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Public Health 2nd Semester > Quality 1 > Flashcards

Quality 1 Flashcards

1
Q

What is the definition of quality in health care?

A

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2
Q

look at quality terminology

A

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3
Q

Why is there an urgent need to improve health care quality?

A

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4
Q

What are the six dimensions of quality health care?

A
  1. safe
  2. timely
  3. equitable
  4. efficient
  5. effective
  6. patient centered
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5
Q

What are the three distinct aspects of quality in health care?

A
  1. structure
  2. process
  3. outcome.
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6
Q

What is the donabedian framework for quality assurance?

A

Look at structure, process, and outcome measures.

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7
Q

What are some of the major accreditation bodies in the US?

A

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8
Q

What are the Conditions of Participation?

A

The standards which are set forth in federal regulations that a health care organization must meet in order to participate in and receive payment from medicare or medicaid.

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9
Q

How do the Conditions of Participation and other accreditation agencies work?

A

If the outside accrediting agency has standards that meeting the Conditions of Participation, CMS lets the accrediting body have authroity.

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10
Q

What is accreditation?

A

both a status and a process. As a status, accreditation provides public notification that the institution meets standards. As a process, accreditation reflects the fact that in achieving recognition byt he accrediting agency, the institution or program is committed to self-study and external review by one’s peers in seeking not only to meet standards but to continuously seek ways in which to enhance the quality of health care.

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11
Q

What is certification?

A

State Survey Agency officially recommends its findings regarding whether health care entities meet the social security act’s provider or supplier definitions and whether the entities comply with standards required by federal regulations.

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12
Q

What is the Baldrige Award?

A

established by congress in 1987 to enhance the competitiveness and performance of US businesses (he was the secretary of commerce). 1999 - includes health care organizations. 2007 - include nonprofits.

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13
Q

How many medical errors?

A

44000-99000 deaths annually. $17-29 billion annually. Human error is inevitable so we need to design a safer system so that human error is minimized.

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14
Q

What did the quality of health care delivered to adults in the US indicate?

A

on average, americcans receive about half of recommended medical care processes.

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15
Q

What is the problem with the rate of increase of insurance costs?

A

administrative overhead is increasing far more quickly that salaries are increasing and more people are seeing more and more of their paychecks going to health care

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16
Q

Where does the largest portion of health care dollars go?

A

hospital care. Then to physican/clinical services

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17
Q

How much money does public health get?

A

not very much. very los like 3-5%

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18
Q

What are some growth drivers of spending on personal health care?

A
  1. medical price growth
  2. population growth
  3. use and intensity growth
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19
Q

Do we spend more money on health patients, acute conditions, or chronic conditions?

A

chronic conditions.

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20
Q

What are some of the chronic conditions that we worry about?

A

heart disease, cancer, mental health, DM, hypertension, back pain.

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21
Q

What are the problems with volume based payment

A

there is a lack of accountability for overall quality and costs of care. Docs just want to do more and more.

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22
Q

What are the american hospital quality outocomes?

A

you can go here to find out about hospitals and complications and infections. We knwo americans spend more time picking out cars than picking out doctors.

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23
Q

What are 7 factors driving up health care costs?

A
  1. FFS - pay for doing more
  2. getting older, sicker, fatter
  3. new technology
  4. tax breaks on insurance - moral hazard
  5. consumers not informed
  6. integrated systems getting market share and demanding higher prices
  7. supply and demand problems and legal issues complicating efforts to slow spending
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24
Q

What is the number 1 cause of premature mortality? What do we act like it is?

A

behavioral facotrs, but we put most of our money in acute illness care which is only 10% of premature mortality.

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25
Q

Where is health care moving because of the astronomical costs?

A
  1. measurement and improvement of quality
  2. public reporting and transparency
  3. new payment models and shared accountability
  4. greater focus on prevention
  5. EMR and health information exchange
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26
Q

Why do we measure and publically report quality emtrics?

A

Too long to get evidence into practices, consumers demanding transparency, it works.

