Management, Governance, and Leadership Flashcards
The most likely single cause for the series of bankruptcies among larger nursing home chains around the year 2000 was
During 1998 and 1999 the price paid per bed i nursing home purchases tended to be too high to sustain over the following years when reimbursements were squeezed by Medicare and Medicaid
In a chance conversation with the owner of an eight-facility chain, the newly hired administrator for the oldest facility in the chain indicates that, because the mortgage is fully retired, the administrator will concentrate more on being effective than efficient since the Quality Indicators are all at or above the state’s average. The owner would likely
It is nearly always desirable to be efficient as well as effective
Occupancy of Facility A has been a steady 70% since the Prospective Payment System was introduced. Two weeks ago, a new 120 bed, equally equipped facility opened several blocks away. The Facility A administrator tells the admissions counselor to continue the usual recruitment approach. The chain owners ought to
The administrator fails to anticipate that the occupancy rate of the facility is likely to fall and that, n any case, with the new competition a new approach to admissions will most likely be necessary
Bankruptcies among larger nursing home chains prior to 2000 were
From the founding of the large-scale nursing home industry in the 1960’s until the year 2000 very few bankruptcies were experienced
Under Prospective Payment System, nursing facilities’ reimbursed costs
Medicare (and Medicaid) forced facilities to give roe services for a single reimbursement rate than had been the case previously
In recent years, Medicare has
Medicare, to cut its own costs, has required facilities to give more services under the medicare reimbursement plan
The nurse newly promoted to director of nursing insists on giving four RN hours of patient care each day on the Alzheimers wing in the 175 bed facility. The administrator should
The director of nursing fails to understand that using expensive RN hours when less expensive licensed practical nurse and certified nurse’s assistant hours are the industry standard will be unsustainably expensive for the facility
The applicant for the administrator position in a facility near a large teaching hospital insists that, as before in his rural facility, if hired he would not let the Medicare reimbursement policies affect his case mix. This applicant
Case mix in the typical rural facility is hard to manipulate, but in the teaching hospital setting the facility normally must maximize the number of Medicare rehabilitation patients in order to remain competitive and solvent
The newly hired assistant to the administrator insists that the organizational chart dotted line between this position and the Department of Nursing be a solid line. The administrator should
The director of nursing normally reports directly to the administrator. The assistant administrator wants too much power or does not understand how normal nursing facilities function
The medical supplies provider tells the administrator of a facility that has not paid bills for the past 3 months but is now operating under a bankruptcy judge’s approved plan for restructuring, that no more deliveries will be made until past bills are fully paid. The medical supplies provider
Under bankruptcy plans, the court ensures that all current bills are paid. The medical supplies provider does not understand the bankruptcy laws
An administrator who adopts the leadership-by-walking-around LBWA approach by walking through the facility weekly and intently observing
Leadership by walking around (LBWA), to be effective, must be done daily; weekly is too infrequent
The nursing facility administrator who, using the LBWA technique, succeeds in actually making appropriate corrections on the spot during her rounds
It is normally better to go through the chain of command and let the employees’ immediate supervisor request the corrections
The rate of increase in the total number of nursing facilities in the United States during the years 2008-2012
A number of market forces have held down any significant building of new facilities in recent years. This may change
The applicant for administrator of the facility insists that he has successfully used democratic leadership to the exclusion of all other leadership styles. The interviewer should
The successful nursing home administrator will need to employ several administrative styles to get the facility’s work successfully accomplished
The candidate for administrator said that she used a variety of administrative styles, but could not say exactly which she would use in every circumstance. The interviewer should be
This candidate understands the need for flexibility in leadership styles and believes that several styles have been used effectively
The candidate for administrator indicated that he consistently chose the charismatic style of leadership. This should ___ the interviewer
Charismatic leadership is given to leaders by followers. A leader cannot just declare himself or herself charismatic
The costs of providing subacute care to nursing home residents
Yes, acute care reimbursement rate are higher than average, but so are the costs!
