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Leadership > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

General tips for cover letter (4)

A
  • no abbreviations
  • mention mission and value of org to show you’ve done your research
  • include date so they review yours prior to others
  • no errors b-c errors indicate you do not pay attention to detail
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2
Q

Purpose of cover letter (2)

A
  • function as first impression alongside resume
  • convey to recruitment and manager that you are different and will be good fit
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3
Q

Cover Letter: Introductory Paragraph (5)

A
  • Do not start with “My name is…”
  • Where you are graduating from
  • When you graduate
  • What are you graduating with
  • Where you are interested in working (Avoid being too specific or too broad)
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4
Q

Cover Letter: Content/Mission Paragraph (4)

A
  • mention strengths and skills
  • Mention past jobs, what you learned, and how the skill set will make you a better nurse
  • Avoid ”I am an excellent nurse” b-c it is pompous and a lie (may give off narcissistic vibes)
  • Be positive and demonstrate self-confidence
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5
Q

Cover letter: Conclusion (2)

A
  • Request an interview with hours you’re available between 8-5 so no evening hours
  • End with written handshake “ I look forward to meeting with you to discuss available positions”
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6
Q

Composition of Resume (6)

A
  • contact info (name, address)
  • professional objective
  • education
  • experience
  • certification (include expiration date)
  • Honors
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7
Q

Resume: Education (5)

A
  • all colleges attended and high school)
  • Expected date of graduation or graduation month and year
  • Degree obtained (or purpose if no degree)
  • City, state (only thing that can be abbreviated is state)
  • GPA (can be included or excluded; not customary to put; usually just last degree)
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8
Q

Resume: Experience (5)

A
  • only work experience (community service in separate section)
  • dates on right margin
  • label in reverse chronological order
  • include organization, job title, city, state
  • main job responsibilities (bulleted and past tense
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9
Q

Resume

What is it?
General tips (4)

A
  • short account of career or professional life that reflects work experience and education

General tips
- accurate and truthful (do not misrepresent your skill set)
- be careful about verbiage (i.e. Nursing assistants do not assess patients; Nursing assistant != certified nursing assistant)
- make sure cover letter and resume info match
- Do not include references (If putting someone as a reference, you must talk to them first and get their permission)

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10
Q

Resume: Objective statement (5)

A
  • one or two sentences long
  • tailored to the job being applied for
  • consider the type of career you are seeking
  • describes attributes that make you the ideal candidate
  • Reminds whoever is reading your resume about what you are looking for
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11
Q

Tips for Background checks (4)

A
  • Can only go back 7 years
  • Multistate check
  • Arrests show up for 7 years
  • Conviction of crime shows indefinitely
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12
Q

Tips for Drug Screens (3)

A
  • Report any prescription drugs to avoid trouble
  • Marijuana detectable for 30 days in urine
  • Cocaine detectable for 3 months in blood
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13
Q

Interview Process

  • Screening (2)
  • Interview (who is it done by?)
  • post interview (4)
  • Job offer (3)
A

Screening
- may be personality test (do in one sitting)
- may include phone interview

Interview (panel, recruiter, department)

Post interview
- thank you note
- background check and drug screen must be done prior to starting
- job testing (physical assessment)
- call after 1-2 weeks if no follow-up from employer (ask if they need anything else from you

Job offer
- be thoughtful and not impulsive about accepting a position
- ensure position aligns w/ your care goals and is a good git
- Company things consider: tenure, education mix of staff, unions, compensation

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14
Q

Types of Interview

  • video conference (3)
  • telephone (3)
A

Video Conference
- Dress appropriately w/ conservative colors
- Have your resume on hand for reference
- Write notes if needed

Telephone
- Typically for screening
- Listen carefully to questions then give thoughtful response
- It is okay to ask for question to be repeated (but not every question

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15
Q

Types of Interview

  • in person (4)
A

In person
- Plan to spend several hours at hospital
- If tour not offered, ask for one to see staff interactions and climate on unit (assignment boards for nurse/CAN ratio, secretary, physician interactions)
- Bring two copies of your resume (1 for you to reference)
- Arrive 10-15 minutes early and account for traffic (on time = late)