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27
Q

What are some legislative mandates to report quality?

A
  1. Medicare Prescription drug improvement and modernization act of 2003 - 10 measures of hospital quality
  2. deficit reduction act of 2005 - 2% of medicare annual payment with hospital qualty measures
  3. section 109 of tax relief and health care act off 2006 - statutory requirement for collection and reporting of measures of quality of care in hospital outpatient departments as well as ambulatory surgery centers.
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28
Q

What about physician reporting of quality?

A
  1. American recovery and reinvestment act of 2009 - want providers to attain meaningful use of certified EHRs. Can get some money. Reduction in reimbursement if they don’t start reporting quality measures.
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29
Q

What is the physician quality reporting system

A

incentive payments 2%, CMS feedback to physicians including national comparisons. 216 measures from which physicians can choose. This can lead to guideline adherence and performance improvement.

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30
Q

What is the national pilot program on payment bundling?

A

integrated care provided to an applicable beneficiary around a hospitalization. There are 8 conditions. You look at an episode of care which is a while. This is kind of like capitation for an episode.

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31
Q

What is a patient centered medical home?

A

a

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32
Q

What is an accountable care organization?

A

patient centered, formal legal structure, accountable for quality, cost, care. at least 5000 enrollees.

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33
Q

what about EHRs?

A

increase access to data, real-time clinical decision-making, proactive outraach to chronically ill patients, prevent adverse events,

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34
Q

What are the three broad aims of the national quality strategy?

A
  1. better health care
  2. better health for people and communities
  3. lower costs through improvement
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35
Q

What are the 2 goals of partnership for patients?

A
  1. keep patients from getting injured or sicker
  2. help patients heal without complication

It has identified nine areas of focus which are common complications of patients in the hospital.

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36
Q

What are tier 1 and tier 2 of HHS action plan to prevent health care associated infections?

A

tier 1 - 6 high priority HAI-related areas within acute care hospital setting
tier 2 - looking at outpatient factilities.

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37
Q

Why is quality taking so long to improve?

A

current efforts are too narrowly focused on preventable complications. We rely too heavily on older improvement methods that have proven ineffective, insuffient attention devoted to changing organizational culture.

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38
Q

What is the cost of quality?

A

some say quality costs more because of the cost of labor, material, design, resources. Juran suggested the benefits exceeded the costs.

The cost of quality isn’t the price of creating a quaity product or service - it is the cost of not creating a quality product or service.

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39
Q

What are the 14 points from W. Edward Deming?

A
  1. create constancy of purpose
  2. adopt new philosopy
  3. cease dependence on mass inspection
  4. institute leadership
  5. institute training on job
  6. drive out fear
  7. break barriers
  8. eliminate slogans.
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40
Q

What are some common themes of quality?

A
  1. customer focus
  2. cease dependence on inspection
  3. continuous improvement
  4. break down barriers
  5. top management has to drive quality
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41
Q

What are some common-cause variations?

A
  1. things that are constantly active within the system
  2. variation predictable probabilistically
  3. irregular variation within historical experience base
  4. lack of significance in individual high or love values.

This is the noise within the system.

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42
Q

What are some special cause variations?

A
  1. new, unanticipated, emergency or previously neglected phenomena within the sytem
  2. variation inherently punpredictable
  3. variation outside the historical experience base
  4. evidence of some inherent changein the system or our knowledge of it.

This is always a surprise. It is a signal within the system.

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43
Q

What are the three components of quality according to Juran?

A

quality control, quality improvement, quality planning.

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44
Q

What is the pareto principle?

A

80% of the problems are caused by 20% of defects.

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45
Q

What is statistical process control?

A

this is a method to control processes:

  1. increased customer satisfaction by producing a more trouble free product.
  2. decreased scrap, rework and inspection costs
  3. decreased operating costs by optimizing the frequency of process adjustments and changes
  4. maximize productivity
  5. predictable and consistent level of quality.
  6. elimination or reduction of receiving inspection by the customer.
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46
Q

What is the theory of bad apples?

