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487- Leadership/Mngmnt > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

quality def

A

measuring performance against standards

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2
Q

quality focus

A

improved pt outcomes
shift focus from assurance and provider to
improvement and patient

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3
Q

six sigma def

A

quantitative data driven
ALMOST error-free environment

improves outcomes by measuring errors

(developed by Motorola)

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4
Q

six sigma themes

A

customer focus
data driven
process emphasis
proactive management
boundary less collaboration
aim for perfection

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5
Q

Team STEPS def

A

EB framework
purpose- optimize team performance

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6
Q

Team STEPS- leadership

A

coord. activities
ensure access to resources

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7
Q

Team STEPS- situation monitoring

A

used to gain understanding or maintain awareness

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8
Q

Team STEPS- mutual support

A

anticipate o/ needs

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9
Q

Team STEPS- communications

A

standardization (ex. SBAR)

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10
Q

Team STEP- 4 a’s

A

assess Status of pt
assess lvl of Team member
assess Environment
assess Progress towards goal

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11
Q

LEAN

A

most value w/ least resources
eliminate wasteful processess
dev by Toyota

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12
Q

LEAN principles

A

listen to customer
map processes (value stream map)
identify waste
create pull system (refresh resources after use)
use standard work

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13
Q

quality management def

A

philosophy
defines helathcare culture
emphasis on customer satisfaction, innovation and employee involvement

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14
Q

quality management 3 P’s

A

paitent not provider
prevention not inspection
process not person (quality should remain same regardless of staff change)

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15
Q

quality management principles (IGCFD)

A

involvement (democratic structure)
goal (improve systems w/o blame)
customers (define quality- internal (employees) and external( pts, insurance))
focus (on outcomes)
decisions (based on data)

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16
Q

PDSA

A

plan
do
study
act (adapt, adopt or abandon)

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17
Q

QM benefits (3)

A

greater efficiency= inc quality
dec malpractice lawsuits= dec costs
inc customer satisfaction
*pt centered care not direct benefit

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18
Q

focus of QI v QM

A

QM-customer satisfaction
includes everyone

QI- focus on identification and prevention of problems
ex. inc ICU transfers

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19
Q

quality improvement def

A

prevention of problems
ongoing process
monitors care through valid and reliable measures

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20
Q

QI steps (6)

A

identify needs
assemble multidis. team
collect data
establish measurable outcomes/quality indicators
select and implement plan
collect/eval plan

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21
Q

QI collect data ex

A

number of occurrences on e/ unit
type of meds

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22
Q

QI select/implement plan ex

A

policy and procedures

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23
Q

QSEN

A

quality and safety education in nursing

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24
Q

QSEN safety compentencies (PTEQSI)

A

patient centered care
teamwork/collab
EB practice
quality improvement
safety
informatics

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25
Q

standards def

A

written value statement
(3)

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26
Q

structure standards

A

organizational resources
physical environment
ex. omnicell for e/ unit

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27
Q

process standards

A

beh of nurse
concerned w/ actual delivery of care
ex. VS q4h

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28
Q

outcome standards

A

reflect desired outcome of care
physical health and function of client
ex. breath sounds are clear

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29
Q

sources that est. standards

A

JCAHO
american nurses association (ACA)
governmental and regulatory agencies (CDC), state boards of nursing, nurse practice acts

organizational internal policies and procedures
EB practice research
national quality foundation

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30
Q

methods of standard assessment (8)

A

peer review
chart audits
observation
checklists
fishbone, flow chart
histograms
questionnaires (pt satisfaction survey)
benchmarking

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31
Q

standard assessment- chart audit

A

most common technique of quality assurance

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32
Q

standard assessment- chart audit types

A

retrospective
concurrent
prospective

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33
Q

standard assessment- chart audit
retrospective

A

after DC
does documentation reflect quality care

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34
Q

standard assessment- chart audit
concurrent

A

real-time
ex. critical pathway
door to balloon time for MI

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35
Q

standard assessment- chart audit
prospective

A

BEFORE care begins
anticipated problems
ex. neuro assessment q1h, fall precautions

