CPHQ Flashcards
1
Q
- According to the Institute of Medicine, which of the following is NOT one of the domains of quality care?
a. Government regulation
b. Customization
c. Safety
d. Interventions consistent with the latest medical findings
A
- A: According to the Institute of Medicine, the three domains of quality care are customization, safety, and interventions consistent with the latest medical findings. These domains provide the basic structure for the IOM’s recommendations about quality care originally presented in the groundbreaking book To Err Is Human. Government regulation is an essential part of quality care, but it is not a domain in itself. Instead, the IOM recommends that healthcare facilities work with government agencies to develop fair but efficient regulatory policies that protect practitioners and patients alike.
2
Q
- Which of the following groups is least likely to report errors?
a. Primary care physicians
b. Support staff
c. Independent contractors
d. Nurses
A
- C: Independent contractors are the group least likely to report errors. In part, this is because they have the least personal interest in the success of the health care facility. Also, an independent contractor is more likely to view his employment as tenuous, and is therefore more nervous about admitting mistakes. A system that explicitly avoids punishing those who report will improve the incidence of error reporting among independent contractors.
3
Q
- Which of the following is NOT one of the types of quality problems identified by the Institute of Medicine’s National Roundtable on Health Care Quality?
a. Misuse
b. Abuse
c. Overuse
d. Underuse
A
- B: Abuse is not one of the types of quality problems identified by the Institute of Medicine’s National Roundtable on Health Care Quality. Misuse, overuse, and underuse are the three most common problems; they also represent three sources of waste in health care. The National Roundtable on Health Care Quality was significant because it asserted that the provision of health care services can be assessed with scientific precision. This was a major step towards incorporating business and manufacturing productivity systems in health care.
4
Q
- In behavioral health, the most important sentinel event for root cause analysis is…
a. Discharge
b. Death
c. Recovery
d. Medication error
A
- B: In behavioral health, the most important sentinel event for root cause analysis is death. A sentinel event is any adverse occurrence that is outside the range of the normal progression of the diagnosed illness. In other words, death can only be a sentinel event when it occurs in patients who are not expected to die. In cases where death is not considered likely, it is usually the most important sentinel event, because it is the one that most urgently requires investigation and prevention. The term sentinel event was popularized by the Joint Commission on Accreditation of Healthcare Organizations.
5
Q
- It is easy to conduct a survey of medication-related errors because…
a. There are very few of them relative to other types of error
b. Deaths caused by such errors are rarely discovered
c. Such errors have small but noticeable effects on health care costs
d. Prescription-drug use is common and well documented
A
- D: It is easy to conduct a survey of medication-related errors because prescription drug use is common and well documented. For this reason, there is a vast literature on the subject. However, many other types of error remain relatively unexplored. For instance, latent errors, like those related to poor training or improper calibration of equipment, are much less likely to be analyzed. Nevertheless, it is important to continue analyzing medication-related errors, both because they are quite common and because they are dangerous and costly. There is currently a movement to establish a standardized medication-error reporting system that will enable the compilation of statistics on a larger scale.
6
Q
- In a successful lean healthcare facility, the largest costs related to quality will be incurred by…
a. Preventive efforts
b. Internal failures
c. Assessment programs
d. External failures
A
- A: In a successful lean healthcare facility, the largest costs related to quality will be incurred by preventive efforts. Indeed, a lean facility is likely to spend much more than another facility on prevention. A lean facility saves money by reducing errors and eliminating waste. Moreover, prevention programs in a lean facility tend to be more efficient and targeted. Over time, a lean healthcare facility may be able to phase out certain elements of prevention.
7
Q
- When is the best time to discuss the results of a meeting exit survey?
a. Immediately upon receiving the responses
b. At the beginning of the next meeting
c. Via email in the interim before the next meeting
d. These results should not be discussed
A
- B: The best time to discuss the results of a meeting exit survey is at the beginning of the next meeting. This gives the team members the best opportunity to apply the results of the survey immediately. A facilitator should use an exit survey to improve the protocol of meetings. It is best for these surveys to remain anonymous so that respondents will feel comfortable being honest. E-mail is not a good medium for exit surveys because it creates a permanent and traceable record and therefore discourages honesty.
8
Q
- Whenever possible, medication orders should be by…
a. Weight
b. Volume
c. Dose
d. Strength
A
- C: Whenever possible, medication orders should be by dose. This is the most important variable related to medication, and the one which has the most relevance to the products actually used by the patient. Medication orders that are classified by weight, volume, or strength are often confusing to pharmacists. Moreover, several different unit systems (e.g., metric or SI) may be used, so there is a greater risk of error. To reduce the possibility of mistakes, healthcare facilities should standardize the protocol for medication orders.
