Systems Management PDF

Systems Management You have just taken a new position as QM Director at the 350-bed Sunshine Community Medical Center in San Diego County, California. You report to the Vice President, Administrative and Support Services. Your first responsibility is to provide administration with an evaluation and...

Systems Management You have just taken a new position as QM Director at the 350-bed Sunshine Community Medical Center in San Diego County, California. You report to the Vice President, Administrative and Support Services. Your first responsibility is to provide administration with an evaluation and recommendations concerning the current status of the quality management program. Use this information to answer the following: One of your first key issues to determine when evaluating the current QM program is a. the climate for change in each department and service. b. the extent of leadership knowledge of and involvement in quality activities. c. the operating budgets for the quality, utilization, and risk management departments. d. Responses to accreditation recommendations following the last two surveys Janet - CH 3 – Systems Management You have just taken a new position as QM Director at the 350-bed Sunshine Community Medical Center in San Diego County, California. You report to the Vice President, Administrative and Support Services. Your first responsibility is to provide administration with an evaluation and recommendations concerning the current status of the quality management program. Use this information to answer the following: In evaluating the current QM program for strengths and weaknesses, it is NOT necessary to assess a. strategic initiatives. b. managed care contracts. c. team minutes. d. alternative QM software products Janet - CH 3 – Systems Management You have just taken a new position as QM Director at the 350-bed Sunshine Community Medical Center in San Diego County, California. You report to the Vice President, Administrative and Support Services. Your first responsibility is to provide administration with an evaluation and recommendations concerning the current status of the quality management program. Use this information to answer the following: The written evaluation should include a. recommendations and resources required to implement them. b. persons concerned about quality problems. c. recommendations for staff salary raises. d. only recommendations that fall within current budget constraints Janet - CH 3 – Systems Management You have just taken a new position as QM Director at the 350-bed Sunshine Community Medical Center in San Diego County, California. You report to the Vice President, Administrative and Support Services. Your first responsibility is to provide administration with an evaluation and recommendations concerning the current status of the quality management program. Use this information to answer the following: Your initial report should be addressed to the a. Quality Council. b. Vice President, Administrative and Support Services. c. CEO. d. Board of Directors Janet - CH 3 – Systems Management The formal functions of management include all except a. planning. b. organizing. c. directing. d. inspecting Janet - CH 3 – Systems Management A large emergency department (ED) reduced its average length of stay for discharged patients from 130 minutes to 1 hour with a goal to improve patient satisfaction. How best might the ED know the changes were also effective financially, as part of a cost-benefit analysis? a. Decreased staffing and decreased costs b. Increased staffing and increased net revenue c. Increased patient volume and increased net revenue d. Increased patient volume and increased staffing Janet - CH 3 – Systems Management Which of the following issues might be most important to health maintenance organizations negotiating contracts with providers? a. Quality/utilization capabilities, disclosure of data, reimbursement b. Disclosure of data, practitioner credentialing, computer capabilities c. Staffing, accreditation, reimbursement d. Reimbursement, physician board certification, malpractice claims Janet - CH 3 – Systems Management Which of the following issues might be most important to a medical group or IPA (independent practice association) negotiating contracts with health plans? a. Reimbursement, physician board certification, staffing b. Data requirements, credentialing requirements, reimbursement c. Credentialing requirements, computer capabilities, MCO accreditation d. Data requirements, MCO accreditation, reimbursement Janet - CH 3 – Systems Management Which of the following issues might be most important to hospitals negotiating contracts with health plans? a. MCO accreditation, bylaws, medical staff practitioner credentialing requirements b. Staffing, reimbursement, confidentiality of peer review information c. Computer capabilities, MCO accreditation, review requirements d. Data requirements, confidentiality of peer review information, reimbursement