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16
Q

Tips for Answering Interview Questions (5)

A
  • Explain why you chose to apply to that hospital (ex. previous experience as patient)
  • If asked about strengths and weaknesses, be honest (no weaknesses is a red flag)
  • If Tell me about a time is asked, give example
  • If why should I hire you is asked, talk about your strengths
  • If where do you see yourself in 1 year asked, be honest
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17
Q

Do’s of interview (5)

A
  • Smile and be pleasant and respectful (no sitting till asked)
  • Review values of organization prior to interview
  • Make eye contact
  • Dress appropriately (suit, dress, slacks; no bulky jewelry or blue jeans or shorts, no perfume or cologne; no open toe shoes)
  • Always have 1-2 questions in your mind b-c no questions shows not interests; can say what you were going to ask if they already answered your questions (residency/orientation programs, response to nurse manager, benefits and pay, unit stability (average nursing tenure, vacancy rate))
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18
Q

Don’ts of Interview (4)

A
  • Do not say negative things about previous managers
  • No mints, gums, food
  • Mute and do not check phone
  • Do not talk too much
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19
Q

Illegal Interview Questions (8)

A
  • Age
  • Race, ethnicity, or color
  • Gender or sex
  • Country of national origin or birthplace
  • Religion
  • Disability
  • Marital or family status or pregnancy
  • Financial/credit status
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20
Q

Post Interview: thank you note

Components (4)
Notes (2)

A

Components
- position you are seeking
- what you found most interesting about interview
- answer any question you were unable to answer
- thank for their time

Notes
- handwritten and mailed 1-2 days after interview
- do even if bad interview

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21
Q

Mission Statement

Ex. “In keeping with the three-fold ministry of Christ — Healing, Preaching and Teaching — Baptist Memorial Health Care is committed to providing quality health care.”

A
  • describes purpose of organization and reason it exists
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22
Q

Vision Statement (2)

Ex. “We will be the provider of choice by transforming the delivery of health care through partnering with patients, families, physicians, care providers, employers and payers; and by offering safe, integrated, patient-focused, high quality, innovative and cost-effective care.”

A
  • desired state that organization wants to be in
  • describes future goals or aims of the organization
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23
Q

Core Values (2)

Ex. trust, goals, teamwork, innovation, ethics, responsibility, customers

A
  • beliefs that guide organization’s activities
  • do not change regardless of what is happening to the organization
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24
Q

Philosophy (5)

Ex. “We believe that a strong patient/physician relationship is at the heart of good health care. We also recognize that part of that relationship is making sure that our patients’ needs, and expectations, are always met.”

A
  • explanation of the systems of belief that determine how the mission and vision will be achieved
  • guiding principle of organization’s behavior
  • basis of organizational planning
  • abstract
  • usually starts with “we believe”
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25
Q

Policy
- What is it?
- Purpose (3)
- Who does it apply to ?

Ex. Attendance, consent, patient privacy, handwashing, DNR orders

A

What is it?
- Formal guidelines for a problem

Purpose
- Guides or directs organizational decision making
- Helps coordinate a plan and control performance
- increases consistency of action

Who does it apply to?
- Applies to everyone

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26
Q

Procedure
- What is it?
- Who does it apply to?
- Components (4)

Ex. Foley insertion, codes, wound care, Invasive procedures (IV, PICC)

A

What is it
- Step by step directions which are written in details for commonly occurring events

Who does it apply to?
- Taken by specific people to complete objective

Components
- purpose
- who can do it
- step by step what to do
- List of supplies

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27
Q

Organizational chart

Components (2)
Purpose

A

Components
- health care org = governing board
- must have Chief nursing officer per CMS (responsible for patient care AND nurse must report to a nurse regardless of what department they are in)

Purpose
- determine lines of communications and lines of authority in organizations

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28
Q

Role of Regulatory Agencies (5)

A
  • Set standards of operation for healthcare facilities
  • ensuring compliance w/ federal and state regulations
  • Approve quality and safety
  • Investigate and make judgments regarding patient and family complaints
  • Should be collaborative effort w/ HCO
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29
Q