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36
Q

standard assessment- benchmarking

A

measuring practices/products against the BEST performing organizations

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37
Q

risk management def

A

interdiscip. process designed to protect financial aspects of organization and maintain high quality medical care

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38
Q

risk management characteristics

A

goal is prevention
takes corrective action against potential risks
an extension of quality management

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39
Q

TeamSTEP characteristics

A

leadership
situation monitoring
mutual support
communication

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40
Q

nurse v risk manager

A

the same
nurses are required to identify and report unusual occurrences and pot. risks

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41
Q

adverse event reduction

A

strategy to reduce mortality and morbidity

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42
Q

adverse event reduction parts (ASNR)

A

adverse event
sentinel event
near miss
root cause analysis

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43
Q

adverse event reduction- sentinel event

A

serious, unexpected occurrence= death or serious harm
ex. suicide, infant abduction, wrong surgery site

*JCAHO requires organizations to respond to these events in a formal way

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44
Q

adverse event reduction- near miss

A

can result in NO harm
highlights problem that must be fixed

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45
Q

adverse event reduction- root cause analysis

A

retrospective review of incident
id sequence of events
leads to dev of specific risk-reduction strategies

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46
Q

policy and procedure def

A

provide order, stability and guide decision making

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47
Q

policies def

A

formalized guideline
inc consistency in decisions and actions
directs action
ex. all nurses should provide quality care

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48
Q

policy requirements

A

written, cover all employees
readily avaliable
can be implied/unwritten

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49
Q

area ex. for policy development

A

confusion about responsibilities
protection of pt/family rights
personnel management and welfare (DNR)(vacation leave)
lack of guidance can cause negligence (ex. med errors)
areas where all staff should adhere to same pattern of decision making (ex. low blood sugar)

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50
Q

procedure def

A

step by step directions
how to carry out specific activity

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51
Q

procedure requirements

A

statement of purpose
identify who is to perform the activity

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52
Q

policy and procedure similarities- purpose

A

means for accomplishing goals and objectives
written rules that are extensions of mission statement

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53
Q

policy and procedure differences

A

policy-gen. guideline
procedure- more specific
give directions for actions

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54
Q

crossing the quality chasm (SEPTEE)

A

safe
effective
pt centered
timely
efficient
equitable

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55
Q

DMAIC method

A

define (From the customer perspective)
measure (w/ system)
analyze
improve (id reasons for variability)
control

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56
Q

Essay question 1:

A

what are the 5 rights of delegation
-name and define

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57
Q

essay question 2:

A

name and define and provide an example of the 4 levels of change

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58
Q

change agent def

A

person skilled in theory and implem of PLANNED change

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59
Q

planned v unplanned change

A

planned- deliberate action

unplanned (accidental)- adaptive response directed towards re-estb balance

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60
Q

change- lvl 1

A

alt in knowledge
ex. pt satisfaction survey

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61
Q

change- lvl 2

A

alt in feelings/attitudes
ex. survey results alert manager that floor moral is low

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62
Q

change- lvl 3

A

alt in behavior
ex. manager changes leadership style

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63
Q

change- lvl 4

A

alt. of multiple forces affecting an entire social system
ex. resurvey after leadership style change

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64
Q

lewin theory

A

driving forces have to be greater than restraining to ensure change
purpose- create future that is more desirable than current state

65
Q

lewin phases- unfreezing

A

creating motivation for change
gather data, assess and analyze
build trust and recognition for change
complete when ppl accept need for change

66
Q

lewin phases- movement

A

develop a plan and implement (use strategies for ovrcmng resistance)
set objectives/goals
include everyone in planning
eval and modify if necces

67
Q

lewin phases- refreezing

A

reinforcement of new beh
practice beh repeatedly

68
Q

lippitt’s focus

A

actions of change agent (not change agent itself)

69
Q

lippitt A-G (DAADCMT)

