Glossary Flashcards
Accreditation
An external “seal of approval.” Usually a voluntary process; accreditation indicates that a facility or service has passed a standardized objective review process (usually an on-site survey) conducted by an impartial organization and that it meets guidelines or nationally/internationally recognized performance standards.
Act
Process to implement changes on a broad scale.
Activity Network Diagram
Tool also known as an arrow diagram, program evaluation and review technique (PERT), or a critical path method (CPM) chart. Through the use of the arrow diagram, a sequence of events is depicted. It is useful
when several simultaneous paths must be coordinated.
Administrative Support Information System
Information system that aids day-to-day operations in healthcare organizations, including financial information
systems, human resources information systems, and office automation systems.
Affinity Diagram
Organizes numerous ideas or issues into groupings based on their natural relationships within the groupings. Typically used to analyze or chart a process and to structure and organize issues to provide a new perspective.
Balanced Scorecard (BSC)
An approach to performance management developed by Norton and Vaplan. The basic idea of the BSC is that performance measures should provide a comprehensive view of organizational performance and not be overly dependent on a few choice indicators. The BSC helps organizations better link long-term strategy with short-term activities.
Baldrige Award
A competitive award that is given to organizations demon
strating a commitment to quality excellence based on successfully meeting the Baldrige National Healthcare Criteria for Performance Excellence.
Benchmarking
The comparison of an organization’s or an individual practitioner ’s results against a reference point. Ideally, the reference point is a demonstrated best practice.
Black Belt
Member of the organization who has been extensively trained in Six Sigma methods. A Black Belt also is experienced in statistical analysis and interested in teaching others.
Brainstorming
A free-flowing generation of ideas with the potential to create excitement, equalize involvement, and result in original solutions to the problem.
Brainwriting
Tool used to aid in sharing ideas in which people who have ideas can make them anonymously. Reduces sense that one has to compete with others to be heard and often results in generation of more ideas than brainstorming.
Budgeting
Formal annual or periodic process through which financial performance goals and actual results are evaluated for the current and previous fiscal years. This allows for the development of formal goals for the next fiscal year.
Capital Budgeting
The process by which an organization evaluates and selects which long-term investments (or capital expenditures) it will make. Typically this is an annual activity, but it also may be triggered by events such as requests for new programs or equipment.
Case Management
Approach to care that consists of intake and assessment, development of care plan, case coordination, discharge planning, and quality management.
Cause-and-Effect, Ishikawa, or Fishbone Diagram
Diagram used to analyze and display the potential causes of a problem or the source of variation. In general, there are at least four categories in the diagram such as the four Ms: manpower, methods, machines, and materials, or the five Ps: patron (users of the system), people (workers), provisions (supplies), places to work (work environment), and procedures (methods and rules).
Centers for Medicare & Medicaid Services (CMS)
Federal government agency within the U.S. Department of Health and Human Services that is accountable for Medicare, Medicaid, and state Children’s Health Improvement Programs (CHIPs); formerly the Health Care Financing Administration (HCFA).
Certified Professional in Healthcare Quality (CPHQ)
Designation received after passing the written examination and adhering to standards established by the Healthcare Quality Certification Board (HQCB) and continuing to maintain those standards through the recertification process.
Check
Measured outcomes compared to predicted outcomes.
Chi-square (χ2) Test
Measures the statistical significance of a difference in
proportions and is the most commonly reported statistical test in the medical literature.
Clinical Information System
Designed to support direct patient care processes; automated clinical information systems have great potential for analyzing and improving the quality of patient care. Expanded clinical information systems in use include medical records and their retrieval systems, computer-assisted medical decision making for history and physicals and antibiotic selection, and clinical
application programs for health risk programs and health maintenance organization encounter data.
Clinical Risk Management
Used to indicate the concern and interest taken in
clinical care provided to patients, clients, and other customers.
Cluster Sampling
Method requires that the population be divided into groups or clusters.
Coaching
The consultative, collaborative interaction of at least two people, characterized by advocacy and encouragement.
Code-Based System
Information system based on retrospective administrative data, such as data in the Uniform Bill document 1992 (UB-92) or claims data, including clinical information spanning the patient’s entire stay but not identifying the specific timing of certain conditions.