Non Governmental Regulatory Agencies

How they work? (2)

Ex.
- The Joint Commission
- Det Norske Veritas Healthcare Inc. (DNVHC)
- Healthcare Facilities Accreditation Program (HFAP)
- Center for Improvement in Healthcare Quality (CIHQ)

A
  • granted deeming authority from CMS to accredit orgs
  • Hospitals must meet conditions of participation from CMS and individual agency’s standards
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30
Q

Center of Medicare and Medicaid Services (CMS)

What is it?
What are the conditions of participation? (3)

A

Largest and most influential health insurance program from government

Conditions of participation
- Quality and safety measures that hospitals must meet to get reimbursement i.e must be CNO in org; HCO must give info on how to contact CMS to patients
- Describes Minimum standards of care
- Orgs that meet conditions of participation become accredited)

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31
Q

Leadership Skills (3)

A
  • Technical (clinical expertise and nursing knowledge to produce product)
  • Human (ability and judgment to work with and lead people)
  • Conceptual (ability to understand complexity of org you work for and how their area fits into org)
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32
Q

Key concepts of Leadership (5)

A
  • Influencing and motivating people
  • Vision development
  • Communication and collaboration (coordinate patient care; awareness of patient satisfaction)
  • Building culture of teamwork and morale
  • Goal attainment (compliance w/ regulations; use EBP and good judgement)
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33
Q

Leadership (2)

A
  • the act of guiding or influencing people to achieve desired outcomes
  • occurs any time a person attempts to influence the beliefs, opinions, or behaviors of an individual
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34
Q

Followership (3)

A
  • interpersonal process of participation
  • follower takes guidance and direction from the leader to accomplish group goals.
  • Followers determine leader’s power (no followers = not a leader)
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35
Q

The best followers are: (7)

A
  • Skilled
  • act synergistically with others (everybody contributes b-c sum of everybody > 1 person)
  • Speak and act with integrity and principles
  • Self-directed (do what they are supposed to do w/o you hovering or step in when you’re not there)
  • Add value to work being accomplished
  • Use critical thinking and problem solving (Question managers and ask for directions if unsure about tasks)
  • Open and support new ideas
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36
Q

Management (4)

A
  • activities involved in coordinating the resources of people, time, and supplies to achieve a desired outcome or goal
  • involves decision making and problem-solving
  • control day-to-day operations toward goal attainment
  • Plan and organize what needs to be done and who, how, and when it should be done
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37
Q

Management Functions: Planning (6)

A
  • Identify and set goals and objectives of what you are going to do (based on mission and customer needs)
  • Assess environment (financial and manpower resources)
  • Identify strategies (What is the right thing to do?)
  • Assign responsibilities (Who is going to do what?)
  • Establish timeline
  • Document plan (action steps)

Note: process fails if ineffective planning; basis of all management functions

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38
Q

Management Functions: Organizing (5)

A
  • establish lines of authority and levels of management needed
  • establish communication method (decision making)
  • determine policies and procedures needed
  • Establish roles and responsibilities
  • Look at necessary resources (staffing qualifications, supplies; policies and procedures)
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39
Q

Management Functions: Staffing (4)

A
  • Determine # and type of staff needed based on goals and budgets (meet patient needs and be flexible)
  • determine recruitment and hiring strategy
  • determine how to orient and provide continuing development to staff
  • determine how schedules and patient care and other assignments will be made

Note: very time consuming

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40
Q

Management Functions: Directing (5)

A
  • Communicate expectations
  • Utilize motivation and influence to coach staff to work effectively and efficiently and make a positive contribution
  • Determine how delegation and assignments can be used to accomplish work
  • Directing and supervising personnel and activities
  • Skills needed: clear communication, behavior modeling, facilitation of feedback
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41
Q

Management Functions: Controlling (4)

A
  • Establish performance standards
  • Determine how to measure nursing care outcomes
  • Compare actual performance to performance standards and benchmarks (benchmark can be changed)
  • Determine what process can be used to develop an action plan to improve and evaluate performance if performance metrics not met
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42
Q

Leadership Theories: Contingency/Situational Theory
- What it says? (3)
- What does it require? (3)

Ex. Patient vs CNA complaints are handled differently (patient may need nonconfrontational and polite communication; CNA may require telling to reinforce task)

A
  • Leader’s organizational behavior is contingenton the situation or environment
  • no one leadership style is ideal for every situation
  • leadership varies by circumstances, maturity of leader, knowledge and skills

Requires
- Trust b/w leader and follower
- task to be accomplished is based on goals and complexities of problems
- positional power

43
Q

Leadership Theories: Trait Theory
- What is it? (2)
- What is the problem?