9
Q
- What is the best explanation for the relatively slow introduction of lean practices into medical laboratories?
a. The variability and complexity of the samples in a laboratory is much higher than in a manufacturing environment
b. Scientists are less receptive to the core principles of lean
c. Medical laboratories function differently than factories
d. Medical research is mostly funded by the government
A
- A: The best explanation for the relatively slow introduction of lean practices into medical laboratories is that the variability and complexity of the samples in the laboratory is much higher than in a manufacturing environment. In laboratories, it is common for a huge number of slightly different samples to be processed. A simple assembly line approach to laboratory processes is rarely successful. However, there are striking analogies between manufacturing and laboratory work, and laboratories can drastically improve efficiency by adopting lean practices. Contrary to the beliefs of some, lean practices do not discourage innovation. Instead, they enable laboratories to handle greater volume and diversity without sacrificing quality.
10
Q
- A simple but effective way for managers to obtain the support of team members is to…
a. Threaten punishment
b. Ask for it
c. Mandate it
d. Ignore the team members
A
- B: A simple but effective way for managers to obtain the support of team members is to ask for it. Unfortunately, many assertive managers feel that openly requesting buy-in from team members is a sign of weakness. What they do not realize is that the members of a team are more likely to respond positively to a leader who they believe is humble and capable of admitting that he needs help. Threats and coercion only antagonize subordinates. In a healthcare facility, team leaders are likely to be dealing with healthy egos. The best way to elicit the support of confident and independent doctors and nurses is to request it directly.
11
Q
- A delay in discharging patients is likely to cause recurrent bottlenecks in…
a. Admissions from the emergency room
b. The filling of prescriptions
c. Admissions from surgical wards
d. All of the above
A
- D: A delay in discharging patients is likely to cause recurrent bottlenecks in admissions from the emergency room and surgical wards and in the filling of prescriptions. Indeed, the negative consequences of discharge delays may include the creation of other bottlenecks. It is important to recognize that inefficiencies in one area of service provision can cause inefficiencies in many other areas. A bottleneck occurs when there are not enough resources available to perform all of the functions necessary at a given time. Discharge delays waste time, money, and resources.
12
Q
- Which of the following conditions should a quality assessment program NOT examine?
a. A condition that is thought to be treatable
b. A condition for which the treatment is susceptible to significant influence by health care providers
c. A condition that has cost-effective treatments
d. A rare condition that has a small effect on mortality or morbidity
A
- D: A quality assessment program should not include rare conditions that have a small effect on mortality or morbidity. Such conditions have a limited bearing on the overall success of care. There is a general agreement as to which conditions are appropriate for inclusion in a quality assessment program. A condition should meet five criteria. First, it should either be common or have a significant effect on morbidity or mortality. Second, there should be scientific evidence that there are treatments effective at preventing or mitigating the effects of the condition. Third, it should be established that improvement in the quality of treatment for the condition will improve overall health. Fourth, the condition should have cost-effective interventions. Finally, the interventions for the condition should be susceptible to significant influence by health care providers.
13
Q
- A doctor fails to administer an indicated test, and the patient’s condition deteriorates to the point that he must be admitted to an inpatient facility. This is an example of…
a. Preventive error
b. Treatment error
c. Diagnostic error
d. Communication error
A
- C: When a doctor fails to administer an indicated test and the patient has an adverse result, the doctor has committed a diagnostic error. A diagnostic error is committed whenever a condition is misidentified or an indicated test is not performed. A diagnostic error can result in even more errors in the future. A preventive error is a mistaken approach to avoiding a condition, while a treatment error is a mistake related to the resolution of a condition. A communication error may occur between two service providers or between a service provider and a patient.
14
Q
- When is the best time for chairing during a meeting?
a. One hour beforehand
b. At the beginning
c. In the middle
d. At the end
A
- B: The best time for chairing is at the beginning of a meeting. In most cases, the facilitator and the chairperson of the meeting are two different people. The chairperson is responsible for reviewing the minutes from the previous meeting and eliciting feedback from team members. A facilitator may be charged with organizing and moderating discussion, but the introduction to the meeting is typically conducted by the chairperson. In many situations, it is appropriate to rotate the chairing duties.
15
Q
- Which of the following does NOT contribute to evidence-based practice in healthcare?
a. Clinical expertise
b. Evidence collected by expert panels
c. Tradition
d. Patient preferences
A
- C: Tradition does not contribute to evidence-based practice in healthcare. The evidence-based practice movement consists of a renewed emphasis on scientific rigor and empirical data. The preferences of patients are considered, but the primary determinant of intervention and therapy is the evidence from research studies and the experience of practitioners. Traditional methods of therapy may be investigated to determine their efficacy, but they are not used for sentimental or cultural reasons. In addition to clinical expertise, evidence, and patient preferences, evidence-based practice devises therapies based on patient history and the availability of resources.
16
Q
- Which of the following is vastly different from the others?
a. SIPOC
b. DMAIC
c. PDCA
d. PDSA
A
- A: SIPOC (suppliers, inputs, process, outputs, customers) is different from the other three acronyms, which are sequential programs for quality improvement. SIPOC, on the other hand, is a form of diagram that enables Six Sigma practitioners to identify the important components of process improvement. DMAIC (define, measure, analyze, improve, control) is a general structure for eliminating defects. Similarly, PDCA (plan, do, check, act) and PDSA (plan, do, study, act) are structures for the improvement of processes.