Janet - CH 3 – Systems Management A quality professional in a home health agency is charged to develop a quality management/ quality improvement strategy. Of the following steps, which should be done first? a. Develop strategic quality initiatives b. Determine the roles of leaders in implementation c. Draft the QM/QI plan for review by leaders d. Review the organization's scope of care and service Janet - CH 3 – Systems Management Which of the following is not relevant to include in both utilization management and quality management plans? a. Confidentiality policy b. Process for appealing treatment denials c. Conflict of interest policy d. Provision for annual program evaluation Janet - CH 3 – Systems Management The principle underlying the selection of an organizationwide quality council is a. one oversight body b. leadership control c. one cross-functional team d. elimination of department/service quality control Janet - CH 3 – Systems Management Why should a UM Plan include a conflict of interest statement? a. To provide for unbiased decisions b. To prevent economic credentialing c. To provide for security and integrity of information d. To provide immunity for physician reviewers Janet - CH 3 – Systems Management The term "corporate compliance plan" refers to the healthcare organization’s a. licensure survey corrective action plan. b. annual financial audits. c. program to prevent fraud and abuse. d. agreement to collect HEDIS® data. Janet - CH 3 – Systems Management A hospital Utilization Management Plan generally includes provision for a. disaster planning. b. transition planning. c. quality planning. d. financial planning Janet - CH 3 – Systems Management The managed care organization’s use of a 24-hour nurse-staffed telephone hotline to inform member/patient callers of care options and provide self-management education is a type of: a. preauthorization. b. case management. c. disease management. d. demand management. Janet - CH 3 – Systems Management The key advantage of case management in managed care is a. control of clinical risk. b. control of hospital use. c. coordination of care. d. prevention of illness. Janet - CH 3 – Systems Management The practical motivation for American Healthplan HMO to develop a disease management system based on practice guidelines and clinical paths is a. capitation. b. healthcare reform. c. collection of HEDIS® data for NCQA. d. its mission as a health maintenance organization. Janet - CH 3 – Systems Management An 85-year-old woman is admitted through the Emergency Department with a fractured right hip. When should discharge planning begin? a. After surgery, once the physical therapist has done an assessment b. When the physician writes a discharge planning order c. At time of admission to the acute hospital d. When the decision is made concerning the next level of care Janet - CH 3 – Systems Management As Director of Quality Resource Management for an integrated delivery system, you have been asked to provide information prior to renegotiation of a contract with a national Preferred Provider Network. What data will be most helpful? a. Reimbursement minus charges b. Reimbursement minus costs c. Charges minus reimbursement d. Charges minus costs Janet - CH 3 – Systems Management Negligence means a lack of proper care. In medical malpractice "proper care" is determined by a. Joint Commission standards. b. jury of civilian peers. c. tort law. d. medical peers. Janet - CH 3 – Systems Management The written scope of care and service of a healthcare organization is best described as a. a plan describing the linkages between care processes and outcomes. b. the delineated activities performed by governance, management, clinical, and support personnel. c. a logical sequence of operations to be performed to care for and serve delineated populations of patients. d. an interactive series of steps, processes, functions, and systems Janet - CH 3 – Systems Management Being immediately responsive and attentive to a family's concerns following a patient's fall in the subacute care facility is a. loss reduction activity. b. loss prevention activity. c. risk shifting activity. d. risk avoidance activity. Janet - CH 3 – Systems Management The utilization management committee for a large medical group is concerned about underutilization. Which data supports the concern? a. Lab report delays b. Reduced pediatric hospitalization rates c. Increased incidence of C-Sections d. Reduced pediatric immunization rates Janet - CH 3 – Systems Management The key issue in integrating the functions of utilization management, quality management, and clinical risk management revolves around a. consolidation of leadership. b. information management. c. control by the quality council. d. cross-training staff. Janet - CH 3 – Systems Management Your freestanding Radiology Center did 200 outpatient CT scans each of the last two years. The average reimbursement rate has decreased from $200 to $150. The scanner and room need