A

inspection to improve quality - quotas, consequences, search for outliers, frightened workforce.

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47
Q

What is continuous improvements?

A

knowing that problems and also opportunities to improve are built directly into complex systems.

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48
Q

How can we make sure that continuous improvement occurs?

A
  1. leads must take lead in quality improvement
  2. investments in quality improvement must be substantial.
  3. respect for health care worker must be reestablished
  4. dialog between customers and suppliers of health care must be oepned and maintained
  5. modern tools for improving processes must be put to use in health care
    health care organizations need to organize for qualit
    individual physicians must join int he efforts.
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49
Q

What are structure measures?

A

Look at the settings in which it takes place and the instrumentalities of which itis the product. Infection committee, right equipment, physical plant clean (can be the resources). Licensing, accreditation, or surveys

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50
Q

What are process measures?

A

look at the process rather than the outcomes. these are performance - ABx for surgery, no razors, barrier protection, HOB elevated 30 degrees, avoiding urinary catheters. These are things we do to the patient in the hospital.

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51
Q

What are outcome measures?

A

outcomes of medical care, in terms of recovery, restoration of function and of survival, has been frequently used as an indicator of the quality of medical care. These remain the “ultimate validators of the effectiveness and quality of medical care.” Surgery infection rate, pneumonia rate, UTI rate, blood stream infection rate, length of stay, mortality rate. These are the end results that the patient experiences.

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52
Q

What are the strengthes and weakness of structure measures?

A

easy to measure, lends itself to survey and licensing activities, often regulated. They are largely implemented routinely, and may have little meaning to consumers and patients. Don’t necessarily correlate with quality

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53
Q

What are the strengths and weakness of process measurs?

A

explicit criteria for measures, no need for risk adjustment, can compare hospitals, fewer resources needed to collect the data, measures are actionable. These have to be linked to desired outcomes which may be difficult. Requires resourcse for data collection, may have less meaning to consumers and patients.

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54
Q

What are the strengths and weaknesses of outcome measures?

A

more meaningful to patients and consumers, can allow comparisons between hospitals if adjustmed for risk, can be resource intensive, hospitals that do good surveillance may look worse, require extensive adjustment for patient risk factors.

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55
Q

How does the method that you use to measure make a difference?

A

No hospitals do it the same way which may lead to selectionbias. If you do a well organized surveillance, then you may look worse because you have better report rates. Ther eis no standard way to do surveillance in many states.

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56
Q

What is a potentially preventable infection?

A

known preventive measures was available but not employed in that patient’s care.

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57
Q

What is an apparently unavoidable infection?

A

an infection that occurs despite the appropriate application of all known preventive measures.

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58
Q

What is the standard patient satisfaction survey and where does it come from?

A

CAHPS, developed by the health care research and quality agency. It is standardized, with emphasis on actual experience, adjsusted forsome patient characteristics

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59
Q

What are some of the value based purchasing measures?

A

nursing communication, doctor communication, responsiveness of staff, pain management, communication of medications, discharge information, cleanliness and quietness of hospital environment, overall ratingl

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60
Q

What is pay for performance and where did it come from?

A

in the deficit reduction act of 2005. secretray was directed to develop a plan to implement a value-based purchasing program based on the expanded measure set for which hospitals will be submitting data. This was developed under leadership of Secretary of HHS MIke leavitt.

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61
Q

What does hte value based purchasing program do?

A

links payment to quality outcomes under the medicare program. It withhold DRG reimbursement percentage amounts more and more based on quality. Hospital boards of directors must get involved in monitoring the quality of care provided in their hospitals.

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62
Q

How can you have perfect performance?

A

you have to have the perfect performance measures.

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63
Q

What is a measure?

A

collecting data that will determine the factors that have influecne over the outcome of the process or procedure. You need to gather data to describe the current situation. You need to critically identify the appropriate process measures and gather baseline data so that when improvements are made the impact can be verified.

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64
Q

What are the three views of a process?

A
  1. what you think it is
  2. what it actually is
  3. what it should be
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65
Q

What is quality project about?