17
Q
- In the perfect lean enterprise, delivery to the customer is…
a. Instantaneous
b. Rapid
c. Customizable
d. Optional
A
- A: In the perfect lean enterprise, delivery to the customer is instantaneous. Of course, instantaneous delivery is rarely possible. Nevertheless, the strategy of lean enterprise is to examine all of the ways in which service provision deviates from the ideal, and then to minimize these ways as much as possible. A lean healthcare facility will never attain instantaneous delivery, but it can continually improve by aiming for this standard. Of the other answer choices, it is true that lean enterprises often offer customizable delivery, but this is not a necessary condition of lean enterprise.
18
Q
- A presentation on the basic structures and processes of clinical governance would be most useful…
a. For small teams of employees
b. For the organization as a whole
c. For the directorate
d. For individual employees
A
- B: A presentation on the basic structures and processes of clinical governance would be most useful for the organization as a whole. Such a general presentation would really only be effective as an introduction for the entire organization. Other presentations, such as those delivered to small teams, the directorate, or individual employees, will need to be more targeted and specific. It is a good idea to introduce the basic concepts of clinical governance to the entire organization because the transition to this method of management often entails drastic change.
19
Q
- A hospital-wide set of professional standards is important because it…
a. Reduces the waste of time and resources
b. Eliminates bottlenecks
c. Encourages duplication
d. Minimizes the need for communication
A
- A: A hospital-wide set of professional standards is important because it reduces the waste of time and resources. As much as possible, healthcare facilities should standardize professional behavior in every department in order to eliminate confusion and reduce inefficient behavior. In some cases, the adoption of universal professional standards will reduce the need for communication, but this is not a necessary consequence. Similarly, it may be that standardization will decrease the number of bottlenecks, though again, this is not inevitable.
20
Q
- What is one disadvantage of the visioning strategy for setting goals?
a. It isolates team members
b. It tends to bring internal conflicts to the surface
c. The group must have at least six members for it to be feasible
d. It tends to reinforce group norms
A
- C: One disadvantage of the visioning strategy for setting goals is that the group must have at least six members for it to be feasible. In visioning, team members gather in groups of two and create lists of possible solutions to a problem. Each person then switches partners and shares his list. This process is repeated at least one more time, though in some visioning exercises team members partner up with seven or eight different people. Visioning is effective because it allows individual team members to interact with a large number of peers within a one-on-one setting that encourages effective communication.
21
Q
- Before conducting a safety audit in an emergency department, an administrator must first obtain…
a. A list of the employees in that department.
b. A map of the department
c. A written set of safety standards
d. Statistics on adverse events
A
- C: Before conducting a safety audit in an emergency department, an administrator must first obtain a written set of safety standards. This is necessary so that the administrator can compare his observations to the established protocol. The general purpose of a safety audit is to identify areas in which the department deviates from standard procedure. In order to perform an effective audit, the administrator needs to have a general familiarity with the rules that his employees follow.
22
Q
- During a meeting, the facilitator notices that one of the participants is getting agitated. After the meeting, what would be the best question for the facilitator to ask the participant?
a. “Why are you so angry?”
b. “What didn’t you like about the meeting?”
c. “Were you feeling irritated during the meeting?”
d. “Don’t you hate it when your coworkers act that way?”
A
- C: In the given situation, the best question for the facilitator to ask would be, “Were you feeling irritated during the meeting?” This phrasing is appropriate because it does not make assumptions about the participant’s feelings. It may be that the participant was not irritated, or was irritated by something unrelated to the meeting. In any case, the facilitator should not make any suppositions without first talking to the participant.
23
Q
- The process chain in a laboratory is particularly subject to…
a. Variability
b. Delay
c. Disorganization
d. Conflict
A
- A: The process chain in a laboratory is particularly subject to variability. In most medical laboratories, there is a great degree of volatility in the number of samples. This can be devastating to efficiency, particularly as it can create delays or necessitate the hiring of extra employees. Many laboratories are adopting lean manufacturing strategies to reduce delays and smooth out the variability of operations.
24
Q
- Research suggests that the largest proportion of adverse events attributable to negligence occur in the…
a. Post-trauma unit
b. Surgery unit
c. Maternity ward
d. Emergency room
A
- D: Research suggests that the largest proportion of adverse effects attributable to negligence occur in the emergency room, where the volatile workload and elevated stress level is most conducive to negligent acts. However, there are steps that can be taken to reduce these adverse events. Standardization and comprehensive training can diminish, though not eliminate, the incidence of adverse events related to negligence.