The nurse supervisor who had just been appointed director of nursing announced at the first department head meeting that she had circulated a memo among the nurses that only formal communication were to be allowed in the nursing department. The administrator should
It is impossible to prevent informal communications among nurses. The nurse supervisor does not seem to have enough communication savvy to understand this
The department head was not surprised to learn that n employee had heard only the positive comments to the employee and ignored the criticisms. The department head’s grasp of the communication process is
The department head understands that employees often engage in selective hearing, that is, hearing good news and screening out anything unpleasant
The administrator routinely accepted as a nearly exclusive information source the director of nursing’s positive report that nursing was going well. The administrator is
The administrator must get information from all levels of management in order to know what is actually going on. It is is dangerous to rely solely on one person
Periodic shortage of nurses available for nursing home employment___
Nursing shortages come and go, but mostly there is a seemingly chronic shortage of good nurse candidates
Congress and the federal rule makers behave as if the facility will run successfully if Congress and the Centers for Medicare and Medicaid Services can write enough rues. They are ___
It is impossible and undesirable to try to write enough rules to make every facility function successfully
When the administrator notices that the director of nursing seeks to turn as many duties as possible over to housekeeping, the administrator should conclude that the director of nursing is
It is normal for the various departments such as nursing, housekeeping, and dietary to seek to ‘turn over’ as much work to other departments as they can
The administrator insists that a timely copy of all reports generated within the facility come across her desk before anyone signs them. The administrator is
The administrator may have all reports made available to him or her, but requiring that the administrator sees all reports before signing would likely be dysfunctional for getting the facility’s work done in a timely manner
The administrator notices that incident reports are being insufficiently filled out, but does nothing, believing that the situation will likely correct itself. The administrator is
Correctly filled-out incident reports are a must for the facility and this situation is not likely to ‘correct itself’ without the administrator’s active intervention
Corporate sends a directive to its flagship facility administrator directing the administrator’s attention more toward the outcome of resident care than the cost of resident care during the coming 12 months. Corporate is more concerned with ___ than ___
Corporate wants that facility to have as nearly deficiency-free inspection as possible and I swilling to pay a little more for that year’s performance to achieve this
The long-term care sector receiving increased funding and attention from the federal government is the
In recent years, federal and state governments have been seeking to reduce the proportion of funds that go to institutional care
The concept that nursing homes should be reimbursed by states for their actual costs was part of the
This was a part of the effort a few years ago to get nursing facilities reimbursed for the actual costs incurred in giving care
The intense health care cost-shifting efforts among providers such as Medicare, Medicaid, and local governments are
Expect that efforts to shift cost from Medicare and Medicaid onto facilities will continue
Worried about the level of actual resident care being achieved in the facility, the administrator directs the nurses to spend less time charting and more time focusing on the effectiveness of care being given to residents. The likely result will be
The residents may in fact get better care, but if it is not documented, the survey team has no real way to give credit for the care given. Give excellent care, but also document, document, document
The new social worker informs the head of nursing that admissions is all she has time for and that nursing must monitor and document each resident’s sociopsychological experiences. The new social worker is
The social worker has to do both if assigned both. The social worker needs to renegotiate the job description with the administrator
Today the twin forces of ___ and ___ are revolutionizing the delivery of health care
Technology/Patient data legislation
Most of the multiple new devices to monitor and diagnose each individual’s health status are creating new monitoring and diagnostic capacities
Outside the hospital and doctors office
For the nursing facility setting, the new capacities to monitor residents’ health offer dramatic new opportunities to improve
Chronic disease management
Patient data legislation, such as the most recent health care legislation, has set into motion a nationwide policy to promote patients access to their
Medical records
Under the Affordable Care Act, the residents can access their own lab test results within 30 days of request