College of American Pathologists (CAP)
In addition to general laboratory accreditation, CAP also provides specialty programs for reproductive laboratories
and forensic urine drug testing programs.
Commission of Office Laboratory Accreditation (COLA)
Accredits physician office laboratories in compliance with clinical laboratory improvement amendments (CLIAs), hospitals, and independent laboratories.
Commission on Accreditation of Rehabilitation Facilities (CARF)
Accreditation commission that promotes the quality, value, and optimal outcomes of services through a consultative accreditation process.
Common Cause
In statistical process control (SPC), it describes problems rooted in basic processes and systems.
Communicability
The ability to clearly communicate a description and value of the innovation to stakeholders.
Compatibility
The degree to which an innovation is perceived as being consistent with the existing values, experiences, beliefs, and needs of potential adopters.
Complex Adaptive System (CAS)
A system of interdependent things (e.g., agents that can be people, departments) wherein there are a great number of con- nections between a wide variety of elements in addition to the ability to learn from experience.
Complex Process
Process that has uncertain outcomes even when formulas or prescriptive procedures have been developed and expertise is available (e.g., successful staffing of a nursing unit for one next shift does not necessarily ensure the success of the next).
Compliance
Conformity in fulfilling official requirements.
Complicated Process
Process that requires a high level of expertise in many
specialized fields and coordination to achieve a high degree of certainty of the outcome (e.g., launching a moon rocket where the formulas are critical and
necessary, and one successful launch increases the likelihood that the next launch will occur as planned).
Confidence Interval (CI)
Provides a range of possible values around a sample
estimate (e.g., a mean, proportion, ratio) that is calculated from data; commonly is used when comparing groups but also has other applications.
Construct Validity
The degree to which an instrument measures the theoretical construct or trait that it was designed to measure (e.g., severity adjustment scales are tools for measuring staffing needs).
Content Validity
The degree to which the instrument adequately represents the universe of content; includes judgments by experts or respondents about the degree to which the test appears to measure the relevant construct.
Continuous
Uninterrupted extension in sequence or an uninterrupted flow.
Control Chart
Used to statistically illustrate upper and lower limits of a process and the variation of an organization’s process within those limits.
Convenience Sampling
Approach allows the use of any available group
of subjects. For example, may include all patients at an organization who are undergoing a certain procedure over a 12-month period.
Corrective Action Plan (CAP)
Also known as plan of correction, improvement
plan, and action plan. Describes documents that organize improvements needed for organizations to be in full compliance with standards or regulations. These
plans often are written in response to a survey, inspection, or gap analyses from assessments that define observations as well as recommendations for actions to achieve compliance for a given standard.
Cost-Benefit Analysis (CBA)
Performed for capital expenditure requests to
determine the viability and broader benefits of such expenditures. This tool helps organizations better utilize financial and human resources and includes a time
frame that demonstrates the costs and benefits of the project over specific periods of time.
Criterion-Related Validity
The extent that the score on the instrument can be related to a criterion (the behavior that the instrument is supposed to predict). Can be either predictive or concurrent.
Cultural Screen
A change management tool focusing on the cultural aspect of change and identifying those factors associated with the culture of the organization that should be assessed to achieve successful change.
Culture
The set of shared attitudes, values, goals, and practices that characterizes a company or corporation. A system of beliefs and actions that characterize a particular group. Culture also refers to norms of behavior and shared values among a group of people. The social “glue” that holds people together. At the heart of culture is the notion of shared values (what is important) and behavioral “norms” (the way things are done). Cultures are described as strong when the core values are intensely held and widely shared.
Customer
The person or entity that receives the process, product, or service and therefore defines the quality of products or services received. Customer focus is a value central to any improvement initiative.
Dashboards
Used to represent key management and performance indicators. Can be used as a data-mining tool to synchronize and synthesize vast amounts of data into visual representations. Can be used for analyzing and forecasting various organizational systems.
Data
The abstract representation of things, facts, concepts, and instructions that are stored in a defined format and structure on a passive medium (e.g., paper, computer, microfilm).
Decision Support System
Deals with functions including strategic planning and marketing; resource allocation; performance evaluation and monitoring; product evaluation and services; and medical management (e.g., evidence-based practice, clinical pathways).