repairs estimated at $100,000. There are two other CT scanners in your immediate vicinity. The most likely decision resulting from a cost-benefit analysis would be to a. quit doing CT scans. b. repair the scanner. c. contract with a competitor for referral fees. d. market heavily and postpone the repairs for 6 months. Janet - CH 3 – Systems Management According to Total Quality Management principles, managers should a. lead with autocratic decision making. b. communicate successes or failures only to the boss. c. lead with participative decision making. d. focus on short term financial impact of quality improvement techniques. Janet - CH 3 – Systems Management Sunshine Community Medical Center had begun performing angioplasty procedures for cardiac patients in anticipation of providing cardiovascular surgery services. The administration then failed to negotiate a contract with the cardiac surgery team of physicians. The hospital and its cardiologists then negotiated an exclusive contract with another hospital in the area to refer all cardiac patients needing angioplasty to that facility. This action constitutes a. risk retention. b. risk avoidance. c. risk shifting. d. risk prevention. Janet - CH 3 – Systems Management Community case management and disease management programs make the most economic sense for which type of reimbursement? a. Fee-for-service b. Shared capitation c. Discounted fee-for-service d. Diagnosis-related group Janet - CH 3 – Systems Management Your hospital case management program monitors length of stay (LOS) by condition. LOS for four conditions has decreased slightly each of the last six quarters. To evaluate cost and quality of care impact, you recommend which measures? a. Denials, comparison with previous two years LOS, readmissions b. Staff productivity changes, reimbursement, LOS at next level of care c. Reimbursement, comparison with conditions with increasing LOS, denials d. Outcome of transition plan, reimbursement, readmissions Janet - CH 3 – Systems Management In revising the Utilization Management (UM) Plan, which of the following is most important to consider? a. External UM contract requirements b. Accreditation survey results impacting UM c. UM performance measure results d. Clinical pathway length of stay variances Janet - CH 3 – Systems Management In your organization, Quality Management (QM) and Risk Management (RM) are separate departments. As QM Director, you recognize the importance of linking with Risk Management to prevent or reduce risk and maximize patient safety. Use this information to answer questions: How can Quality Management link with Risk Management on peer review cases? a. Provide information about peer review actions b. Provide information about patient occurrences c. Provide aggregate occurrence data d. Meet with RM Director regularly in confidence Janet - CH 3 – Systems Management In your organization, Quality Management (QM) and Risk Management (RM) are separate departments. As QM Director, you recognize the importance of linking with Risk Management to prevent or reduce risk and maximize patient safety. Use this information to answer questions: Of the following, sharing which data best supports risk prevention? a. Annual practitioner profiling b. Monthly event/occurrence reporting c. Root cause analysis d. Failure mode and effects analysis Janet - CH 3 – Systems Management In your organization, Quality Management (QM) and Risk Management (RM) are separate departments. As QM Director, you recognize the importance of linking with Risk Management to prevent or reduce risk and maximize patient safety. Use this information to answer questions: One of the three aspects of quality discussed in Chapter I concerns "perceptive quality," the perspective of the recipient or observer of care. Of the following options, how might this aspect of quality best be utilized in linking the QM and RM goals? a. Involve the patient in ideas to improve safety. b. Teach the patient self-care. c. Involve the physician in ideas to improve safety. d. Teach the staff effective hand-washing Janet - CH 3 – Systems Management Comprehensive Health integrated delivery system IDS) consisted of four acute care hospitals, a behavioral health center, two long-term care facilities, and an ambulatory surgery center. One year ago, after cost- benefit analysis, the IDS added a home health agency, with investments in a building, staff, marketing, computer system, and other equipment and materials. Tracking expenses and revenue over time, when would you expect a return on investment (ROI)? a. After two years b. At the break-even point c. When revenue consistently exceeds expenses d. When patients consistently use agency services Janet - CH 3 – Systems Management Most commonly the primary purpose for incident/occurrence reporting is to a. record infection rates. b. identify medication errors. c. identify adverse patient events. d. identify patient grievances Janet - CH 3 – Systems Management At Sunshine Community