Without going through the physician who ordered the test
The concept of lab-on-a-chip will
Speed up lab diagnoses in the nursing facility
Attempting to find the right person for each well-defined job is known as the management function of
Staffing
The administrator who takes steps that ensure that the goals are accomplished and that each job is done as planned is successfully
Controlling quality
The administrator’s job is to ensure that the ___ employees do the tasks of the organization at an acceptable quality level
Appropriate
The administrator who conducts a national search fro a director of nursing position and interviews 20 candidates from seven different surrounding states by phone is engaged in the managerial function of
Staffing
In the end, it can be said that the administrator’s responsibility to meet resident care needs and facility financial needs are
Both about equal
Superior performance depends on taking exceptional care of residents via superior service and
Constant innovation
Superior performance for a nursing facility comes through
Innovation in ways to serve residents
The superb nursing facility is superb by virtue of its
Success in serving the residents
Answering the phones and resident call bells with common courtesy and doing things that work are examples of
A blinding flash of the obvious
Giving every employee the space to innovate at least a little; listening to residents and acting on their ideas; and wandering around with residents, staff, and suppliers are examples of the difficult-to-achieve ___
Commonsense; obvious
In a facility of 120 beds, the administrator ___ personally perform each of the management tasks
Need not
To ensure that all the management tasks are successfully accomplished the administrator of a 120 bed facility will typically divide management into
Three layers
A licensed person responsible for formulating and enforcing policies that will be applied to an entire facility is thought of as a/an
Upper level manager
The staff member responsible for reporting to upper-level management and at the same time interacting significantly with several lower level managers int he
Director of Nursing
The staff person for whom both upward and downward communication skills are the most necessary is the
Director of Nursing
When the director of nursing makes an effective policy decision without consulting the administrator that impacts all nursing personnel, the administrator should
Be pleased
In the typical nursing facility, the decision-making process is ___ establishment of lower, middle, and upper levels of management
Noticeably more complicated than simple
Among the following positions, the ___ has no authority to make decisions for the facility
Assistant to the administrator
Decisions made by persons on the staff to whom the administrator has delegated line authority are, n the final. analysis, regarded as decisions by ___
The administrator
When a nurse practitioner, who is more highly qualified than the director of nursing, gives orders to nurses in the hallways, the director of nurses should feel
Undermined
In times of crisis, corporate representatives, who hold a staff or advisory relationship with their counterparts in the local facility, may expect that their advice as staff be
Acted on as carrying line authority
As a generalization, in can be asserted that managerial success belongs to those who
Successfully prepare for the future
Nursing home administrators should anticipate and successfully prepare for
Rapid change
The long term care industry has entered a period in which ___ change(s) can be expected
Rapid and far reaching
The ability to accurately predict the future implications for nursing facilities of new trends to which the present environment may offer small clues is the skill needed to successfully
Forcast
Historically, during the 1970s and early 1980s (until the introduction fo the diagnosis related group methods DRG of reimbursement) nursing facility administrators made long range projections during a periods of
Relative stability in the health care field
The rate of change in the health care field is believed to be
Increasing exponentially
Researchers have predicted that every 10 years ___ of all current knowledge and accepted practices in the health care and other industries will be ___
One fourth/Obsolete
It is conceivable that the core business of the nursing home in this decade will ___ the core business of the nursing home of the next decade
Be entirely different from
One should expect that over the next few decades the rules governing the nursing home will be
New, never experienced before
Nursing homes that stick to conventional formulas for success are/will
Miss new markets and be in a backwash
In the text it is argued that, for the first time in human history, the capacity exists to provide
More health care than any nation can afford
The roles possible for hospitals, nursing homes, home health agencies, and managed care organizations are
Endless and will remain up for grabs
The staff in nursing facilities, over the next two decades, will likely
Experience culture shock
Plans can be said to be statements of teh
Organizational goals of the facility
In order to survive, each facility must