A

diagnose problem
assess motivation for change
assess change agent’s motiv/resources
dev action plan and eval criteria
choose a change agent (role expert, cheerleader or facilitator)
maintain change
terminate the helping relationship

70
Q

everett rogers

A

diffusion of innovations

71
Q

diffusion of innovations purpose

A

how, why and @ what rate new ideas/tech spreads

72
Q

diffusion def

A

process where an innovation is communicated over time among ppl in a social system

73
Q

rogers- 4 main elements (same as def of diffusion)

A

innovation itself
communication channels
time
social system

74
Q

diffusion of innovations relies on

A

human captial
must be widely adopted to self sustain
an innovation should reach critical mass

75
Q

rogers diffusion of innov.-adopter categories

A

innovators
early adopters
early majority
late majority
laggards

76
Q

rogers diffusion of innov- 3 phases

A

1- invention of the change
2- diffusion (communication) of info
3- consequences of change (adoption or rejection)

77
Q

rogers- 2 key considerations

A

ppl must be interested in the change and committed to making it happen

78
Q

rogers process step (kpdic)

A

knowledge- ideas are presented to group showing that innov is available
persuasion- interest in innov begins (can be - or +)
decision- adopt or reject innovation and eval
implementation
confirmation- eval innovation- seek reinforcement that decision was correct

79
Q

chaos theory

A

quantum physics
stephen hawking
changes occur at random
must be able to self organize, adapt and accept that change is inevitable
permanent organizational structure is not possible

80
Q

empirical rational assumption

A

if ppl believe info is rational and makes sense they are more apt to make change
*use if little resistance is expected
NOT incl. social/emotional response to change
ex. dangers of smoking

81
Q

power-coercive assumption

A

use if great resistance is expected and little participation

ppl less pwr have to comply to higher pwr
ex. getting assignment from charge nurse

82
Q

normative reeducative assumption

A

time consuming
**take into account- norms, feelings, attitudes and commitment

ppl will change if actively involved in the process
group problem solving
BEST OPTION
ex. discussion on how to change psych final

83
Q

response to change- + v -

A

(+) further growth
(-) resistance to change, threatened self interest, fear of losing control

84
Q

response to change- active v passive

A

active- attack idea, argues against
passive- ignores, avoids, agrees but does not assist

85
Q

level of resistance to change

A

depends on type of change proposed
social/attitudinal changes have more resistance
ex. tech update v intermountain merger

86
Q

overt v covert resistance & cause

A

overt- can be heard and addressed
convert- hidden, result of low trust and inadeq participation

87
Q

steps for handling resistance

A

introduce change gradually
allow participation- facil ownership
provide ed- constant comm
dev and maintain trust
provide rewards/incentives

88
Q

charac of effective change agents

A

respected membr of group
excellent comm skills
possess expert and legitimate power
takes risks
understands the change and its impact

89
Q

who is a change agent

A

everyone

90
Q

wider environment connection

A

critical for success
organizations must learn externally and internally
ex. billboards

91
Q

4 components of management

A

planning
organizing
directing
controlling

92
Q

organization def

A

collection ppl working together under defined structure to achieve predetermined outcomes

93
Q

components of organization

A

process
people
structure

94
Q

management- organizing

A

est formal structure

95
Q

prereq to designing an organization

A

road map

vision
mission
philosophy
goals+objectives

96
Q

vision statement

A

brief (1-2 sentences)
future oriented
id desired future of organization
inspire/motivate employees

97
Q

mission

A

purpose statement
CRITICAL- enacts vision statement
detailed
organizations reason for being
id services provided, HR and identifies customers
influences dev of goals, policy and procedures
*impacts all lvls of organization

98
Q

philosophy

A

value and beliefs that guide all actions of organization
abstract

99
Q

goals v objectives

A

goal- main idea
objectives- specific actions (measurable, observable, and obtainable)

action plans

100
Q

organizational theory

A

execution plan

101
Q

classical theory 4 elements

A

efficiency through design
1-division/ specialization of labor
2- span of control
3- scalar process
4- ordering positions