Medical Center, occurrence forms are sent directly to the risk manager, who summarizes the data and submits quarterly reports of the prior quarter’s data (totals and some rates) to administration and the governing body. Use this information to answer questions: Why might this process be considered inadequate, based on PI process principles? a. The process does not include priorities for data collection. b. The report does not include data collection tools. c. The report does not include claims information. d. The process does not trend the data over time. Janet - CH 3 – Systems Management At Sunshine Community Medical Center, occurrence forms are sent directly to the risk manager, who summarizes the data and submits quarterly reports of the prior quarter’s data (totals and some rates) to administration and the governing body. Use this information to answer questions: What is another reason this process should be improved? a. Occurrence indicators should first be approved. b. The process is not collaborative with other PI activities. c. There is no cost data included in the report. d. The process does not identify responsibility for investigating the occurrence Janet - CH 3 – Systems Management Over the last few months, the organization has experienced several adverse events concerning trips and falls on the grounds outside, although without serious injury to date. Use this information to answer questions What can the Quality Professional do to best facilitate risk reduction? a. Coordinate a failure mode and effects analysis. b. Coordinate a root cause analysis. c. Recommend new lighting for the areas involved. d. Research the events to identify a pattern. Janet - CH 3 – Systems Management Over the last few months, the organization has experienced several adverse events concerning trips and falls on the grounds outside, although without serious injury to date. Use this information to answer questions Which of the following offers the best rationale for the Quality Professional’s involvement in this situation? a. Successful prework improves team efficiency. b. Successful proactive improvement activities improve processes. c. Successful improvement activities reduce costs. d. Successful reactive improvement activities minimize recurrence. Janet - CH 3 – Systems Management Your organization has approved a new strategic initiative that will change a key clinical service in which a sentinel event occurred. When is it most important for leaders to participate? a. During the design process b. During intensive analysis c. When approving the planned improvement d. When reviewing the effectiveness data Janet - CH 3 – Systems Management One of the best ways for a patient safety program to be effective is to provide anonymity in a. root cause analysis. b. individual case review. c. occurrence/incident reporting. d. decision making Janet - CH 3 – Systems Management In a cost-benefit analysis of a bar-code medication administration system, implemented as part of a patient safety program, which of the following would be the best indicator of success: a. A decrease in adverse drug events from dispensing errors b. A decrease in adverse drug events from administering errors c. A decrease in total medication errors d. A decrease in total adverse drug events Janet - CH 3 – Systems Management As part of the program to improve patient safety, you will make many core process changes, including changes to improve the organizational culture as it relates to patient safety. The percentage of staff reporting a positive safety climate measures a. the outcome of educational efforts. b. the attitude of staff toward leadership. c. the effectiveness of the program. d. the results of a process change. Janet - CH 3 – Systems Management If leadership is the critical success factor for an effective patient safety program, what is the first key responsibility of leaders? a. Provide resources. b. Set strategic goals. c. Establish the value system. d. Designate a champion. Janet - CH 3 – Systems Management The determination of annual National Patient Safety Goals is linked to reported a. sentinel events. b. adverse events. c. core performance measures. d. claims. Janet - CH 3 – Systems Management Nurses and pharmacists are encouraged to report medication errors upon first knowledge of occurrence. What is the most important thing the organization can do to support them in this effort? a. Instill a culture of accountability. b. Instill a culture of no blame. c. Provide computerized physician order entry. d. Provide adequate nurse staffing. Janet - CH 3 – Systems Management A patient using a large exercise ball in outpatient rehabilitation fractures three ribs when the ball bursts and she falls onto the floor. The risk manager tells the patient that all costs of care will be covered. Of the following, this action best represents risk a. avoidance or prevention b. assessment or analysis c. transfer or shifting d. handling or intervention Janet - CH 3 – Systems Management