Deal with the outside world
A major advantage associated with carefully developed plans is making it possible to
Compare what happens with what was predicted
When external conditions change, plans
Can be altered to meet the changed conditions
Each facility’s strategic plan must be endorsed by
The governing body
The average number of prescriptions for persons in the United States aged 65 years and older is six. In nursing facilities it is
Often double that number
The observation about the idea ‘if it ain’t broke, don’t fix it’ is
That if it ain’t broke today, it will be tomorrow
The approach of planning know as SWOT refers to focusing on
Strengths, Weaknesses, Opportunities, and Threats
When considering building a new facility, necessary approvals by government agencies, such as zoning requirements, building codes, certificate of need, is/are
Sometimes difficult or impossible to obtain
In general, government purposes and the facility goal of providing high quality care are
The same
Looking at competitors’ expansion plans, occupancy levels, and local hospital plans when considering building a nursing facility is known as conducting a
Needs assessment
When planning a new nursing facility, the goal of being in operation within 4 months is best describes as a/an
Short range objective
As a general rule, the planning process moves from
General to specific
One view of the planning process includes the observation that
the future will change our plans
Nursing home administrators who expect the unexpected and thrive on it
Will last in the prfession
Facilities that embrace each new technology as it becomes available are knows as
Early adapters
The area offering the richest opportunities for innovation is
The unexpected
When one accepts the idea that change is a permanent part of life
One can take advantage of new opportunites
One must assume that other nursing home administrators in the community
Are ‘searching for new ways to climb the mountain
In the process of organizing the work of a facility it is of real importance to ensure that
There is no duplication of work
Organizing is the first step in implementation of a/an
Plan
What the worker does, how the worker does it, what aids are necessary, what is accomplished, and what skills are needed are parts of a
Job analysis
It can be argued that all nursing facility administrators organize their facility according to
Some theory of organization
Viewing organizations as systems has the advantage of offering the manager framework for visualizing the ___ of the organization
Internal and external environment
An organized or complex whole, an assembling or combining of things or parts forming a complex or single whole, best describes the
Systems concept
A primary advantage of systems theory is that it serves a s tool for making sense of the world by making clearer
Interrelationships within and outside the organization
If the outputs of the organization do not meet the administrators expectation he takes ___ actions to bring the outputs into line with those planned
Control
In essence, what nursing facilities do is ;use money to hire staff and provide materials needed to
Give patient care
The patient care that is given by the facility (output)
Can range from good to unacceptable
Asking if the work accomplished by the facility is up to expected standards and, if not, taking corrective actions is the act of
Controlling quality
The administrator uses___ as the guidelines to compare the output with the expected results
The facility’s policies and plans of action
Allocating resources is the process fo dividing resources among the various ___ of those resources
Competing possible uses
Optimizing resources is is allocating resources with the result that ___ use is achieved
Most effective possible
Suppliers, bank creditors, visiting regulators, and advocacy groups can be thought of as ___ who evaluate the facility
Stakeholders
The most direct and immediate stakeholders within the facility are the ___
Care recipients
The passage of the Nursing Home Reform Act can be viewed as a form of ___ the nursing home industry
External feedback of
The external environment of the nursing facility consists of ___
Opportunities and constraints
If something relates meaningfully to a nursing facility but is something over which the facility has no control, for example, enforcement of the federal certification requirements, ic can be said to be ___
A constraint in the external environment
Increasing availability of managed care contracts, new niches, and increasing numbers of elderly needing care can be considered to be
Opportunities
Systems analysis is most/equally useful to
The administrator, DON, and head of housekeeping
Typically, the output of the nursing home as a system becomes the input for
The hospital or the resident’s home
A nursing home and similar organizations can grow
Without any time limit
The entropy process is considered universal law of nature that all organisms
Move towards death
As a general characteristic of organizations, it has been argued that, in general, organizations seek to
Grow
Once in place, organizations become creatures of habit and develop a tendency to ___ change
Resist