102
Q

classical theory- division of labor

A

specialization makes employees more efficient
est. Scope of practice
ex. cna v rn

103
Q

classical theory- span of control

A

number of ppl manager can oversee is limited
3-50
based on managers abilities, experience, task complexity
ideal 15-20

104
Q

classical theory- scalar process

A

chain of command
top to bottom

105
Q

classical theory- ordering of positions

A

line positions- direct line hierarchial authority
authority for decision making
ex. rn, cna

staff positions- expertise and knowledge to assist line positions
advisory
no authority for decision making for pts
ex. staff dev, risk mgmt, dm educator
dm rn educator has to report to floor nurse

106
Q

scientific management

A

adjusted classical approach
inc performance by maximizing individual productivity

107
Q

scientific management 4 principles

A

1- standardize work- ex. central line dressing
2- select right workers
3- carefully train workers
4- support workers by planning work (ex. duties of CNA v RN)

108
Q

bureaucracy

A

most efficient form of organization
dev organizational chart
actions of management to be fair and predictable

109
Q

bureaucracy- characteristics

A

1- division of labor
2- hierarchy of authority
3- rules and regulations
4- emphasis on technical competence

110
Q

bureaucracy- division of labor

A

specialty skills
emphasis on technical competence
ex. rn, cna

111
Q

bureaucracy- hierarchy of auth

A

workers ranked according to degree of auth
pyramid shape- centralized

admin at top
VERTICAL comm- chain of command

112
Q

bureaucracy- rules and regulations

A

policies, procedures
uniform actions, limit variance
communication written

113
Q

bureaucracy- technical competence

A

premium for quickness and control

114
Q

bureaucracy- pro v cons

A

pro- efficient
con- inc time to get approval, lots of levels, lack of input from lower levels, rigid, impersonal

115
Q

systems theory

A

convert info into planned outcome for use within or outside of system

116
Q

systems theory 4 elements

A

1- structure
2- technology
3- people
4- the environment (materials, resources)

117
Q

systems theory- input ex

A

money, human
material, time, information

importation of energy
data collection, assessment
ex. pain lvl after surgery 10/10

118
Q

systems theory- throughput ex

A

interventions
ex. medication
transformation of energy

119
Q

systems theory- output ex

A

better health, LOS,
inc QOL

exportation of products
final outcome (was goal achieved)
NOT equal reass. of pain

120
Q

organizational design- complexity

A

division of labor, number of hierarchial lvls, geographic dispersion of units

more dispersed= inc demands

121
Q

organizational design- formalization (main idea)

A

degree to which org, has rules that define members role
ex. how many restrictions rn has

122
Q

organizational design- centralization

A

location where decision is made

centralized= top- tall pyramid
ex. vp, DON

decentralized= flat, few levels
pt care lvl
ex. DON admits pt

123
Q

organizational chart

A

visual display of formal structure

shows chain of comm. and who to report to

124
Q

organizational chart formal v informal

A

formal- roles and functions defined

informal- friendship circles that are not on the chart
ex. coworker that ppl always go to for help

125
Q

functional structure

A

departments and services arranged accord to specialty

dept w/ similar func report to same manager

ex. diff nursing specialties all report to same nursing

126
Q

functional structures cons

A

delays in decision making
ex. communication across grps must be raised to senior management lvl

127
Q

service line structures

A

all units needed to dev specific product report to one manager
ex. cardiology service (center in ED, CCU, ICU tele unit, cath lab, cardiac rehab)
advantage- coord of services, faster decision making
con- fragment management on a floor
ex. 2 nurses on same floor have to report to diff managers

128
Q

flat structures

A

decentralization
“participatory management”

removes hierarchial layers- low lvl formalization

authority at action lvl
power is at the bottom

129
Q

flat structure- pro v con

A

larger the organization= mre need for decentralization
pro- faster response time, more creativity, inc job satisfaction
con- different skill lvls may not have auth

130
Q

shared governance

A

professional practice model
philosophy- nurses practice is best determined by nurses