A

improvign care for your patients.

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66
Q

Why do we care about measurement?

A

Measurement is needed to show improvement and to know how to improve. You need to know your baseline and assess your progress.

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67
Q

What are the differences between improvement research and clinical research?

A

improvement has test observable, stable bias, just enough data, adaptation of the changes, sequential small tests of change. clinical research is blinded, eliminatign bias, large statistical samples, fixed hypotheses, and one large test.

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68
Q

What are some key measurement guidelines?

A

monthly meausres should clarify your teams’ problem statements. Make use of administrative data if it is there. Integrate measurement into daily routine and plot measures each month.

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69
Q

For each of the key measures, you should do these things?

A

define each of the measures for your population
begin reporting your measures immediately
use current administrative data as the means to obtain your measures whenever possible
develop run charts to display your measures each month.

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70
Q

What are some pitfalls of measurement?

A
  1. not measuring often enough. you need to know the trend and then what the change did to the trend.
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71
Q

What are some consequences of quality improvemnet?

A
  1. may result in inappropriate care and even patient harm because of efforts to achieve high performance rates - direct harm or indirect harm. Think Abx for pneumonia when people didn’t have pneumonia.This started to occur when it was recommended that abx started within 4 hours was best.
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72
Q

What is the difference between direct and indirect harm?

A

direct - they get C. diff or sick from whatever you did.

indirect - caregivers shift attention to those conditions that are subject to payment incentives.

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73
Q

How do we avoid unintended consequences?

A
  1. incentive structure - absolute performance thresholds, relative performance thresholds, improvement in performance, stepped or scaled approach for improvement
  2. focus on patient outcomes
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74
Q

What is the 4 P model of improvement?

A

plan, plan, plan, plan

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75
Q

What is the breakthrough series?

A

brings together health care organizations that share a commitment to making major, rapid changes the produce breakthrough results

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76
Q

what is a collaborative?

A

20-40 health care organizations working together for six to 8 months on improving a specific clinical or operational area.

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77
Q

What are the fundamentals of the collaborative model?

A
  1. spread
  2. adaptation of existing knowledge
  3. multiple settings
  4. accomplish a common aim

ahiceves goals that would not have been attainable for an organization working on its own.

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78
Q

What is the four step model for improvement?

A
  1. plan
  2. do
  3. study
  4. act
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79
Q

What are the things that make a collabroative work?

A
  1. visible commitment
  2. creating peer pressure
  3. focus on results
80
Q

What are the key attributes of a collaborative?

A

action oriented, every body learns and teaches, create a sense of family and support, create a sense of urgency and compettition

81
Q

what are essential elements ofr improvement?

A

leadership support, measurement system, poool of diseae and QI experitise, opportunity to collaborate with peers.

82
Q

What is an action period?

A

the time between learning sessions (plan, do study act sessions). This is the time of greatest learning in which we learn from failures, expand on successes and use successes to build consensus.

83
Q

What is in a senior leader report?

A

monthly summary of progress to leadership - statement of aim, defined population, defined measures, goals, change concepts to implement, lessons learned and barriers, run charts

84
Q

What are the steps to creating a new order in health care organizations?

A

improvement in pilot population, hold gains, and then spread. - hold the gains by establishing and documenting standard processes, using measurement and audits, make changes to job descriptions, pay attention to orientation and training, assign ownership, make reversal as difficult as possible.

85
Q

How do you address the social aspects of change?

A

provide information, seek input, publicize the results and learning, show appreciation for people’s efforts, understand and address causes of resistance.

86
Q

What are the different type sof change adopters?

A

innovators - ready to try the latest, greatest thing
early adopters - among first to try
early majority - stage at which masses begin to accept
late majority - skeptical. driven to use out of economic need, peer pressure, or policy
laggards - adopt only because there is no other alternative.

87
Q

What is the spread modeL/

A

the way that IHI helps you to spread the change. You have better ideas whihch are communicated to the social system. there is an infrastructure. Mkake the case with stories and data. Use multiple methods to do it. Gather the core content so it can be communicated in differnet ways. Make sure you spread your purpose and key messengers.