The most predictable response of a nursing facility experience a ‘disruptive employee’ is to
Let the employee go
When a nursing facility chain goes from being the leader to being behind the pack, this can likely be attributed to
A deep reservoir of outmoded attitudes and policies
The training received in nursing school, medical school, and physical therapy school tends to
Create resistance to change
The real purpose of systems thinking is to
Empower people to introduce organizational change
The movement of American medicine from 80% general practitioners in 1870 to 20% general practitioners in the 200s is an illustration of the tendency of organizations to
Grow increasingly complex
Directing is the process of communicating to employees what is to be done by each of them and
Helping them to accomplish it
It is ___ to make policies that direct the activities of employees everywhere in the facility 24 hours a daily
Possible
It is neither possible nor desirable to establish policies for
Every conceivable situation
The specific spelling out, step by step, of the intended implementation fo a policy is known as a
Set of procedures
A detailed plan of actions expected of each employee upon hearing the fire alarm is known as
A set of procedures
Normally, the ___ for the facility sets the mission and goals
Governing body
Normally the facility’s role in implementing a facility’s mission to
Write and implement more specific policies and procedures
The internal process by which managers make decisions is
Imprecise not well understood
It is the administrator’s job to ensure that all employees make the right decisions for the facility
As often as possible
Ethical practices throughout the facility are the ___responsibility
Administrator’s
Organizations that thrive over an extended period of time depending on having
Effective leaders
Compared to defining the concept DECIDING, defining the concept LEADING is
Much less difficult
The concept that history is MADE or measurably influenced by individuals who become leaders is known as
The great leadership theory of history
Democratic authoritarian and lassez-faire are
Types of leadership styles
A supervising staff member whom the administrator might most want to provide leadership by walking around is the
DON
A major information advantage to leadership by waling around is the opportunity to
Do naive listening
It is ___ to maintain the chain of command when and administrator practices leadership by walking around
Entirely feasible
An effective administrator does not overrule middle-level managers uless
Harm could result
The administrators work begins once the board has set forth the ___ of the organization
Mission statement
The best time for the administrator to introduce change in the facility is when
He or she does not have to
The better administrator is the one who
Spends the most hours in the facility wings
For every successful decision the administrator makes
He or she may experience two or three wipeouts
One thing that the successful administrator remembers about the environment is that it
Remains beyond control
One reason for the administrator not to give all attention to the most immediate opportunity is that
Better opportunities may also exist
The best time to begin a move toward introducing a change into a facility when
Change is still on the horizon
In the views of some contemporary corporate managers, change should be viewed more as a/an
Continuous process, not an event
Being knowlegable about the field and having competence and experience will take today’s administrator to
A good level
When nursing facility administrators have ‘that particular thing’ in their blood they have a fire int he heart for
Continuously improving the quality of daily life of each resident
Manager-centered leadership retains a ___ degree of control and uses ___ extensively
High/Authority
Permitting subordinates to make the decision and function within the limits defined by the manager is closest to a ___ style of management
Laissez-faire
When deciding what style of management to employ in a given situation, administrators should consider factors within themselves, factors in the employees, and factors in the ___
Organization
A manager who is responsible for the development of more specific policies that interpret administrations policies for the employees one supervises is closest to ___ managing
Middle level
The charge nurse responsible for applying policies provided by the director of nursing services is functioning most closely at the ___ level of management
Lower
Origination, change, creation, and elimination of structure are the responsibility of ___ management
Upper level
Operational use of existing structure is the responsibility of ___ management
Middle level
Successful leaders need to be keenly aware of relevant forces in the situation to understand themselves, and also ___ vis-a-vis the situation
Be able to behave appropriately
The acts of the ___ leader are typically unexamined
Charismatic
A valuable goal for each administrator is to deliver short term results while secuuring
Long term viability
When one is able to motivate someone to do something he or she would not otherwise do, one is said to be weilding
Power
In the american culture power is a/an