Delphi Method
Combination of brainstorming, multivoting, and nominal group techniques. This technique is utilized when group members are not in one location, and frequently is conducted by mail and or e-mail when a meeting is not feasible.
Deployment Chart
Used to project schedules for complex tasks and their associated subtasks. It usually is used with a task for which the time for completion is known; used to determine who has responsibility for the parts of a plan or project. Also called a planning grid.
Diffusion
The process by which an innovation or new idea is communicated through certain channels over time among members of a social system (dissemination can be synonymous with diffusion).
Do
Make changes on an experimental, pilot basis.
Effective
Care provided based on scientific knowledge as to who will likely benefit, and restrain from providing care when it is not likely to benefit the patient (Institute of Medicine [IOM] Six Aims).
Efficient
Care provided in ways that avoid waste, including waste of equipment, supplies, ideas, and energy (IOM Six Aims).
Empowerment
The giving away of power traditionally held by the manager. It typically involves a higher level of information sharing, decision making, and problem solving at the level closest to the situation, and shared recognition.
Equitable
Care does not vary in quality because of patients’ personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status (IOM Six Aims).
Evidence-Based Medicine
The conscientious, explicit, and judicious use of
current best evidence in making decisions about the care of individual patients.
Expectancy Theory
Is concerned with how individuals decide which behaviors to engage in and how much effort they should give to that behavior; focuses on the individual’s perception of effort-to-performance and performance-to-outcomes links.
Expert Sampling
Type of purposive sampling that involves selecting experts in a given area because of their access to the information relevant to the study.
Fail Forward
Approach whereby one faces failure rather than avoids failure.
Failure Mode and Effects Analysis (FMEA)
A preventive approach to identify failures and opportunities for error; can be used for processes as well as equipment. An FMEA is a systematic method of identifying and preventing failures before they occur.
First-Order Change
Comprises small, relatively easy steps; requires minimal
effort to achieve; rarely has a significant effect on complex systems or organizations.
Fitness for Use
As explained in The Juran Triology, the cost of quality accounting means that there is a break-even point of less than 100%. Beyond a certain point, the cost of providing quality exceeds the value of the incremental improvement in quality.
Flowchart/Process Flowchart
Graphical display of a process outlining the sequence and relationship of the pieces of the process.
Focused/Intensive Review
Those activities whereby processes or outcomes are
utilizing preestablished criteria or indicators.
Force Field Analysis
A method to systematically identify the various forces
that facilitate or increase the likelihood of success, and the opposite factors, those that decrease or restrain the likelihood of success or improvement in the process.
Goal
Broad, general statement specifying a purpose or desired outcome and may be more abstract in nature than an objective (one goal can have several objectives). Establishing a goal is the initial step in the strategic planning process and sets the direction for the activities to follow.
Green Belt
Organization member who usually carries out projects. This individual is knowledgeable about Six Sigma methods but has received less training.
Guiding Principles
The organization’s attitudes and policies for employees
that help to direct the vision.
Healthcare Facilities Accreditation Program (HFAP).
American Osteopathic Association’s HFAP accredits acute-care hospitals, hospital laboratories, ambulatory care/surgery, mental health, substance abuse, and physical rehabilitation medicine facilities.
Heroes
Company role models whose ideals, character, and support of the organizational culture highlight the values and norms a company wishes to reinforce. Heroes provide a role model for success.
Histogram
Used to illustrate the variability or distribution of data; tool presents the measurement scale of values along its x-axis (broken into equal-sized intervals) and the frequency scale (as counts or percents) along the y-axis.
Hoshin Planning
A Japanese term that means policy deployment; Hoshin
planning is a component of the total quality anagement/quality improvement (TQM/QI) system used to ensure that the vision set forth by top management
is being translated into planning objectives. Also includes the actions that both management and employees will take to accomplish long-term organizational strategic goals.
Information
Obtained when data are translated into results and statements that are useful for decision making. To be meaningful, data must be considered within the context of how they were obtained and how they are to be used.
Innovation
An idea, practice, or object that is perceived as new by those who adopt it.