88
Q

How do hospital administrators feel about quality?

A

> 50% do not have it as one of their two top priorities and only a minority reported receiving training in quality. Boardoversight and evaluation of CEO measures that include quality are done at higher performing hospitals. The lowest performing hospitals do not think that they are performing as poorly as they are.

89
Q

What are some barriers to transformation?

A

culture of quality not promoted, inadequate tools to drive quality improvement efforts, lack of perceived leadership and prioritization of quality

90
Q

Who owns quality?

A

leaders are responsible for everything in an organization, especially what goes wrong.

91
Q

What are some Medicare quality assurance strategies?

A

Certification - Medicare provider certification program (done by state agencies and private accrediting organizations), HMO qualitification program

Medical record review - medicare peer review program

92
Q

Tell me about the CMS certification program.

A

Medicare law require institutional providers of care to comply with certain physical and organizational requirements. The focus is on ensuring that providers meet minimum structural and process requirements (hopefully this will change otucomes)

93
Q

What are some private accrediting organizations?

A

The joint commission, american osteopathic association, det norske veritas health care, national committee on quality assurance (HMOs)

94
Q

What is a professional standards review organization?

A

created by congress in 1972 to promote the effective, efficient, and economical delivery of health care services of proper quality with a focus on medicare and medicaid populations. Have to submit a review of utilization.

95
Q

What are the problems with professional standards review organizations?

A

limited effectiveness because of physician protectionism, lack of concern about non-technical aspects of care, and over emphasis on cost containment

96
Q

What is a QIO?

A

A quality improvement organization was established by congress in 1982 to

  1. promote quality health care services for medicare beneficiaries
  2. determine if services rendered are medically necessary, appropriate, and meet professionally recognized standards of care.
97
Q

By law, what do QIOs do?

A

mission is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries.

98
Q

How do QIOS function?

A

there is one per state, usually a contract with a non-profit who oversees the function. There are strict conflict of interest requirements, often physician based organization. Local physicians can not review local care.

99
Q

What are the implicit critiera for chart review done by quality improvement organizations?

A

critier is formed by a respected clinician who uses clinical judgment in evaluating performance. These implicit criteria remain concealed int he mind of the reviewer and the judgments based on these criteria have been shown to vary greatly.

100
Q

What are some sanctions that quality improvement organizations can do?

A

if a provider will not or cannot correct an identified poor practice, the QUI may recommend to the DHHS inspect general to impose a sanction of suspension of eligibility to receive reimbursement from medicare or monetary penalties.

101
Q

What were some problems with PROs (now QIOs)?

A

reflect the bad apple approach. Reviewed thousands of medical records to discpline just a few providers

102
Q

What is the foundation of corporate accountability?

A

a

103
Q

What categories fall under corporate accountability?

A
  1. fiscal responsibility
  2. responsibility for quality of care
  3. responsibility of safety
  4. responsibility for appointing only qualified and compettent physicians and other providers to the medical staff
104
Q

What is a brief history of hospital accountability?

A
  1. darling v. charleston memorial hospital (kid breaks leg, leg dies, amputated) - Dr. found negligent and hospital found liable. Prior to this, hospitals not liable under doctrine of charitable immunity and corporate practice theory.
  2. 1965 Medicare legislation
  3. Oklahoma - Strubhart v Perry Memorial Hospital Trust Authority 1995
105
Q

How does a board accomplish all of its responsibilities?

A

Board of directors delegates to the administrative staff and oversees the medical staff. Administrative staff and medical staff interact when it comes to quality.

106
Q

Must a hospital be accredited?

A

follow the incentives

107
Q

What are the incentives for accreditation?

A
  1. Must meet conditions of participation to receive payment for medicare
  2. some states require it by law
  3. some payers require it as a condition of contracting
108
Q

How do hospitals demonstrate conditions of participation compliance?