Complex concept
The administrators ability to award or withold a year end bonus represents ___ power held by the administrator
Reward
Fear that the administrator may write a negative report and place it in one’s personnel file represents teh administrator’s power
Punishment
Employees identifying and admiring the administrator yield ___power to the administrateor
Referent
Two types of power available to all staff members are
Expert and referent
As a general rule, it is better if an administrator can possess and exercise ___ power
Expert and referent
The presence of numerous professions such as the medical, nursing, dental, and pharmaceutical professions in the facility tend to ___ the administrators power
Constrain
Communication is the exchange of information and the transmission of
Meaning
The administrator initiates a communication and it is transmitted from its source to its destination. Communication has
Not yet taken place
Listening with intensity, acceptance, empathy, and a willingness to assume responsibility for understanding the speaker’s complete message is sometimes called
Active listening
Two systems of communication usually exist side by side in an organization and are known as
Formal and informal
Two nurses chatting while on break in the nurse’s lounge about a patient’s status is ___ communication
Horizontal
Two nurses chatting about the most recent events in the administrator’s office while on break in the nurses’ lounge are engage in ___ communication
Informal
It can be reasonably argued that every communication is likely to have
Multiple levels of meaning
The informal communication process most closely resembles
The nurse assistant chatting with a resident while making the bed
The director of nursing giving instruction to the nurse supervisor is considered
Downward communication
The nurse assistant reporting to the nurse supervisor about an incident in a patient room is an example of ___ communication
Upward
The closer one gets to the organization center of control, the administrators office, for example, the
More pronounced the emphasis is on the exchange of information
The nurse assistant, preoccupied and angry over unsettled matters at home, interprets the comments by the nurse as hostile comments. This illustrates a barrier to communication known as
Agenda carrying
The charge nurse who remembers the words of praise from the director-of nursing but ignores the criticisms also received from the director of nursing illustrates a barrier to communication known as
Selective hearing
A nurse assistant realizes that her fellow nurse assistant is sleeping much of the night shift, but decides not to resort her. This illustrates
Subgroup allegiance
The nurse’s aide realized taht the patients condition should be pointed out to the attending physician who had just popped into the patients room, but hesitated to approach the physician. This illustrates the effects of
Status distance
The medication nurse thought she understood what the pharmacist had just said about the side effects of a medication, but found the technical jargon used by the pharmacist to be intimidating. This illustrates
The language barrier
The charge nurse decided not to write up an incident on her shift because four incidents had already been written up that week on her shift. This illustrates
Self protection
The new 30 page long policy on universal precautions contained so many new requirements that staff soon began to revert to their time tested approaches conducting patient care. This illustrates
Information overload
Under Tag F241 the government defines dignity as caring for residents in a manner that maintains full recognition of the residents
Individuality
Dignity has been interpreted by states examiners
With wide variations
Standardized patterns of required behaviors developed by the facility to enable staff to accomplish necessary work defines a
Role
Since about the year 2000 the percentage of nursing facilities in the US given deficiencies in quality of life, dignity
Varied widely by state and over time
Treating all residents with respect is best described as a
Value
A statement broadly defining the purposes and values held by a facility is a
Mission statement
When the administrator concentrates on getting paperwork done, meeting regulations, and saving money, the staff
Do the same
The area in which it is especially important for the administrator to implement a ‘no excuses’ approach is
Patient care
It is easier for staff to buy into and be motivated by a
Dream or vision
If a facility administrator can communicate a vision or dream
Goals can be more easily set and achieved
Each state legislature publishes standards of practices and sets the ___ behavior expectations for nursing home administrators
Ethical
Corporate generated goals or mission statements generally
Have difficulty motivating local facility workers
Organizations need the leadership of the administrator because in the final analysis
All organizational designs are imperfect
The actual behavior and functioning of an organization such as a nursing facility
Are infinitely more complex and incomplete than the plan
The concept of delegation is permitting decisions to be made
At the lowest level possible