Ex. knowledge, initiative, tenacity, energy, decision making skills, flexibility, creativity, charisma, emotional intelligence, drive and motivation, confidence, honesty, integrity

A
  • Based on assumption that leaders are born with certain leadership characteristics
  • leaders are not made and traits are not learned
  • Problem: people can develop/learn skills and it fails to account for stuff learned
44
Q

Leadership Theories: Systems Theory

What is it? (3)
When is it difficult to implement?

A
  • system is set of interrelated and interdependent parts that together form a whole
  • If something happens with one part, all parts are affected
  • Rational approach necessary to achieve common goal
  • Difficult to implement in hospital if a bunch of silos (isolated individuals or units that feel more important than other parts
45
Q

Leadership Theories: Chaos Theory (2)

Ex. people responding to a code

A
  • degree of order can be obtained by viewing complicated behaviors and situations as predictable
  • Variation in these situations is normal
46
Q

Leadership Theories: Complexity Theory (3)

Ex. History of blood pressures says more about patient than one moment in time blood pressure b-c discusses relationships b/w blood pressures

A
  • world is full of patterns that interact and adapt through relationships
  • Studies interrelationships on unit and across other units to explain behavior of organizations
  • Look at behavior and relationships over time rather than 1 isolated incident
47
Q

Transactional Leadership: Leader’s behavior (5)

A
  • Comfortable with the status quo (no reaction until a problem; reactionary)
  • Reward staff for the desired work
  • Monitor work performance and correct as needed
  • Concerned with day-to-day operations
  • Relies on their authority and formal position to reward or punish
48
Q

Transactional Leadership: Followers (3)

A
  • Fulfills the contract or get punished
  • Does the work and gets paid
  • Errors are corrected in a reactive manner
49
Q

Transactional Leadership: Organizational Outcomes (4)

A
  • Work is supervised and completed according to the rules
  • Deadlines are met
  • Limited job satisfaction
  • Low to stable levels of commitment (do not go above and beyond to get job done)
50
Q

Transformational Leadership: Leader behavior (5)

A
  • Identify and clearly communicates vision and direction
  • Empowers the workgroup to accomplish goals and achieve the vision -> followers and leader exceed expectancy and rise above on needs
  • Imparts meaning and challenge to work (mentor)
  • Anticipates and tries to alleviate problems
  • Traits: admired, emulated, inspiring, charismatic
51
Q

Transformational Leadership: Followers (4)

A
  • Motivated to reach fullest potential (followers change over time) via mentoring and coaching
  • A shared vision
  • Increased self-worth (A sense of being valued b-c helping leader reach goals)
  • engage in Challenging and meaningful work
52
Q

Transformational Leadership: Organizational Outcomes (3)

A
  • Increased loyalty and commitment
  • Increased morale and job satisfaction b-c feel what you are doing is important
  • Increased performance (usually but can have trouble w/ day to day b-c so visionary)
53
Q

Autocratic Leadership

What is it?
Manager Characteristics (3)

A
  • unilateral downward flow of info

Manager characteristics
- makes all decisions (no staff input or collaboration; directs)
- provides little feedback or recognition for work done
- uses position authority to make decisions and accomplish goals

54
Q

Autocratic Leadership

What is the downside?
What is criticism?
When is it effective?

A

Downside: Emphasis on I and not we which can stifle innovation and creativity

Criticism: punitive

Effective: those w/ little formal education or in emergencies

55
Q

Democratic Leadership

What is it?
Manager Characteristics (2)

A
  • bilateral flow of information
  • emphasis on we vs I (what’s your opinion)

Manager Characteristics
- provides direction via suggestions and guidance
- provides rewards as ego (good job) or economic (bonuses)

56
Q

Democratic Leadership

What is the downside?
What is criticism?
When is it effective?