A
  1. state certification agency
  2. joint commission
  3. american osteopathic association
  4. det norske vertias health care
109
Q

What is the end results theory and who came up with it?

A

Ernest codman. He was a surgeon. Had first M&M conference and promoted transparency. Suggested evaluating surgical competence and reporting end results (caused some negative things to happen to him).

110
Q

Tell me about the Joint commission.

A

not-for-profit organization, accredits and certifies health car eorganization. Recognized nationwide symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

111
Q

What is history of joint commission?

A

ACS is founded by codman 1913, 1918 - begins inspection of hospitals. 1951 - other physician groups joint the american college of surgeons to form the joint commission.

112
Q

What are some other areas, besides hospitals, that the joint commission looks at?

A

labs, ambulatory health centers, long term care center,s hme care, behavioral health care. officebased surgery

113
Q

What are the benefits of accreditation?

A

competitive edge, improves risk management and risk reduction, helps organize patient safety efforts, decrease liability insurance, evaluation of organization, recognized by insurers and 3rd parties, provides tools for accredited organization

114
Q

What do we mean when we say a hospital accreditation/certification survey or inspection?

A

external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve

115
Q

Where do we find the standards for accreditation?

A

the hospital accreditation standards manual - 21 chapters, 600 specific standards with several elements of performance, full compliance is expected

116
Q

What should you expect during a joint commission survey now?

A

unannounced, 3-5 surveyors, silent code system - they announce they are there at 0730, will ask for a work room and some basic documents. Two hours later they start tracer activities (select random patients. They give you a summation session prior to departure. This gives the hospital an opportunity to address findings, challenge or clarify the observations and to submit action plans if necessary so that there can be changes posted on the JC website.

117
Q

How should errors be handled?

A

should investigate, correct, and apologize instead of blaming, punishing, or covering up. Be transparent.

118
Q

What are six key dimension of the health care system?

A

STEEEP: safe, timely, equitable, efficient, effective, patient-centered.

119
Q

Every system is perfectly designed to get the results it gets.

A

a

120
Q

Who are the founders of science of improvement?

A

deming and shewhart.

121
Q

What are the four key aspects of deming’s system of profound knowledge?

A
  1. systems thinking
  2. variation
  3. theory of knowledge
  4. psychology
122
Q

What are the two parts of the model for improvement?

A

three fundamental questions and the plan-do-study-act cycle

123
Q

What are the three fundamental questions of the model for improvement?

A
  1. aim: what are we trying to accomplish
  2. measures - how will we know a change is an improvement
  3. changes - what changes can we make that will result in improvement
124
Q

What makes a good aim?

A

addresses issue and the specifics about it. Remember the six institute of medicine dimensions when thinking about this (STEEEP)

125
Q

What are the types of measures?

A

outcome - where are we trying to go?
process - are we doing the right things to get there?
balancing - are the changes we are making causing problems in another part of the system

126
Q

What are five useful ways to develop changes?

A

critical thinking, benchmarking, using technology, creative thinking, and change concepts.

127
Q

What is the PDSA cycle?

A

plan
do - try on a small scale
study
act - refine the change

128
Q

What are the steps to making a run chart?

A
  1. plot time along x axis (or patients)
  2. plot the varialbe you’re measuring along y axis
  3. label both the x and y axes and give graph a title
  4. calculate and place a median of the data on the run chart
  5. Add other information as needed. (goal line, unusual events)
129
Q

How do you count the number of runs on a run chart?

A
  1. Count the # of times the line crosses the median and add 1.
130
Q

How do you know if your chart is showing a nonrandom pattern:

A
  1. a shift is indicated by 6 or more consecutive points above or below the median
  2. trend is 5 or more consecutive points all increasing or decreasing
  3. too many or too few runs indicate a nonrandom pattern
  4. astronomical data point is pretty good signal of nonrandom pattern.
131
Q

What is a shewhart chart (control chart)?

A

statistical tool used to figure out whether variation is within a predictable range or whether it’s an indication of change in the system.

132
Q

What are the different types of sampling which help control sampling bias?