25
Q
- Which of the following is the source of the most medication errors?
a. Orders that require lab results
b. High-risk orders
c. Automatic orders
d. Verbal orders
A
- D: Verbal orders are the source of the most medication errors. Automatic orders, on the other hand, are responsible for the least medication errors. Verbal orders are more likely to be misunderstood or forgotten. Even though many doctors have notoriously bad handwriting, written prescriptions are still likely to be filled correctly. It is best to automate prescriptions as much as possible, and then to standardize the process for verbal orders. For instance, many facilities reduce errors by mandating that verbal prescriptions always be measured in metric units.
26
Q
- Which of the following is NOT one of the typical questions in a force-field analysis?
a. “What do you hope to accomplish in the meeting?”
b. “What was bad about the meeting?”
c. “What was good about the meeting?”
d. “How can we improve meetings in the future?”
A
- A: “What do you hope to accomplish in the meeting?” is not one of the typical questions in a force-field analysis. A force-field analysis is a retrospective rather than a prospective look at meeting structure and organization. In other words, it is a tool used to review what has happened in the past rather than to plan for the future. Force field analysis is based on the idea that progress can be made by enumerating the forces that contribute to or hinder the achievement of goals. Facilitators often use this technique to streamline meetings.
27
Q
- The definitive proof of the success of a regulation program is…
a. Fewer complaints from customers
b. A decreased need for inspections
c. A boost in employee morale
d. An increase in throughput
A
- B: The definitive proof of the success of a regulation program is a decreased need for inspections. Ultimately, the presence of a comprehensive and effective regulatory system means that rules are followed without enforcement being required as often. The other answer choices represent frequent positive consequences of effective regulation, but are not necessarily indicative of regulatory success. The initial costs of implementing a regulatory program can be high, but become cost effective over time.
28
Q
- A hospital manager notices that a significant proportion of medication errors in the facility involve the same two drugs. What is the most likely cause of this?
a. The drugs are widely available
b. The drugs are made by the same company
c. The drugs come in similar packaging
d. The drugs are habit-forming
A
- C: In the scenario described in question 28, the most likely cause is that the drugs come in similar packaging. Errors resulting from similar packaging are surprisingly common in healthcare facilities. As a result, many facilities take specific steps to label or otherwise differentiate such medications. Although it can be valuable to have standardized packaging for drugs, there must also be a clear and universal system for differentiation.
29
Q
- One advantage of the kaizen approach to DMAIC implementation is that…
a. It replicates the project-team approach
b. All of the team members are involved in all phases of the process
c. It can be performed while employees complete their normal tasks
d. It is accomplished in about a week
A
- D: One advantage of the kaizen approach to DMAIC implementation is that it is accomplished in about a week. During this period, almost all other operations must be suspended as employees devote themselves entirely to learning the new system. There are a few different systems for implementing a DMAIC (define, measure, analyze, improve, control) program for process improvement. The appropriate implementation system depends on the situation. However, the success of the kaizen approach helps refute the argument that Six Sigma is costly and time-consuming to implement.
30
Q
- The practice of waiting for a certain number of samples before commencing a test run results in…
a. Fewer bottlenecks
b. More bottlenecks
c. Shorter lead times
d. Longer lead times
A
- D: The practice of waiting for a certain number of samples before commencing a test run results in longer lead times. In any process, lead time is the interval between the first step and the delivery of results. It stands to reason, then, that intentional delays in sample processing will create longer lead times. Many laboratories feel that it is more efficient to wait for a larger batch of samples before conducting a run. Lean practitioners, however, recommend that samples be processed as soon as they are ready. Reduction in lead time contributes to greater efficiency and the ability to handle larger volume.
31
Q
- A whole systems approach to clinical governance is important because…
a. It isolates particular areas of concern
b. It can be administered within one week
c. Changes must be applied at all levels of the organization
d. Delays in service provision are rare
A
- C: A whole systems approach to clinical governance is important because changes must be applied at all levels of the organization. Men and women involved in clinical governance have to look at the big picture, which means that they must consider all of the elements and interrelationships of the healthcare facility. It may be that consideration of the healthcare facility as a whole will lead to the isolation of particular areas of concern, but this is not a necessary consequence. Taking the whole systems approach to clinical governance requires more than one week; indeed, it is an orientation that lasts for the entire life of the healthcare facility.
32
Q
- Because of a doctor’s poor handwriting, a prescription must be reworked before it leaves the pharmacy. Which of the following is true?
a. The doctor should be reprimanded
b. The pharmacy should incorporate bar coding
c. The prescription should not count towards the pharmacy’s yield
d. The error should be reported to the FDA
A
- C: In this scenario, the prescription should not count towards the pharmacy’s yield. In lean service provision, only those processes that are completed without the necessity of reworking or repair are considered as a part of yield. The goal of lean service implementation is to improve yields by reducing errors and defects. Mistakes due to bad handwriting are common in healthcare, which has led many facilities to standardize notation and introduce labeling or bar-coding systems. Such errors do not need to be reported to the FDA.