131
Q

shared governance goals

A

shared decision making
accountability
inc autonomy and control for nurses
have authority to make decisions regarding all aspect of pt care
ex. budget, quality management, continuing ed, policy changes

RN is the core of the structure

132
Q

shared gov- congressional model

A

nurses form committees have say in decision-making
ex. until counsel

133
Q

shared gov- staff criteria

A

dev of interpersonal relationships
conflict resolution
acceptance of responsibility

134
Q

shared gov pro v con

A

pro- inc efficiency and productivity
better pt care, cost effective
inc rn satisfaction and retention

cons-
inc time in meetings, lack of admin support, long term committment

135
Q

hybrid model

A

flat and functional

136
Q

magnet status- 5 criteria

A

appointed by American academy of nursing (AAN)

requires
decent and open management style

criteria
1- transformational ldrshp
2- structural empowerment
3- exemplary professional practice
4- new knowledge, innovation
5- empirical quality results

137
Q

professional practice model- magent

A

autonomous nursing practice through
self gov
appropriate staffing
clinical expertise
clinical ladder opport.

138
Q

delegation def

A

increases nurses responsibility
decisions r/t deleg must be based on protection of health, safety and welfare of public

139
Q

assigning v delegating

A

assigning- distribution of work
based on # of staff or given time period

delegation- skill
requires nursing judgement
directing performance of ppl to get task done on nurses behalf
based on acuity. not # of pt’s

140
Q

delegation advantages

A

saves time
inc attention for pts
cost effective
empowering

141
Q

delegation disadvantages

A

poor pt outcomes if task is wrongly delegated
liability- costly
time consuming
dec pt satisfaction

142
Q

tasks NOT delegate

A

nursing process as a whole
nursing assessment
nursing dx, care goals, care plans
complex interventions
discipline of employees

LPN can contribute but NOT design

143
Q

delegation- factors

A

potential for harm
complexity of task
need for problem solving
predictability of outcome
lvl of interaction w/ client (do not delegate teaching)

144
Q

5 rights of delegation

A

task
circumstances
person
direction/communication
supervision

145
Q

delegation circumstances

A

is the setting, resources appropriate?

146
Q

delegation- right person

A

do they demonstrate competency in skills, is it in their SOP

147
Q

delegation- direction/comm

A

are directions specific, and expectations pronounced

148
Q

delegation- supervision

A

approp. monitoring, eval,
need to be available for delegatee

149
Q

delegation steps

A

assess and plan (determine client needs)
communication (why, who, what, where, how)
surveillance and supervision (pt status, task complexity, are outcomes predicatable?)
eval/ feedback (outcomes acheived?)

150
Q

delegation obstacles

A

unsupportive environment
hiearcheal organziation culture (do it yourself)
staff qualities (poor morale)
insecure delegator
unwilling delegates

151
Q

insecure delegator

A

liability
loss of control
don’t want to overburden others
fear of dec job satisf because less pt interaction time
fear of criticism/competition

152
Q

unwilling delegates

A

fear of loss of autonomy
letting ppl down
inexperienced
confused about instructions

153
Q

under delegating causes

A

fear that ppl think pawning off jobs bc don’t know how to do them yourself
desire to do everything themselves
lack of experience w/ delgation
enjoyment of the work
fear of liability

154
Q

over delegating causes

A

POOR TIME MANAGEMENT
insecurity about ability to perform task

155
Q

improper delegating causes

A

wrong time, person, task, circumstance
not within persons SOP
decision making w/o providing adequate info

156
Q

when to reconsider delegating

A

change in pt condition
failure to report
person does not follow instructions
additional work has already been delegated to person

157
Q

delegation- BSN

A

designers, managers, coordinators of care
LPN cannot titrate, blood products, program inserted IV pump, manipulate central lines, perform arterial sticks,

158
Q

delegation- LPN

A

provide care under specific guidelines
depends on state rules

159
Q

delegation- UAP

A

cannot supervise or delegate tasks to other UAPs
ARE legally responsible for the care they provide

487- Leadership/Mngmnt (3 decks)

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