Chapter 12: Quality of Care: From Quality Assurance and Improvement to Cultures of Patient Safety Flashcards
Which statement is true regarding the public perception of health care?
a. Health care is considered to be a right.
b. Health care is believed to be accessible to all.
c. Health care is considered to be a privilege.
d. Health care providers administer minimal care.
ANS: A
The Canadian public perceives health care to be a right, not a privilege, and expects that health care providers will administer not just care, but quality care.
Historically, quality assurance in health care was defined as being which one of the
following?
a. Media campaigns targeting satisfied patients
b. Self-regulating activities of various professions
c. Actions designed to improve processes and outcomes
d. Increasing attentiveness and responsiveness to those receiving care
ANS: B
Historically, quality assurance in health care was defined as the self-regulating activities of various professions.
Continuous quality improvement (CQI) in health care includes which of the following
actions?
a. Controlling the staffing budget
b. Integrating internet technology into practice
c. Educating staff on principles of primary health care
d. Responding to patient experience surveys
ANS: D
Patient experience (satisfaction) is an important quality indicator that is used widely in
nursing management. Patient experience surveys are meant to help organizations
understand whether the patient felt safe, whether the patient felt involved as a partner in their care planning, and whether they felt they were treated with dignity and compassion.
The first documented study in health care and nursing based on standards is attributed to which following person?
a. Jean Watson
b. Virginia Henderson
c. Florence Nightingale
d. Sister Mary Dorothy Ross
ANS: C
The first documented study in health care and nursing, based on the use of standards, is attributed to Florence Nightingale, who, in 1858, investigated the quality of care provided to military personnel.
Which committee became responsible for accrediting hospitals, beginning in 1958?
a. Commission for the Study of Hospitals
b. Joint Committee on Accreditation of Hospitals
c. Canadian Council on Hospital Services Accreditation
d. Canadian Association of Hospital Accreditation Board
ANS: C
In 1952, the Joint Committee on Accreditation of Hospitals (JCAH) was formed, assuming responsibility for accrediting Canadian hospitals until 1958, when the Canadian Council on Hospital Services Accreditation (CCHSA) was established to accredit health care agencies in Canada.
Which of the following is the common denominator of all quality assurance programs?
a. Process
b. Outcome
c. Standards
d. Structure
ANS: C
The common denominator of all quality assurance programs is standards.
Which of the following reflects a process standard in the proposed levels for assessing quality?
a. Nursing activities
b. Environmental characteristics
c. Anticipated results of the care provided
d. Philosophy and mission of the institution
ANS: A
Process standards are focused on nursing roles and activities to meet patient care goals. Examples of process standards include the nursing process, communication between nurses and patients, and nursing activities.
Which type of validity was established with the majority of instruments that were
developed to measure quality assurance?
a. Face validity
b. Content validity
c. Concurrent validity
d. Predictive validity
ANS: A
Most instruments have demonstrated little more than face validity, raising questions about the value of results in quality assessment programs using inadequately tested instruments.
Which one of the following is a limitation of most quality assurance programs?
a. The high validity of the instruments used for evaluation
b. The retrospective focus on achievement of standards
c. The need to achieve predetermined standards in the clinical setting
d. The acceptable reliability of the instruments used for assessment
ANS: B
A limitation of quality assurance programs is the retrospective focus on achievement of standards. Considerable emphasis of quality-monitoring activities occurred after the fact when it was least possible to make necessary changes.
For which percentage of the time were critical standards expected to be achieved in quality assurance programs, in relation to the level established by the program directors?
a. 50%
b. 75%
c. 90%
d. 100%
ANS: D
The foundation of quality assurance programs—achieving predetermined standards in the clinical setting—was seen as somewhat arbitrary. Administrators and program directors established the level to which each standard was to be achieved. Critical standards were expected to be achieved 100% of the time, while less critical standards, perhaps 80% to 90% of the time.
What is the goal of methods used to standardize the process of continuous quality
improvement?
a. Detection of errors
b. Prevention of errors
c. Identification of people problems
d. Evaluation of organizational functioning
ANS: B
The goal of continuous quality improvement is prevention, not detection, of errors. Quality improvement is a continuous cycle of improving processes before errors are made or complaints are received. Doing the right thing the first time and all the time is considered much more cost-effective than redoing work.
Which one of the following is an associated domain of outcomes measurement?
a. Nursing care plans
b. Nursing care pathways
c. Evidence-informed best practice guidelines
d. Professional association standards of practice
ANS: C
An associated domain of outcomes measurement is the use of evidence-informed best practice guidelines as a support to nurse decision making in the delivery of quality nursing care.
What clinical outcome was supported in the Canadian Council on Health Services
Accreditation (CCHSA) Survey Standards in the early 1990s and is now reflected in the
C-HOBIC standards of care in Canada?
a. A quality improvement focus
b. Facility-wide integration of processes
c. Clinical outcomes for evidence-informed nursing practice
d. Methods for identifying unsafe practice by health care providers
ANS: C
In the early 1990s, the CCHSA Survey Standards included clinical outcomes to support
evidence-informed nursing care that are now reflected in the C-HOBIC standardized
clinical outcomes.
Which one of the following is a modern example of a quality-monitoring instrument?
a. A chart audit
b. A workload measurement tool
c. A Pareto chart for delay in patient transfer
d. A performance appraisal process
ANS: C
An example of a quality-monitoring instrument is a Pareto chart, which uses data derived from a check sheet that shows the frequency of occurrence. If a team is studying reasons for delay in patient transfer, a Pareto chart will determine the specific factors that cause delays 80% of the time.
Which following quality management tool would be the most appropriate for displaying data over time—for example, showing the length of time a non-emergent patient waits to see a nurse in the emergency department?
a. A flow chart
b. A histogram
c. A run chart
d. A check sheet
ANS: C
The most appropriate quality management tool for displaying data over time (e.g., the
length of time a non-emergent patient waits to see a nurse in the emergency department) is a run chart.