33
Q
- A hospital manager finds that he is unable to effectively supervise all of the employees who report directly to him. A reorganization of the hospital hierarchy should…
a. Eliminate some of the subordinate employees
b. Reallocate material resources
c. Minimize the manager’s span of control
d. Call for the hiring of another manager
A
- C: In this scenario, a reorganization of the hospital hierarchy should minimize the manager’s span of control. The span of control is the number of subordinates who report directly to a single supervisor. Over the past few decades, a general trend towards flattening organizational structures has increased the average span of control. Whereas, in the past, 10 was considered the largest number of employees that could be effectively supervised by a single manager, now it is common for a single manager to be responsible for the work of dozens of employees. As a result, ineffective leadership has increased.
34
Q
- Hospitals that implement computerized provider order entry (CPOE) almost always see a decline in…
a. Medication errors
b. Diagnostic errors
c. Adverse events
d. Latent errors
A
- A: Hospitals that implement computerized provider order entry (CPOE) almost always see a decline in medication errors. CPOE is a standard program for automating medical instructions. Implementation of a CPOE program diminishes errors related to faulty transcription or unclear handwriting. These programs also simplify inventory and decrease delays in order completion. Perhaps more importantly, the implementation of a CPOE program in large facilities enables employees to give and receive orders without being in physical proximity to one another.
35
Q
- In a traditional meeting, the timekeeper and the minute-taker roles are…
a. Filled by different people every time
b. Filled by the same person
c. Filled by the same two people in each meeting
d. Filled by employees who are not required to participate in the meeting
A
- A: In a traditional meeting, the timekeeper and the minute taker roles are filled by different people every time. Rotating these positions enables every member of the group to participate. It is a good idea to have these functions performed by two different people because they can be somewhat distracting and time-consuming. Establishing a regular rotation for timekeeping and minute taking is one way to improve teamwork and cooperation in a group.
36
Q
- An adverse drug reaction can be best described as…
a. An unforeseen side effect of the administration of a drug
b. The interaction of one drug with another drug being administered at the same time
c. Harm that occurs during or after the administration of a drug
d. Harm that occurs as a result of the administration of a drug
A
- D: An adverse drug reaction is defined as harm caused to a patient as a result of the administration of a drug. It may manifest as a presentation of a negative symptom or simply a reduced effectiveness of other therapies. An unforeseen side effect or a drug interaction may or may not be harmful to the patient. Harm that occurs during or after a drug administration would be better identified as an adverse drug event, unless it can be shown that the medication was the cause.
37
Q
- A meeting of department managers is discussing the catering service and menu for a hospital-wide special occasion. This decision should be made by…
a. Building a consensus
b. Voting
c. Fiat
d. Brainstorming
A
- B: This sort of decision should be made by voting. Relatively insignificant decisions should not be allowed to take up a large amount of time. The process of building a consensus or brainstorming on a trivial subject, such as the one described in question 37, would be a waste of resources. At the same time, it is always productive to give managers a voice rather than to make decisions by decree. A simple vote will quickly dispatch this unimportant issue so that the group can move on to more important subjects.
38
Q
- Confronted by excessive WIP levels, many laboratories take the unhelpful step of…
a. Decreasing the number of test runs
b. Acquiring a larger laboratory
c. Hiring more employees
d. Installing new technology
A
- D: Confronted by excessive WIP levels, many laboratories take the unhelpful step of installing new technology. Too often, laboratory managers assume that new technology will solve their problems without considering just how this will occur. Before installing new technology, a laboratory manager would be wise to run a DMAIC program to identify areas for improvement.
39
Q
- When establishing a clinical-governance training program for the directorate, it is useful to…
a. Align the subject matter with the specific tasks of the audience
b. Eschew case studies
c. Emphasize the basic concepts of clinical governance
d. Customize instruction for each person
A
- A: When establishing a clinical governance training program for the directorate, it is useful to align the subject matter with the specific tasks of the audience. Because it can be assumed that members of the directorate will already be familiar with the general concepts of clinical governance, it is much more effective to choose training programs for narrow and specific tasks. However, it is not efficient to customize instruction for each member of the directorate. Case studies are an essential part of clinical governance training.
40
Q
- In the lean enterprise model, what is the first step toward improving quality?
a. Establishing performance metrics
b. Reviewing product design
c. Understanding the expectations of the customer
d. Identifying potential defects
A
- A: In the lean enterprise model, the first step toward improving quality is establishing performance metrics. These metrics are the scale on which progress will be measured. They should be appropriate and general so that performance can be compared between departments and with other successful organizations. The other answer choices to question 40 represent essential steps in lean enterprise, but they are based on solid performance metrics.
41
Q
- Time available divided by time available and time required is the Six Sigma ratio for…
a. Productivity
b. Dependability
c. Customer satisfaction
d. Selectivity
A
- B: Time available divided by time available and time required is the Six Sigma ratio for dependability. In Six Sigma, dependability is the degree to which a process or product is available when it is needed. The implementation of Six Sigma practices requires products with a high degree of dependability because processes need to be completed as quickly as possible. One of the major contributions of Six Sigma and other productivity philosophies has been the application of scientific principles and formulas to manufacturing and the provision of services.