Instruments
Devices that healthcare quality professionals and researchers use to obtain and record the data received from the subjects (e.g., questionnaires, rating scales, and interview transcripts).
Interrater Reliability
The degree to which two raters, operating independently, assign the same ratings in the context of observational research or in coding qualitative materials.
Interrelationship Diagram
Organizes numerous complex problems, issues, or ideas by sorting and displaying their interrelations. Requires multidirectional thinking when there is not a straight-line, cause-and-effect relationship.
Interval Data
The distance between each data point is equal (e.g., the values on a Fahrenheit thermometer).
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Accreditation commission that aims to improve the safety of care using accredi- tation and certification as risk-reduction activities; compliance with standards is intended to reduce the risk of adverse outcomes.
Knowledge Management
The process of collecting information about the spread with the measurement and feedback component for modifying the spread process as necessary; focuses on the knowledge that people need to do their work, improve services, remain current with changing needs, and develop innovative solutions.
Leadership
The ability to influence an individual or group toward achievement of goals.
Lean Enterprise
Includes the application of value stream analysis, a tool for exposing waste, and root cause analysis, which is a method for pursuing perfection. Lean enterprise also includes the use of new technologies to facilitate more efficient practices. Major focus in a lean enterprise is to eliminate waste in the following areas: production, waiting time, inappropriate processing, inventory, transporting, and defects.
Management Information System (MIS)
Can contain both the manual and the automated methods to provide information for decision making. Other names for an MIS, which are used interchangeably, include data-processing structure, clinical information system, medical information system, hospital information system, or decision support system.
Matrix Diagram
Displays the connection between each idea or issue in one group to one or more groups. Can show the relationship between two items as well as the strength of the relationship.
Mean
The sum of all scores or values divided by the total number of scores. The mean, also known as the average, is the most widely used measure of central tendency in statistical tests of significance.
Median
The measure of central tendency that corresponds to the middle score; that is, the point on a numerical scale above which and below which 50 percent of the cases fall.
Mission
Refers to the organization’s purpose or reason for existing. It basically answers questions such as, “Why are we here?” “Whom do we serve?” and “What do we do?”
Misuse
When patients receive appropriate medical services that are provided poorly, exposing them to added risk of preventable complications.
Mode
The score or value that occurs most frequently in a distribution of scores. Of the three measures of central tendency, the mode is the easiest to determine; simply determine which value occurs most often in the data set.
Multiple Regression Analysis
Estimates the effects of two or more independent variables (x) on a dependent measure (y).
Multivoting
An easy, quick method for determining the most popular or important items from a list. This method utilizes a series of votes to cut the list in half each time, thus reducing the number of items to be considered.
National Committee for Quality Assurance (NCQA)
Accreditation committee that evaluates the quality of care and service provided by healthcare organizations. NCQA assesses organization performance against standards for care and service delivery, including the Health Plan Employer Data and Information Set (HEDIS).
Nominal Data
Called count, discrete, or qualitative data. In statistical process control, these are known as attributes data. Binary data are categorical data with only two possibilities (e.g., gender).
Nominal Group Technique
A group decision-making process for generating a large number of ideas in which each member works by himself or herself.
Nonparametric Tests
Statistical tests used with categorical (attributes) data and should be used with ordinal data, especially if the ordinal categories have a small range of possible values or a nonnormal distribution.
Norms of Behavior
Common or pervasive ways of acting that are found in a group.
Objectives
Specific statements that detail how the goals will be achieved; they therefore are relatively narrow and concrete. Objectives represent the organization’s commitment to achieving specific outcomes.
Observability/Visibility
The degree to which the use of an innovation and the results it produces are visible to those who should consider it.
Ordinal Data
Characteristics are put into categories and are rank-ordered. Assignment to the categories is not arbitrary. Examples of ordinal scale data are nursing staff rank (nurse level 1, nurse level 2), education (BS, MS, MD), or attitude toward research scale (strong agree, agree, neutral, disagree, strongly disagree).
Organizational Learning
Describes organizations skilled at creating, acquiring and transferring knowledge, and at modifying behavior to reflect new knowledge and insights.
Outcomes
The results of care processes (e.g., how patients fare as a result of treatment, satisfaction, length, and quality of life).