How people relate to each other in the organization and the overall style or feel of an organization are referred to as
The corporate culture
The concept of unity of command emphasizes the importance of each person
Being accountable to one supervisor
When the board of directors gives equal authority to manage the facility to the medical director and the administrator, the board has ignored the ___ concept
Unity of command
The principle that there should be as few levels of management between the chief administrator and the rank and file is the
Short chain of command
When the number of interpreters through whom information must be filtered before it reaches top management is minimized, the concept of ___ has been implemented
Short chain of command
The administrator who pays attention to the size of the various departments, centralization and decentralization, span of control, and short chain of command is paying attention to
The concept of balance
The administrator who begins with the nursing assistants ideas then moves upward through the director of nursings ideas and does so for each department is utilizing the concept of
Management by objectives
In determining the need for information; sources of information and the amount, form, and frequency of information, the administrator is considering his or her
Management information system
The administrator tells the admissions director to drop the daily reporting and to report only on days census drops below 90%. the administrator is utilizing the ___ concept
Management by objectives
Mapping out time estimates for the completion of each step in renovating a wing is using
Delegation
The administrator in the chain who is achieving the best level of resident care, but not necessarily the lowest cost per patient day, can be said to be___ although perhaps not the most efficient administrator
Effective
Studies of top corporate administrators suggest that these persons feel that they can
Manage almost anyting
The administrator who focuses on the time it takes for each housekeeper to clean an area and the time it takes for a nurse assistant to make a bed identifies with the
Scientific management school
Administrators who believe that human factors exercise the most powerful influences due to worker need to participate in social groups identify with the ___ school of management theory
Human relations
Security of residents medical records is of special concern because it is covered under
HIPPA
Encoding data into unrecognizable streams of data while data are in transit is known as
Cryptology
Web based technologies to create interactive platforms through which individuals and communities share, create, and discuss ideas is known as
Social media
An administrator judging the extent of actual results of the facility efforts to achieve the outcomes proposed in its plans is
Comparing
The administrator who is successfully taking the steps necessary to adjust policies and plans of actions to more satisfactorily achieve stated goals is engaged in
Controlling
Translating goals into clearly stated policies, identifying appropriate measures, and stating limits to deviation are some of he requirements for
Effective control of quality
Getting information in a useful form to staff at appropriate levels, stating policies of actions to be taken when limits are exceeded, and taking corrective actions are some of the requirements for
Effective control of quality
Setting up a system for constant renewal of quality measures, finding control measures that are functional and valued by staff, and knowing the limitations of the scope and capabilities of a system are some of he requirements for
Effective control of quality
Physicians diagnose and treat patient illnesses; administrators diagnose and treat ___ illnesses
Organizational
When an administrator studies an determines what is believed to be a problem adversely affecting the nursing facility, the administrator is engaged in a study of
Organizational pathology
Which of the following is not a federal quality measure
Percent of staff having a good feeling about patients
Managers have always sought to achieve quality control in their organizations and
This remains an elusive aspect of managing
Ensuring that all the organizational arrangements believed to be needed are in place puts the emphasis on ___ as a quality measure
Process
Focusing on the results of the effort made and the measurable impact on the patient given care places the emphasis on ___ as a quality measure
Outcome
The federal focus on the idea that a resident’s abilities in activities of daily living do not diminish unless circumstances indicate it is unavoidable places the focus o n
Outcome measures
Quality, argued Deming, comes from
Improvement in the process
Deming observed that too often nurses and nurses aides
Learned their job from workers who were never trained properly
The nurse supervisors job according to Deming is to
Lead
An atmosphere, according to Deming, in which employees feel secure enough to ask questions, take positions, and admit errors is free of
Fear
The best source of slogans or work goals, in Deming’s view is
The facility
Deming would ___ of setting the number of beds to be made each day or the number of rooms to be cleaned or floors scrubbed
