is on the competency of individual practitioners (it focuses on process/system competency instead).
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Total quality management emphasizes the responsibility of top management for quality communication, as an internal organizational issue not dependent on cost budgets.
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Healthcare providers' policies replaced "charitable immunity" with concepts of corporate liability and tort liability.
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The most common form of reimbursement for primary care physicians in managed care is capitation with withholds.
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The probability that each process step will occur as needed is called reliability.
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A healthcare organization's liability for employee negligence is known as respondeat superior.
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The typical or usual definition of organizational culture is assumptions about people and how work is done.
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Ostensible agency is the concept of liability for the conduct of independent practitioners acting as representatives of the healthcare organization.
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Prospective payment systems are for reimbursement prior to care being rendered.
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Prioritizing, measuring, and identifying effective process measurements are main applications for the Pareto Principle.
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Special cause variation within processes is identifiable, extrinsic, and assignable.
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"Managed competition" is usually grouped healthcare providers competing within a geographic region.
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The key goal of reengineering is to improve care processes.
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An integrated delivery system is a horizontal healthcare system.
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The Transitional Care Center aims to meet patient needs within an integrated delivery system through case management, which includes continued physical therapy, diabetic management, and home evaluation.
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The goal of quality improvement when common cause variation is discovered is reducing variation through established procedures and policies.
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Comorbidities within inpatient stays are patient conditions existent from admission and requiring treatment throughout the stay.
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Interdisciplinary teams often attempt breakthrough improvements to reduce delays.
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Reliability rating in a 5-step process is a product of the reliability rating of each individual step.
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Quality performance measures for success in implementing quality care bundles may include the number of patients meeting key steps, and the total measures met per total patients included in the sample group.
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An example of res ipsa loquitor would be a surgical team removing the wrong body part.
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Healthcare quality professionals who engage in impact assessments of an organization's quality culture evaluate organizational mission/vision statements, strategic plans, policies, and procedures.
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A successful merger/redesign effort within a healthcare system necessitates each organization involved to commit to fundamental change, for overall success.
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Success of a merged quality strategy depends on the team's understanding to solicit input from identified stakeholders.
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Creating a seamless continuum of healthcare care within a network system usually involves interfacing financial planning and information systems together with marketing endeavors.
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Leadership skills vital for quality redesign efforts include communication, negotiation, systems thinking, and effective planning, and financial strategy.
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In an integrated system, QI team process effectiveness is the main factor in quality strategy success.
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A clinical complication is not present at the time of admission, while comorbidities are typically present from admission.
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Evaluation of a healthcare system's structure requires evaluating bylaws, organizational charts, and community assessments.
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Understanding behavioral patterns over time during organizational adjustments is best understood using story telling, "The Five Whys," brainstorming, constructed gap hypotheses, creating line graphs, storytelling, Pareto charts, and brainstorming.
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In statistical process control, the initial step is to eliminate assigned reasons for variation.
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A healthcare organization seeking to adapt to contracting arrangements with reduced reimbursements should prioritize lean thinking activities to efficiently eliminate unnecessary steps, forms, and other responsibilities; and to prioritize process efficiency.
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Shifting quality emphasis from practitioners to process leads to better quality outcomes, through measures for optimizing the effectiveness for the care process itself.
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The medical group reorganization necessitates changes to staffing, position descriptions, and processes through a paradigm shift in organizational concepts.
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Provider financial incentives aligned with purchaser, payer, and provider performance can potentially lead to overutilization or underutilization depending on the incentive structures.
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The ideal method in determining customer types for a change in health care system is to determine who receives care services and who your facility employees serve during their workday.
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Lean thinking within a process can incorporate suppliers and inputs to identify wasteful aspects in the process.
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Measuring the event that requires further investigation is one definition of a process indicator.
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Practitioner credentials and privileges are reviewed via federal, state, and organizational standards of performance.
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Reviewing medical necessity and appropriateness of inpatient services is crucial through admission review and diagnosis-related group (DRG) validation methods.
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Utilization management includes care coordination/after-care planning, review of medical necessity/appropriateness, and resource allocation (timeliness, efficiency, cost).
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Evaluation of how many were able to receive a flu shot is a performance assessment evaluation of availability.
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To evaluate appendectomy surgeons, consider factors such as pre-operative screenings, surgeon information, patient diagnosis, and patient age.
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The most important patient safety issue for a utilization reviewer is medical necessity for the treatment involved.
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Performing a radiology department evaluation of repeat x-rays/rejections, timely report dictation, and patient wait times requires measuring process evaluations. Appropriate review is also needed.
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Zero waste in health care is determined by using resources efficiently.
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Appropriateness of appendectomy, when assessing, usually reviews pathology tests rather than preadmission or clinical tests or a patient's age.
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The evaluation of how many people caught influenza after flu shot administration measures the efficacy, not prevalence.
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Evaluation of patients developing influenza after a flu shot measures efficacy.
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Appropriateness is the dimension evaluated when choosing a chemotherapeutic medication for a hepatocellular carcinoma patient based on clinical trial data and lack of other treatment options.
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Patient-reported measures are most credible in evaluating patient-provider interactions.
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The least probable factor related to nurse response to alerts by a computerized drug utilization system is the patient's medical condition since the issue is more likely the number/appropriateness of alerts, or if the system is perceived as unhelpful or annoying.
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The primary role for external quality consultation regarding the selection of an alternative approach in certification is to uncover opportunities for improvements, not take the final decision or alleviate facility goals; it supports quality choices for improvements.
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Measuring the adequacy of the social service department's interventions involves evaluating the attainment of social service goals, the timeliness of referrals, and the adequacy of documentation in progress notes to ensure appropriateness.