Overuse
When patients undergo treatment or procedures from which they do not benefit (e.g., 50% of X rays in back pain patients are unnecessary).
Parametric Tests
Statistical tests used with data measured on a continuous scale (i.e., interval or ratio data, which are also known as variables data).
Pareto Diagram/Pareto Chart
Tool used to prioritize a series of problems or possible causes of problems. Displays a series of bars in which the priority for problem solving can easily be seen by the varying height of the bars.
Patient-Centered
Care that is respectful and responsive to patient preferences, needs, and values. Further, patient values should guide all clinical decisions (IOM Six Aims).
Patient Safety
Any improvement effort focused on eliminating medical errors; the degree to which the healthcare environment is free from hazards or dangers.
Pay for Performance
Incentives that drive breakthrough performance to improve the quality of care and service rendered by healthcare providers. Typically includes performance metrics, public report cards, and payment differential for providing better quality care and service.
Performance Management
The use of performance management information to effect positive change in organizational culture, systems and processes, by helping to set agreed-upon performance goals, allocating and prioritizing resources, informing managers to either confirm or change current policy or program direction to meet those goals, and sharing results of performance in pursuing those goals.
Performance Monitoring
Monitoring the impact and effectiveness of the quality improvement action and collecting additional data.
Plan. Question the capacity or capability of a process. Pose theories on how to improve the process and predict measurable outcomes.
Plan
Question the capacity or capability of a process. Pose theories on how to improve the process and predict measurable outcomes.
Plan, Do, Check, Act (PDCA)
Four-step process designed to continuously improve quality, originally conceived by Shewhart.
Plan, Do, Study, Act (PDSA)
Later adaptation by Deming of the PDCA cycle;
also is referred to as the Deming Cycle, or the Deming Wheel.
Population (N)
The total aggregate or group (e.g., all cases that meet a designated set of criteria for practitioners, all patients who have died at a particular hospital, or all registered nurses with a tenure of 10 years or more).
Prioritization Matrix
Organizes tasks, issues, or actions and prioritizes them
based on agreed-upon criteria. The tool combines the tree diagram and the L-shaped matrix diagram, displaying the best possible effect.
Probability Sampling
Sampling that requires every element in the population
to have an equal or random chance of being selected for inclusion in the sample.
Procedural Justice
Focuses on fairness with respect to processes or procedures used to allocate outcomes.
Process
Involved with how the care is delivered (how patients were diagnosed and treated; the activities involved in prevention, diagnosis, and treatment).
Process Analysis
A method of analyzing data using industrial quality
improvement techniques to improve clinical or administrative outcomes. Process analysis occurs whenever a group of individuals diagrams a healthcare process.
Process Decision Program Chart
Maps out the identified events and contingencies that can occur from a problem statement to its solution. Attempts to identify potential deviations from the desired process, thus allowing the team to anticipate and prevent the deviation.
Purposive/Judgment Sampling
Method selects a particular group or groups
based on certain criteria. Subjective, because the researcher uses his or her judgment to decide who is representative of the population.
Quality Circle (QC)
A group of employees who perform similar duties and
meet on a regular basis, with or without management, to discuss quality and productivity problems and propose solutions and/or suggestions for improvement.
Quality Control
Evaluation of actual quality performance, comparing actual performance to quality goals and acting on the differences.
Quality Improvement
Means by which quality performance is achieved at
unprecedented levels by establishing the infrastructure needed to secure annual quality improvement; identifying the specific areas for improvement; establishing clear accountability for bringing QI projects to a successful conclusion; and providing the resources, motivation, and training needed by the teams (i.e., diagnose the causes, stimulate establishment of a remedy, and establish controls to hold the gains).
Quality Improvement Teams
Can be natural work teams, for example, teams with members who work “permanently” as a team each day to complete the task; can be cross-functional, as with an operating-room team; or intact, such as a team of nurses in a particular unit.
Quality Planning
The activity of developing the products and processes required to meet customer needs by determining who the customers are as well as their needs; developing product features and processes that respond to needs and produce desired product features; and transferring the resulting plans to the oper- ating forces.
Quota Sampling
Researcher makes a judgment decision about the best type of sample for the investigation and prespecifies characteristics of the sample to increase its representativeness.