Disapprove
In Deming’s view, workers are
Eager to do a good job
Evaluation by performance, merit rating, and annual review of performance in Deming’s view
Destroys teamwork and nurture rivalry
If the administrator tells the director of nursing to compare how the facility’s nursing services are organized with what is considered the best organized nursing services int eh area, the administrator is
Benchmarking
A benchmarking effort ___ be justified by seeking out significantly better practices rather than solely focusing on best practices
Can
When Deming warned not to simply copy others’ efforts when benchmarking, he was advocating
Adapting, rather than copying, benchmarked ideas
Total organizational involvement in improving all aspects of quality of service is the goal of
Total quality management
The approach in total quality of management of placing responsibility with the workers who produce a service is sometimes knows as
Quality at the source
Employee empowerment in decision making, use of teams, and use of individual responsibility for services characterizes
Total quality managemtn
In the American Hospital Association’s view the goal of total quality management is to ___ customer expectations
Exceed
Visionary chief executive officers acting as coaches, commitment to customers, and trained teams characterize
Total quality management
Managing for quality consists of quality planning, quality control, and
Quality improvement
Bringing new ideas into the away an organization accomplishes its purposes is the result of
Innovating
The role of innovator is
Available to all employees
One writer suggests that managers should ___ specific objectives that will guide the organization over an extended period of time
Avoid trying to set out too
In the nursing facility, innovation is
Finding new solutions to creating quality of life for residents
Innovation can be expected
From all levels in a nursing home again
Google’s Android and Apple’s iOS have facilitated unprecedented development of
Apps
In the nursing facility the microphone on the smartphone can be used to quantify components of
Lung function
In the near future, ultrasound will be available to
Nursing home nurses
Daughters and the government are increasingly likely to ___ timely diagnosis of changes in health conditions
Force nursing facilities into
Due to new technologies, health care provided by nursing facilities will be increasingly
Multilayersd
A social graph of information such as demographics, location, family, likes, are part of the medical information of the future know as the
Phenome
The residents individual anatomy, documenting the individuals heterogene
Anatome
All the environmental exposures of the resident has experienced are described as the residents
Exosome
Like many hospitals, nursing homes are increasingly turning to ___ to maintain satisfactory income
Filling a market niche
When a facility has archived the premier status as the best caregiver in the community, experience suggests that it will likely
Lull itself into coplacency
In today’s competitive market, good nursing facilities
Abound
The downside of being a good nursing facility is that it
Only puts you with the rest of the pack
Several years ago, the US Supreme Court ___ self imposed restrictions by health and other professionals against advertising services or prices that result in keeping the public ignorant or inhibiting free flow of information
Ruled illegal
Competition occurs when tow or more organizations seek to serve ___ in an exchange process
The same individual or group
The audit, market segmentation, choosing a market mix, implementing the plan, evaluation of results, and control are the steps in
Marketing
The marketing of the nursing facility is in a special context because of
Public ambivalence toward the nursing facility
Selecting a target market or markets, choosing a competitive position, and developing an effective marketing mix to reach and serve the identified customers is
Developing a mareketing strategy
A marketing strategy includes
Seleting a target
The administrator asks a committee to engage in the process of identifying, collecting, and analyzing information about the external environment. In marketing terminology the administrator is seeking an
Audit
When the administrator decides to serve only longer term residents, Medicare residents, and Alzheimer residents, in marketing terminology the administrator has selected the
Product mix
The steps of problem recognition, information search, alternative evaluation, purchase decision, and post purchase evaluation are, in marketing texts identifies as the steps in
Consumer decision making
Factors such as general appearance of the facility, absence of odors, and the appearance of the patients may be those about which the decision maker may not be consciously aware while visiting a facility into which to place a relative. These are referred to as ___ factors
Subliminal
Normally one of the most effective marketing tools is
A tour through the facility
Cognitive readiness, affective readiness, and behavioral readiness are
The goals of advertising
Which staff should normally talk to the press
The administrator