A

Downside: takes a lot of time so not useful in emergencies
Criticism: constructive
Effective: when collaboration and cooperation are necessary

57
Q

Laissez Faire Leadership

What is it?
Manager Characteristics (3)

A
  • Permissive and promotes complete freedom for the group or individual to make decisions

Manager characteristics
- unwilling or unable to make decisions
- Communicates by emails or memos b-c do not want to deal with face-to-face
- No interference or guidance (“you’re on your own”)

58
Q

Laissez Faire Leadership

What is the downside?
What is criticism?
When is it effective?

A

Downside: employees become apathetic and disinterested
Criticism: not present
Effective: self-efficient employees who do not need a lot of guidance

59
Q

Formal vs Informal Leadership

A

Formal Leadership: Someone appointed to a position and given authority to lead (ex. Manager, charge nurse, CNO)

Informal Leadership: No official authority or position to act but persuades and influences people

60
Q

Informal Leaders

  • Impact (3)
  • How to work with them as the manager? (2)
A

Impact
- positive or negative influence
- affect efficiency of workplace
- affect success of initiatives

Managing informal leaders
- seek informal leaders out to get their support b-c they can make or break what you are trying to do
- address their behavior if negative influence on others OR if undermining what is done on the unit

61
Q

Power (2)

ex. nurse has power during patient advocacy

A
  • Ability to motivate people to get things done w/ or w/o legitimate right of organization
  • you need power to lead and get support
62
Q

Authority

What is it?
What is the flow?
What is the source?

Ex. nurse has authority to delegate to UAP; manager has authority to discipline

A
  • Legitimate and formal right to direct others

Flow: involuntary and unidirectional submission required due to authority

Source: given by organization through authorized position

63
Q

Influence

What is it?
What is the flow?
What is the source?

A
  • informal, dynamic, ambiguous strategy to get people to support your goal

Flow: multidirectional flow (no involuntary submission)
Source: personal characteristics, expertise, opportunity (anyone can influence)

64
Q

Influence Behaviors

  • Assertiveness
  • Ingratiation
  • Rationality
  • Sanctions
A

Assertiveness: express opinion and take charge w/o violating the rights of others (aggression is violating rights)

Ingratiation: trying to make someone feel important by giving praise or offering sympathy with the goal of advancing yourself

Rationality: presenting logical arguments, providing pertinent information, presenting reasons, and laying things out in a structural manner

Sanctions: threats

65
Q

Influence Behaviors

  • Exchange
  • Upward appeal
  • Blocking
  • Coalitions
A

Exchange: you do something for me and I’ll do something for you

Upward appeal: goes to higher authority to arbitrate (going to mom)

Blocking: deliberately keep others from getting their way (ex. Ignoring, not being friendly)

Coalitions: group of people get together to speak or negotiate in one voice

66
Q

Position Power (Direct)

  • Legitimate
  • Reward
  • Coercive
A

Legitimate: based on official organizational power; person’s role in organization

Reward: ability to grant favors or reward others for complying with your wishes. Ex. Money, praise, recognition

Coercive: opposite of reward power; based on fear of punishment for noncompliance or fear of consequences

67
Q

Personal Power (Indirect)

  • Referent
  • Expert
  • Information
  • Connection
A

Referent: respect or admire person which gives them power

Expert: based on knowledge, skills or expertise (ex. Good at starting IVs)

Information: possess information that is valuable to others

Connection: r/t who you know that others see as powerful

68
Q

Performance Appraisal

What is it?
Timing

A

formal appraisal or evaluation of how well employee performs based on job duties or description (employees should get ongoing feedback throughout year; should not be a complete surprise)

Timing: usually one after 90-day probational periods and then one annually

69
Q

Performance Appraisal: Purposes

  • Administrative (3)
  • Measurement (2)
A

Administrative
- Required to prove hospital meets standards of compliance and organizational goals (safe and quality care)
- Assists in determining hiring, scheduling, and termination decisions
- Affects culture of organizational (gives opportunity to identify problems and grievances)