42
Q
- When prescriptions are being prepared, the labeling process begins at the same time as the medication is being packaged. However, the labeling does not take as long as the packaging. This difference in time does not add to the overall duration of the prescription-filling process. This is an example of…
a. Just-in-time manufacturing
b. Slack time
c. Mistake proofing
d. Inherent process variation
A
- B: The scenario described in question 42 is an example of slack time. Slack time is the interval between the first and last times at which a process can be completed without delaying the overall project. In this case, some slack time is inevitable. The packaging process will always take a little longer than the labeling process. As a result, the duration of this step of the process has a minimum duration equal to the time required for packaging. Almost every system has some slack time, but it should be diminished as much as possible.
43
Q
- A hospital manager operates on the assumption that his employees will thrive when they are given responsibility and the opportunity to perform well. The manager’s beliefs are aligned with…
a. The theory of constraints
b. Theory X
c. Theory Y
d. Theory Z
A
- C: The hospital manager’s beliefs are aligned with theory Y. Theory Y is the management philosophy that believes employees will thrive when they are given responsibility and the chance to innovate. Theory Y amounts to an optimistic view of human nature. Theory X, on the other hand, is a more skeptical management orientation. Adherents of theory X believe that people are lazy by nature, and will only perform their duties competently if they are monitored closely. Most managers blend these two theories in their professional practice.
44
Q
- Which of the following steps should be taken before QA activities begin?
a. Responsibility should be shared
b. The principals should be informed
c. Resources should be pooled
d. The scope of involvement should be identified
A
- D: Before QA activities begin, the scope of involvement should be identified. The scope of involvement is the entire set of materials, processes, and people that are required for a project. It is impossible to understand fully the influences on a project’s success without first identifying the scope of involvement. Quality assurance requires a systematic approach to identifying the scope of involvement. Responsibility and resources should not necessarily be shared before the initiation of quality assurance activities. On the contrary, one hallmark of successful QA is clear designation of responsibility, in particular for resources.
45
Q
- The protocol for ordering a medication should be…
a. The same every time
b. Customizable
c. Adaptable to verbal or written situations
d. Dependent on inventory
A
- A: The protocol for ordering medication should be the same every time. Medication errors are among the most common and most preventable in a healthcare facility. One way to reduce these errors is to standardize the prescription process. Many healthcare facilities achieve a drastic reduction in medication errors by forbidding verbal orders. In any case, the protocol for ordering a medication should not be customizable, as this is likely to create confusion and lead to error.
46
Q
- Because the hospital is busy, an anesthesiologist is given less time than usual to examine the infusion device that will be delivering medication to a patient during surgery. The machine malfunctions and the doctors on hand must work feverishly to save the patient’s life. This is an example of…
a. Active error
b. Equipment error
c. System error
d. Latent error
A
- D: The scenario described in question 46 is an example of latent error. A latent error is one made during setup or programming that creates negative consequences in the future. These sorts of errors are very difficult to identify, because they take place at a time far removed from the adverse events. In question 46, a latent error is present both in the malfunction of the machine and the short amount of time allotted to the anesthesiologist. Many times, it takes a combination of multiple latent errors to create an adverse event. Hospital managers are responsible for taking a detached and broad view of operations to identify and eliminate the sources of latent error.
47
Q
- In a typical hospital, approximately what percentage of errors is reported?
a. Less than 5
b. Between 25 and 50
c. 75
d. Between 80 and 90
A
- A: In a typical hospital, less than five percent of errors are reported. Many hospital managers are surprised by this statistic, because the number of reported errors can seem large. However, healthcare facilities often have unclear or relaxed reporting policies. Part-time employees and independent contractors are much less likely to report errors. Unfortunately, the failure to report errors has negative consequences far beyond the point at which the specific error occurs. The best healthcare facilities establish mandatory error-reporting programs with an emphasis on being nonjudgmental and accepting of inevitable human error.
48
Q
- A behavioral health specialist notices a particularly high number of restraint deaths at a facility. An analysis of the root causes of these events is most likely to indicate problems with…
a. Equipment
b. Staff orientation and training
c. Staffing levels
d. Alarm systems
A
- B: An analysis of the root causes of an abnormally high number of restraint deaths is most likely to indicate problems with staff orientation and training. Equipment, staffing levels, and alarm systems can also be culpable in restraint deaths, but problems with orientation and training are much more likely. Restraint equipment has been designed to be very safe when it is used correctly. When used improperly, restraint equipment can be deadly. It should be noted that most root cause analyses indicate problems in multiple areas.