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The purpose of a healthcare survey is the measurement of patient expectations.
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For successful CQI, required staff personnel include department supervisors, administrators, facilitators, staff members performing process-related tasks, and quality management representatives.
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Quality council is the staff group typically responsible for establishing QI direction.
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Everyone within an organization is responsible for quality improvement within the organization.
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The team leader is usually responsible for creating and implementing improvement project work plans with a set time frame, and the sponsor determines overall direction.
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The governing body is typically ultimately responsible for effective quality program implementation.
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To establish evidence-based practice guidelines, including those with resistance to the process involves a systematic review of appropriate interventions and treatments with those who resist the new process included in the review.
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Appropriateness and timeliness of diagnostic accuracy measure quality improvement in terms of valid use of medical knowledge and technology.
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The six dimensions of healthcare quality as outlined in the Crossing the Quality Chasm are safe, effective, patient-centered, timely, efficient, and equitable.
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The Joint Commission empowering customers through education materials for healthcare systems focuses on creating patient safety goals and empowering patients with knowledge to "speak up."
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Systems thinking links the structure, process, and outcome paradigm by understanding that systems are complex, open, and composed of multiple interacting elements that influence the output (structure, process, and outcome).
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Misuse of resources occurs when appropriate treatment services are provided poorly, which negatively affects patient outcomes; this could include poor communication or inaccurate processes, not only the dispensing of services.
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Mortality reviews analyze clinical errors and determine accountability and necessary corrective disciplinary actions.
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Purchasers/payers demand objective evidence for quality of care and cost management.
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Healthcare facilities concerned with overall patient quality, which includes safety, nutrition, and staff friendliness, will not focus on disciplinary processes to address patient safety and quality of care, but rather on processes for addressing and eliminating such issues.
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Integrating quality findings into governance and management requires aligning reimbursement systems, establishing effective policies and procedures, and possibly re-writing bylaws for governance and management to account for new data inclusion processes and strategies.
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TQM is a holistic management philosophy, while Six Sigma is a specific tool for reducing variation in products or processes.
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Total Quality Management (TQM) results in a change through emphasis on customer satisfaction, a reduction of hierarchical structure, and increased individual involvement in improvement processes.
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Walter Shewhart created statistical process control (SPC) methodology to chart variation within processes.
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Evaluating quality improvement program effectiveness requires integrated data collection, quantified objectives, well-defined culture and staff characteristics to establish performance criteria and standards.
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An indicator to assess staff commitment to a clinical procedure involves measuring the process of how closely staff follows procedure guidelines.
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For excellent hospital quality, staff members will not worry about reporting errors in their personnel files without having a culture that supports open communication of errors and a blame-free environment; and such a culture supports the process of improvement and learning.
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An assessment of quality improvement should evaluate compliance to mission/vision statements, strategic plans, policies, and procedures and to ensure they are followed.
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Quality culture spread through organizational leadership involves developing mission/vision statements, flexible management styles, and the creation of quality initiatives.
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Culture enhancement features such as excellence, no errors, and cooperation encourage better quality of care.
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The medical procedure follow-up to remove a misplaced surgical item is considered quality improvement, not quality control, or assurance.
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A Just Culture focuses on preventing unwanted and potentially harmful situations through a blame-free approach to medical errors by establishing a clear process for reporting and resolving errors without fear of reprimand or retribution.
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For an organization to create a safe quality culture, identification of safety risks and interventions, as well as input from external suppliers, is critical in developing organizational structure and support.
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Educating leaders in a healthcare organization is considered the most effective role of the quality professional in promoting cultural changes and quality.
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The organization's level of quality leadership training and the facility leadership's demonstrated people skills are vital for the success of quality improvements since this promotes the needed support and compliance.
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Fair and just culture is important since learning from errors is vital for reducing future errors.
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A survey of a random sample of 5% of all annual discharges/visits within a given organization provides a sufficient representation for reliable survey results related to patient satisfaction, but not when all people with names starting with A-E are surveyed since this is not a balanced or representative sample.
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Processes within a facility experiencing issues with call lights not being answered at night, finance billing issues related to outpatient/ambulatory processes, and lack of preadmission testing for inpatients all involve deploying a quality improvement team to re-evaluate and implement solutions; this is the initial approach for quality improvement issues.
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For turnaround improvement in outpatient x-ray reporting, teams should involve representatives from both facilities, including radiologists, primary care physicians, clinical staff, and administrators from both facilities.
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Pre-authorization is typically not needed in ambulatory care.
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Exceptions for JCAHO's no smoking policies are usually determined by a licensed independent practitioner, based on the specific situation.
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Predicting outcomes of care often proves difficult in ambulatory care because a multitude of variables impact outcomes, such as factors outside the control of the ambulatory care facility.
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A useful outcome measure for an ambulatory setting is evaluating claims data and tracking annual discharges and visits, especially if a representative sample is used for a survey.
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Primary care physicians may be less likely than other staff groups, such as nurses, to report errors, as they may be unaware of errors or lack an incentive to report them, leading to potential errors going unreported.
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The best measure to evaluate a reliability of 96.1% in a care bundle implementation for pneumonia patients would involve individual and composite process measures, not an all or nothing approach or inpatient deaths due to the illness; measuring patient care improvement is a more relevant approach.
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Additional note: "process outcome" and "clinical outcome" are often used interchangeably to measure performance aspects, and they differ only in the type of outcome measured.
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Description
This quiz explores the essential quality concepts within healthcare management, including appropriateness of care, efficacy of medication, and the roles of respect and effectiveness in quality improvement. Participants will learn about the challenges related to access and the impact of departmental structures on quality management activities.