Measurement
- Measure employee’s performance against the standard
- Allows manager to examine if each employee is meeting the standard or needs improvement

70
Q

Performance Appraisal: Purposes

  • Development (3)
  • Relationship (3)
A

Development
- Used to identify if employee or org has learning need
- Gives the manager a chance to help employee meet developmental needs i.e. further education, training, certification to promote from within (not meant to be punitive)
- First step to ensure legal compliance w/ standard

Relationship
- Develop one on one trusting relationship
- Manager is positive and open while giving feedback
- involves be mutual goal setting

71
Q

Performance appraisal

How to choose a tool? (3)
Who should appraiser be? (3)

A

Choosing a tool
- must be dependent on a standard (job description)
- More effective if employee has input in development of evaluation method
- Must adequately and efficiently assess the job that you do

Appraiser
- somebody that employee trusts and respects
- someone who has seen employee do work
- someone who who makes employees feel supported and have expectations clarified

72
Q

4 Types of Performance Appraisals

What is the type?
What is the problem with the type?
When is the type useful?

A

Self-assessment
- employee rates themselves
- Problem: difficult for manager to counter this type of assessment if people are too hard or soft on themselves
- Useful with experienced staff

Peer-reviewed
- feedback obtained from people you work with
- Problem: can cause hard feelings if peers have negative feelings about you
- Useful to give well-rounded view of person

360-degree feedback
- assessment based on tool evaluated by peers, other departments, subordinates and all the results compiled via comparison and contrast and given to the person
- Problem: Bias if fear of getting the person upset or upset at the perso
- Useful to give validation and recognition and encourage continuous improvement; makes person feel more accountable since multiple people evaluating them

Written by manager:
- Standardized vs individualized
- Useful because based on observations, skills, and pre-set standards i.e. job description

73
Q

Bias in Performance Appraisals

  • Halo effect
  • Recency
  • Leniency (2)
  • Similar to me
A

Halo effect: positive or negative rating based on one skill or incident

Recency: Positive or negative based on recent events vs entire evaluation period

Leniency
- Everyone on the unit gets the same ratings regardless of how they actually do
- Not holding anyone accountable

Similar-to-me: Higher rating for those with similar characteristics to appraiser

74
Q

Bias in Performance Appraisals

  • Contrast
  • Horns effect
  • Central Tendency (2)
A

Contrast: Employee rated against peers rather than job description

Horns effect: Focusing on negative experiences

Central tendency
- Rater does not want to give too high of a score or too low of a score
- Everyone is average

75
Q

Grounds for immediate Termination (2)

A
  • abuse or mistreatment of patient
  • substance abuse on the job (hospitals can do on the spot drug screen)
76
Q

Notes on Disciplinary process (3)

A
  • If unionized hospital, contract will state this process must be followed prior to termination of person (know the steps)
  • If nonunionized hospital, you may not have to follow this process i.e can skip verbal warning
  • Not meant to punish; meant to correct performance problems to improve employee’s success
77
Q

Disciplinary Process
- Verbal Warning (2)
- Written Warning (4)

A

Verbal warning
- informal reprimand or admonishment where manager discusses the issue and suggest ways to improve
- may or may not be signed

Written Warning
- written document that specifically addresses the behaviors, rules, or policies that were violated.
- Indicates specific consequences if behavior is not altered
- includes specific plan of action to improve behavior
- Signature doesn’t not mean you agree with it, just means you are aware that it will be in the file (if you choose not to sign, two managers will sign it)

78
Q

Disciplinary Process
- Suspension (3)
- Termination

A

Suspension
- remove the person from work environment for a few days (Typically 1-3 days; longer if pending investigation)
- If during investigation and there was nothing found that they did wrong, they will get paid for the suspension.
- If you are found guilty or if it is a regular suspension w/o investigation, you do not get paid for those days

Termination
- permanently released from employment
- last resort because want employee to be better

79
Q

Performance Improvement Plan

Purpose
Components (4)

A

Purpose: corrects performance issues and helps person be successful prior to termination