Range
The difference between the highest and lowest values in a distribution of scores.
Rapid Cycle Improvement
Strategy whereby organizations collaborate to identify and prioritize aims for improvement, and gain access to methods, tools, and materials that will enable them to conduct sophisticated, evidence-based quality improvement activities that they could not conduct individually.
Ratio Data
The distance between each point is equal and there is a true zero (e.g., weight and height).
Readiness
Being prepared mentally or physically for some experience or action, immediately available, or ready for immediate use.
Reengineering
Efforts focused on work force redesign; restructuring systems and departments into more efficient processes.
Regression Analysis
Based on statistical correlations or associations among
variables.
Relative Advantage
The degree to which an innovation is perceived as better
than the idea it supersedes.
Reliability
The extent to which an experiment, test, or measuring procedure yields the same results on repeated trials.
Resilience
The process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stressors.
Reversibility
The ability to stop the adoption or use of the innovation and return to a normal or “safe” position if the innovation is not effective.
Risk Adjustment
Technique used to take into account or to control the fact that different patients with the same diagnosis might have additional conditions or characteristics that could affect how well they respond to treatment.
Risk Management
Strategies deployed to protect the organization from
financial losses, which may arise because of the risks to which it is exposed.
Run/Trend Chart
Graphic displays of data points over time. Run charts are
control charts without the control limits.
Safe
Avoid injuries to patients from care that is intended to help them (IOM Six Aims).
Sample
Selection of cases from the accessible population to provide a logical way of making statements about a larger group based on a smaller group and to permit researchers to make inferences or generalize from the sample to the population.
Scatter Diagram
Tool used to display possible cause and effect. Can determine the extent to which two variables (quality effects or process causes) relate to one another. Often used in combination with fishbone or Pareto diagrams/charts.
Second-Order Change
Complex and requires a significant change in behavior to achieve desired new ways of performing or new processes.
Severity of Harm
An estimation of how serious the effects or harm would be if a given failure did occur.
Shared Values
Important concerns and goals shared by most of the people in a group; they tend to shape group behavior and often persist over time even when group membership changes.
Simple Process
Allows people to follow a prescribed procedure to get the same results every time; for example, cooking with a recipe that has been tested ensures replicability without particular expertise (e.g., running preprogrammed or automated reports).
Simple Random Sampling
Each individual in the sampling frame (all subjects in the population) has an equal chance of being chosen (e.g., pulling a name out of a hat containing all possible names).
Simplicity/Complexity
The degree to which an innovation is perceived as simple to understand and use.
Six Sigma
A rigorous methodology that uses data and statistical analysis to measure and improve performance. Quality is improved by eliminating errors in production and service-related processes. Six Sigma is based on the concept of the normal distribution or curve and the belief that there is a point, six standard deviations from the mean, where there should be almost zero defects. Therefore, error rates should not exceed 3.4 defects per million opportunities (dpmo).
Snowball Sampling
A subtype of convenience sampling that involves subjects suggesting other subjects for inclusion in the study, so that the sampling process gains momentum. This type of sampling process gains subjects who are difficult to identify, but are known to others because of an informal network.
Special-Cause
In statistical process control, it describes problems that stem from isolated occurrences that are outside the system.
Special-Cause Variation
Occurs when an activity falls outside the control limits or there is an obvious nonrandom pattern around the central line. This type of variation should be interpreted as a trend and investigated.
Standard Deviation
An average of the deviations from the mean, it is the most frequently used statistic for measuring the degree of variability in a set of scores. Standard refers to the fact that the deviation indicates a group’s average spread of scores or values around their mean; deviation indicates how much each score is scattered from the mean.
Statistical Process Control (SPC)
Allows management to determine a range of random variation that always occurs in a process. SPC describes two types of causes of random variation: common cause and special cause.
Strategic Goal
Broadly stated or long-term outcome written as an overall statement that relates to a philosophy, a purpose, or a desired outcome.
Strategic Objective
Specific statements that are written in measurable and ob- servable terms using quantitative and qualitative measurement criteria. Written as an action-oriented statement, it indicates the minimum acceptable level of perfor- mance and specific time limit or degree of accuracy.