49
Q
- A good meeting facilitator will…
a. Not need to ask very many questions
b. Focus on process rather than content
c. Refrain from offering suggestions
d. Focus on content rather than process
A
- B: A good meeting facilitator will focus on process rather than content. Indeed, a facilitator need not even be familiar with the subject of the meeting to do his job well. No matter the content, the structure and administration of the meeting will proceed along similar lines. The other answer choices for question 49 represent poor choices for a meeting facilitator. The facilitator should always ask a great many questions before leaving a meeting. He should also offer suggestions whenever appropriate. With experience, a facilitator learns when to interject and when to stay on the periphery.
50
Q
- During the periods with the highest incoming workload, a laboratory that has not implemented lean practices is likely to have…
a. Substandard lead time performance
b. Diminished productivity
c. False positives
d. Selective engagement errors
A
- A: During the periods with the highest incoming workload, a laboratory that has not implemented lean practices is likely to have substandard lead time performance. Lead time is the full interval required to complete a process or fill an order. Longer lead times are considered substandard. Productivity, on the other hand, may be higher than normal during the periods with the highest incoming workload, as the laboratory is engaged in constant processing. A big spike in productivity is not necessarily a good thing, however, because it may indicate that the lab is not making the best use of its down time. In an ideal scenario, there is little difference in productivity or lead time regardless of incoming workload. This is known as smoothing out the workload.
51
Q
- As much as possible, medications should be standardized. However, when this is impossible, it is important to…
a. Assume that side-effects will occur
b. Warn clinicians about the potential for overdose
c. Only use them as a last resort
d. Differentiate them clearly
A
- D: When it is impossible for medications to be standardized, it is important to differentiate them clearly. Many medications have similar packaging and labeling, and so should be clearly distinguished in order to reduce medication errors. Hospitals and healthcare facilities often use color-coding or electronic tags to differentiate similar-looking medications.
52
Q
- Individual instruction on clinical governance is most effective when…
a. It is delivered to a group
b. It is delivered before a performance review
c. It is combined with targeted training
d. It is targeted at new employees
A
- C: Individual instruction on clinical governance is most effective when it is combined with targeted training. Clinical governance is a comprehensive approach to improving the quality of healthcare. It is a vast and complex subject that requires a great deal of employee education. Clinical governance training should not be tied to performance review, nor should it be delivered exclusively to new employees. It requires ongoing attention at all levels of the organization.
53
Q
- When establishing an incentive program for employees, the critical-to-quality parameters should be…
a. Agreed upon by all participants
b. Attainable and significant
c. Determined while the program is underway
d. Established by the senior administrator
A
- B: When establishing an incentive program for employees, the critical-to-quality parameters should be attainable and significant. The critical-to-quality parameters are targets that, when attained, will result in superior performance. Employee incentive programs should always focus on task performance rather than results. After all, employees can only be held responsible for doing their jobs according to prescribed protocol. If the results of their efforts are negative, then the protocols should be examined. Although the critical-to-quality parameters should not be determined by a democratic process, neither should they be established solely by a senior administrator. Instead, they should be the result of a clear-eyed determination of the most important and variable tasks in every process.
54
Q
- A hospital uses the same labels for all of its prescriptions, but these labels do not fit on the smallest container, so employees must cut and paste the labels in a special way in order to fill the prescription. This is an example of…
a. Overproduction
b. Queuing
c. Work-in-progress
d. Extra processing
A
- D: The scenario described in question 54 is an example of extra processing. Extra processing is anathema to the philosophy of lean. Whenever a lean manager spots a situation like the one described in question 54, he will immediately work to resolve it. In this case, the hospital would be wise to adopt a labeling system that is appropriate for all of its containers. In addition to the obvious creation of more work, the extra processing described in this question may encourage medication errors.
55
Q
- The discharge department of a hospital is at optimal efficiency when it completes the discharge process…
a. More often than customer requests occur
b. At about the same rate as customer requests occur
c. Less often than customer requests occur
d. Twice as fast as customer requests occur
A
- B: The discharge department of a hospital is at optimal efficiency when it completes the discharge progress at about the same rate as customer requests occur. Discharges cannot occur more often than customer requests. If discharges occur less frequently than customer requests, the discharge department is inefficient. It can be difficult to optimize a discharge department, as discharges tend to occur in clusters, which can be difficult to predict.
56
Q
- When a hospital official notes that most errors are occurring at the “sharp end,” he means that…
a. They involve surgical tools or knives
b. They occur in clusters
c. They occur during the interactions between caregivers and patients
d. They are more likely to occur during busy periods
A
- C: When a hospital official notes that most errors are occurring at the “sharp end,” he means that they occur during the interactions between caregivers and patients. The phrases “sharp end” and “blunt end” are used by quality management professionals to describe areas of practice. The “sharp end” is all of the operations that involve direct contact with the patient, client, or customer. The “blunt end” is all of the behind-the-scenes actions that take place outside of the awareness of the patient, client, or customer. Although patients are more likely to notice errors at the sharp end, there are significantly more errors committed at the blunt end.