Components
- time frame to correct behavior
- identify resources needed i.e. training
- details and examples of behavior
- SMART goals developed by person and manager

80
Q

Factors that interfere w/ culture of safety (6)

A
  • Flawed systems, processes are flawed. (ex. ED surges; ICU overflow)
  • Clinician doesn’t want to get blamed
  • Focus is on rules/policy and procedures not on the knowledge
  • Assumptions on educational background
  • focus is on punishing individual rather than improving system.
  • Assumption that if the pt is not injured, no action is necessary (near misses also need to be reported)
81
Q

Culture of Safety (4)

A
  • attitudes, beliefs, perceptions and values that employees share in relation to safety in the workplace
  • Safety is important in every aspect of the care
  • All staff see safety as a priority in the work environment
  • Reporting errors is ENCOURAGED and Rewarded
82
Q

Why is safety important? (3)

A
  • key component in accreditation process
  • TJC requires formal safety program
  • allows nurse to coordinate quality care for patients
83
Q

Key findings from IOM Report: To Err is Human: Building a Safer Health System (5)

A
  • healthcare and technology are becoming more complex and advanced
  • more complex healthcare = more errors
  • overuse of expensive equipment and underuse of inexpensive equipment
  • healthcare system is wasting money and disorganized
  • death from preventable medical errors is the 3rd leading cause of death (heart disease and cancer are first two)
84
Q

AHRQ’s 8 Common Root Causes of Medical Errors:

A
  • Communication Problems (majority of errors)
  • Inadequate Information Flow r/t info not following pt when they are discharged or move to another facility
  • Human Problems (ex. Pstandards of care not being followed by staff)
  • Pt Related Issues (ex. inappropriate pt identification, education)
  • Organizational Transfer of Knowledge (ex. training + education of the staff)
  • Staffing Patterns and Workflow (ex. Putting healthcare workers in situations where they are more than likely to make a mistake i.e. INADEQUATE STAFFING)
  • Technical Issues
  • Inadequate Policies
85
Q

Goal of IOM Healthcare Quality Initiative (3)

A
  • improve health of population
  • enhance experience + outcome of patients
  • Reduce per capita cost of care
86
Q

IOM STEEEP Principles

A
  • Provide safe care and prevent injuries to patients
  • Provide timely care reducing waits and harmful delays
  • Provide effective care based on scientific knowledge (EBP)
  • Provide efficient care reducing waste of time or energy
  • Provide equitable care that does not vary in quality due to gender, ethnicity, socioeconomic status.
  • Provide patient centered care based on preferences, needs and values
87
Q

10 principles of Redesign of Healthcare

A
  1. Care is based on continuous healing relationships w/ providers
  2. Care is customized according to patient needs and values i.e Individualized rather than standardized
  3. The patient is the source of control
    - Ask patient for their daily goal and put it on the whiteboard
  4. Knowledge is shared and information flows freely b-c you want patient to be informed
  5. Decision making is evidenced based and not based on opinion
  6. Safety is a system property (not only a nursing priority; everyone helps)
  7. Transparency is necessary and important
  8. Needs are anticipated to prevent unnecessary calls
  9. Waste is continuously decreased
  10. Cooperation among clinicians is a priority
88
Q

Components of Healthcare Safety: Patient-Centered Care (4)

A
  • Care that is respectful of and responsible to individual patients
  • Partnership between nurses, physicians and patients
  • Takes into consideration patient values
  • Providing education and support to help pt make informed decisions
89
Q

Components of Healthcare Safety (6)

A
  • Leadership commitment (Safety important from governing board to bottom level)
  • Interdisciplinary participation (Everyone is involved; not only important to nursing staff)
  • Evidenced Based (EBP = more effective)
  • Education (All staff understands the goals)
  • Just Culture
  • Patient Centered Care
90
Q

Just Culture: Human Error

What is it?
Care for it?
Management for it?