Strategic Planning
The development and codification of a major direction for an organization’s future.
Strategy
The plans and activities developed by an organization in pursuit of its goals and objectives, particularly in regard to positioning itself to meet external demands relative to its competition.
Stratification
Breaks down single numbers into meaningful categories or clas- sification to focus corrective action; used to isolate and illuminate improvement opportunities.
Stratification Chart
Designed to show where a problem does and does not occur, or to demonstrate underlying patterns.
Stratified Random Sampling
A subpopulation is a stratum, and strata are two or more homogeneous subpopulations. After the population has been divided into strata, each member of a stratum has an equal probability of being selected (e.g., sex, ethnicity, patients with particular diseases, or patients living in certain parts of the country).
Structure
The resources available for care delivery (e.g., the qualifications of practitioners and facilities/technology available to them).
Symbols
Things that represent an idea. The purpose of symbols is to reflect the culture, trigger values and norms, and help people make sense of their organization.
System
Regularly interacting or interdependent group of items forming a unified whole; a framework for seeing interrelationships, rather than things; for seeing patterns of change rather than static “snapshots.”
Systematic Sampling
After randomly selecting the first case, this method involves drawing every n-th element from a population (e.g., picking every third name from a list of possible names).
Team
A group of people who are interdependent with respect to information, resources, and skills and who seek to combine their efforts to achieve a common goal.
Timely
Wait times and harmful delays for those who receive and provide care should be eliminated (IOM Six Aims).
Total Quality
Best defined as an attitude, an orientation that permeates an entire organization, and the way that an organization performs its internal and external business. Total quality integrates fundamental management techniques, existing improvement efforts, and the use of technical tools utilizing a disciplined statistical quality control (SQC).
Total Quality Management (TQM)
An approach to organizational development and change that ensures the organization meets or exeeds customer expectations; a strategic, integrated management system that involves all managers and employees and uses quantitative methods to continuously improve an organization’s processes to meet and exceed customer needs, wants, and expectations.
Tree Diagram
Maps out the full range of paths and tasks that are involved in the process and must be accomplished in order to achieve a goal; resembles an organizational chart.
Trialability
The degree to which an innovation can be tested on a small scale.
t Test
Used to analyze the difference between two means to determine whether the difference between two group means is significant; a distinction must be made regarding the two groups.
Uncertainty
The fear and discomfort associated with the implementation of the innovation.
Underuse
When patients do not receive beneficial health services (e.g., 50% of heart attack victims fail to receive beta-blockers).
Unfreezing
Beliefs, expectations, and norms that can be remolded into new beliefs and behaviors. Through a process of learning new information, attitudes, and processes, people are able to redefine their current beliefs and “refreeze” these new concepts into their behaviors.
Utilization Management
An organized, comprehensive approach to analyze, direct, and conserve organizational resources, so as to provide care that is both high in quality and cost-effective (e.g., medical necessity appropriateness review; discharge planning and monitoring; overutilization and underutilization surveil- lance; and identification of over, and underutilization).
Utilization Review Accreditation Commission (URAC)
Accreditation organization for case management, claims processing, consumer-directed healthcare, core accreditation, credentials verification organization, disease management, health call center, health network, health plan, health provider credentialing, health utilization management, health Web site, Health Insurance Portability and Accountability Act (HIPAA) privacy, HIPAA security, independent review, and workers’ compensation utilization management.
Validity
The degree to which an instrument measures what it is intended to measure. Validity usually is more difficult to establish than reliability.
Values
The beliefs and philosophy within an organization that establish the basis for the operation and provide guidelines for daily behavior.
Variability
The degree to which values on a set of scores differ.
Variation Analysis
Used to explain statistically significant differences in the
data. These differences may be due to clinical factors, patient characteristics, data collection (e.g., sampling characteristics), or organizational characteristics (e.g.,
staffing) .
Vision
An organization’s statement of its goals for the future, described in measurable terms that clarify the direction for everyone in the organization. An organization’s direction is built upon its mission and is guided, through leadership, by its vision.
Work Motivation
The psychological forces that determine the direction of a
person’s behavior in an organization, a person’s level of effort, and a person’s level of persistence.