57
Q
- During a meeting, the facilitator must intervene several times to stop disputes between participants. Is this appropriate?
a. Yes, but the facilitator should stay in the background unless the progress of the meeting is threatened
b. Yes, the facilitator should rule in favor of one participant
c. No, the facilitator should never intrude upon a meeting
d. No, the facilitator should leave this duty to the chairperson
A
- A: It is appropriate for a facilitator to intervene when the progress of the meeting is threatened. After all, it is the job of a facilitator to maintain forward momentum and adhere to the meeting protocol. In some cases, however, disputes between meeting participants can be fruitful and should be allowed to continue. But more often than not, confrontations only serve to alienate participants.
58
Q
- Which of the following procedures is NOT a good way to mitigate injury?
a. Maintaining a ready supply of antidotes to high-risk medications
b. Simulation training
c. Programming equipment to shut off in the event of a crisis
d. Requiring employees to practice crisis response
A
- C: Programming equipment to shut off in the event of a crisis is not a good way to mitigate injury. Equipment should be programmed to default to the least-harmful setting, but in many cases shutting off is as harmful as operating incorrectly. For instance, a respirator should never default to an “off” position. All of the other answer choices represent excellent strategies for mitigating injury.
59
Q
- The first and most important step in a disclosure conversation is…
a. Assessing the patient’s mood
b. Admitting error and apologizing
c. Discussing the root cause analysis
d. Compensating the patient
A
- B: The first and most important step in a disclosure conversation is admitting an error and apologizing. The wisdom of apologizing has long been a source of contention in healthcare circles. For many years, it was widely thought that an apology would leave the practitioner vulnerable to malpractice suits. However, recent legislation has established that an apology does not mean an admission of negligence or malpractice. It is now considered prudent to mollify a potentially confrontational patient or client by issuing a sincere apology.
60
Q
- Which of the following factors is NOT included in a calculation of risk priority number?
a. Severity of possible adverse effects
b. Effectiveness of controls
c. Likelihood of an adverse effect
d. Cost of controls
A
- D: The cost of controls is not included in a calculation of risk priority number. A risk priority number, or RPN, is an objective picture of the importance of a particular danger to performance. It is calculated by rating on a scale from 1 to 10 the severity of each possible adverse effect (where 10 is the most severe), the likelihood of each of these effects (where 10 is the most certain to occur), and the effectiveness of possible controls (where 1 is the most effective), and then multiplying these three numbers.
61
Q
- One consequence of the implementation of Lean Six Sigma practices in a hospital will be…
a. Reduction in inventory
b. The creation of systems for verifying orders
c. Reduction in staff
d. Reduction in manufacturing costs
A
- A: One consequence of the implementation of Lean Six Sigma practices in a hospital will be a reduction in inventory. Indeed, reduced inventory is one of the fundamental goals of Lean Six Sigma. The developers of this organizational philosophy assert that there are numerous costs associated with maintaining a large inventory. Essentially, they believe that it is impossible to operate at peak efficiency while maintaining a large store of products and resources. Although many people believe that the implementation of Lean Six Sigma practices will lead to reductions in staff and manufacturing costs, this is not necessarily the case.
62
Q
- A program for assessing the validity of rolled throughput yield calculation is called…
a. Composite clinical indication
b. Performance measure selection
c. Continuous quality management
d. Measurement systems analysis
A
- D: A program for assessing the validity of rolled throughput yield calculation is called measurement systems analysis (MSA). MSA is used to evaluate many of the metrics used in business. All sorts of factors can influence the equipment and methodology used to measure performance. Because advanced productivity systems like Six Sigma and lean depend on accurate and detailed statistics, effective measurement systems analysis is essential.
63
Q
- The general intent of the PDSA cycle is to…
a. Optimize a process
b. Reduce bottlenecks
c. Incorporate new technology
d. Automate processes
A
- A: The general intent of the PDSA cycle is to optimize a new process. This cycle has four steps: plan, do, study, and act. It is sometimes referred to as PDCA (plan, do, check, act) or the Deming cycle. The first step of this cycle is to identify the targets that must be met in order to achieve output goals. The next step is to implement the new processes, often on a small scale. The third step is to measure the performance of the new processes and compare it with the expected results. Finally, the last step is to determine areas for improvement.
64
Q
- What are the three dimensions of quality in the most common framework for quality assessment?
a. Service, process, and mortality
b. Structure, process, and outcomes
c. Population, structure, and satisfaction
d. Function, outcomes, and clinical status
A
- B: In the most common framework for quality assessment, the three dimensions of quality are structure, process, and outcomes. The structure of care is the basic elements of the population and the health care provider. Care can only succeed to the extent that the structure allows. Elements of structure include the characteristics of the community, healthcare organization, population, and healthcare provider. Process is the dynamic act of care provision. It includes both technical and interpersonal excellence, because quality care requires not only competence but responsiveness to the emotional needs of patients. Finally, outcomes are the full range of results from care. Clinical status and mortality are outcomes, but so is patient satisfaction.