A
  • Product of current system design or flaw

Care: console and teach vs punish person

Managed through choices, processes, procedures, training, design, environment

91
Q

Just Culture: At-risk behavior

What is it?
Care for it?
Management for it? (3)

A
  • Taking risk but believe insignificant or justified; taking shortcuts and not doing it the way it needs to be done

Care: correcting misperceptions and coach

Managed through removing incentives for at-risk behaviors, giving incentives for good behavior, increased situational awareness

92
Q

Just Culture: Reckless Behavior

What is it?
Care for it?
Management for it? (2)

A
  • Conscious disregard of substantial and unjustifiable risk i.e. person completely ignoring the safety steps

Care: punish

Managed through remedial and punitive action

93
Q

What is a Just Culture? (3)

A
  • Foundational steps of culture of safety
  • medical event reporting which emphasizes learning + accountability over placing blame on the incident.
  • Environment is not punitive but respectful and open to speaking up and learning from mistakes b-c people are going to make mistakes
94
Q

Pros of Just Culture (4)

A
  • Increased incident reporting, b-c reporting is rewarded
  • Increased reporting of risk issues prior to events happening (near misses)
  • Fair and consistent application of justice
  • Reduced fear of punishment (avoids unnecessary punishment)
95
Q

National Patient Safety Goals of 2023 (7)

A
  • Identify patients correctly (ex. Two patient identifiers (DOB, Name, MRN); Give correct blood to correct person (reason for 2 RNs to check))
  • Improve staff communication (ex. Policy on notifying HCP about stat labs)
  • Use medicines safely (ex. Labelled w/ name of drug and dose; Med reconciliation; Anticoagulant home management)
  • Use alarms safely (ex. Never turn alarms completely off (telemetry))
  • Prevent infection (ex. Hand hygiene)
  • Identify patient safety risks: fall, suicide risks
  • Prevent mistakes in surgery (ex. Time out; Correct surgery on correct patient on correct site; Surgeon marks surgical site prior to anesthesia)
96
Q

What are Standards of Quality? (3)

Ex. Sponges accounted for in surgery; want 100% accounted for

A
  • Predetermined standards of excellence that act as a guide for practice
  • Rules that apply to key processes
  • measured via benchmarks (ex. 0% for Falls; 100% for sponges accounted for in surgery)
97
Q

Model of Quality: PDSA (4)

A

Plan = what you want to do, how will you do it, where do you want to go (action plan)

Do = carry it out. Test of change.

Study the results, what happened. (Did it work? What is the compliance? i.e are people doing it)

Act: adopt the change at larger scope or modify change based on the results.

98
Q

Components of Standards of Quality (3)

A

Structure (ex. humans, resources)
- internal characteristics of organization

Process (ex. workflow, sequence of events, behaviors, nursing process)
- whether activities in organizations are being conducted appropriately, EBP, and implemented efficiently

Outcomes
- did the care provided make a difference
- done as unit of measurement (numbers)

99
Q

Process Improvement Tools

  • Flow chart
  • Pareto chart
  • Fishbone chart
A
  • Flow chart: tool that tells you what actually occurs
  • Pareto chart: bar graph which shows frequency in which events occur
  • Fishbone chart: tells you cause + effect (important to look at environment, processes, people)
100
Q

Process Improvement Tools: Root Cause Analysis

Purpose
Steps (5)

A
  • quality and risk tool after adverse patient event to determine process and systems issues rather than place blame

Steps
- identify and define problem
- understand problem
- identify root cause
- provide corrective action
- monitor system

101
Q

Roles in Quality improvement: Executive Team (6)

A
  • leads cultural transformation
  • sets the priorities on what to decrease (i.e. falls)
  • provides resources needed to do the work incl. education
  • assess where organization is currently b-c can not change past
  • Assess what is staff + management’s knowledge level about quality.
  • implement and monitor plans
102
Q

Roles in Quality improvement: Nurse Manager (3)

A
  • responsible for quality and safety over unit/department
  • Meet regularly w/ employees to communicate and monitor progress
  • document performance and share across department
103
Q

Roles in Quality improvement: Staff (5)

A
  • follow policies, procedures, and protocols to ensure you are providing safe care
  • provide evidence based care (not unit-based)
  • report quality and safety issues to manager
  • Actively participate in quality activities
  • Stay up to date on quality and improvement policies and procedures

Leadership (4 decks)

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