A
  1. simple random sampling
  2. proportional stratified random sampling
  3. judgment sampling
133
Q

what is simple random sampling?

A

selection of data from a sample of the population by use of random process, such as random #’s obtained from a computer or random number table.

134
Q

What is proportional stratified random sampling?

A

dividing population into separate categories and taking random sample for each category

135
Q

What is judgment sampling?

A

judgment of those with knowledge of the process to select useful samples for learning about the impact of your changes on process performance.

136
Q

What is stratification?

A

separation and classification of data according to specific variables, demographics, factors. Goal is to find patterns in data that will help us understand the causal factors at work.

137
Q

What are the four phases of a life cycle of improvement project?

A
  1. innovation - come up with new ideas
  2. pilot - testing change on small scale
  3. implementation - making change in one defined setting
  4. spread - in several settings
138
Q

what are some techniques for coming up with innovative ideas?

A
  1. critical thinking about current system
  2. benchmarking
  3. take the patient’s perspective
  4. using technology
  5. creative thinking
  6. using change concepts.
139
Q

Why do we do a pilot test?

A

your idea will not work perfectly, so you test them on a small scale.

140
Q

What are five characteristics of ideas that spread naturally?

A
  1. relative advantage
  2. compatability
  3. simplicity
  4. trailability
  5. observability
141
Q

What are the key components of the framework for spread?

A
  1. leadership - set agenda and assign responsibility
  2. setup for spread - ID your target population and strategy
  3. better ideas - make the case to others
  4. communication
  5. social system
  6. knowledge management
  7. measurement and feedback.
142
Q

Why do people resist change?

A
  1. expected autonomy or independent of health care workers
  2. stability that comes with routine
  3. programmed behaviors - divison of labor, recruitment, reward structures, promotions
  4. limited focus or tunnel vision
  5. real of perceived limit on resources
  6. accumulation of policies, procedures, regulations
143
Q

According to Lewin, what are the three phases of organizational change?

A
  1. unfreezing - loosening attachment to the current behavior or practice
  2. change or transition - when the process of change actually occurs
  3. freezing or refreezing - making sure the change can continue to oeprate as designed.
144
Q

What are some ways that we can better understand what motivates people to change?

A

can assess individual strengths and preferences.

145
Q

What is the Myers-Brieggs type indicator?

A 
individual assessment. 
extraverts v. introverts
sensing v. intuition
thinkers v feelers
judging v perceiving
146
Q

What are soem different types of changes?

A

processes changes and cultural changes. cultural changes are more difficult to accomplish.

147
Q

How are you supposed to change an organizational culture?

A

one way is to use process change to target aspects of the culture that need improvement. Use positive deviance (find the ones who are doing good and find out why they are doing good) to identify what is successful. Use data to make decisions.

148
Q

What is the leadership stance?

A

form a clearer pic of real situation, reframe the problem, connect the problem of powerless to the strategic and business concerns of the powerful, connect the problem of the powerless to the hearts of those in power, seek out a powerful ally, start looking for strong ideas about how to solve the problem, put it together in an action plan.

149
Q

What are three different types of people that you must appeal to when you are atrying to make a change?

A
  1. logical or rational
  2. formal or physical - looking for signs that those in power and authority agree
  3. emotional people
150
Q

What are latent errors?

A

defects in the design and organization of process and systems that lead to failrues and errors. Often unrecognized. They lead to active errors.

151
Q

What are active errors?

A

effects are felt immediately.

152
Q

How do you prevent errors?

A

need to design processes that make it easy for people to do things right, and hard to do things wrong.

153
Q

What is the good thing about errors?

A

represents and opportunityt o improve a process.

154
Q

How are many errors reported in health care systems?

A

through voluntary reporting systems. however, this is bad for some of the hospitals who are really good at this because they may look worse than other hospitals.

155
Q

What is the swiss cheese model?

A

holes do not line up, but sometimes they do line up.

156
Q

What are some important points about error that we should know?

A

error doesn’t always result in harm but it is still important to recognize it. Errors that lead to serious harm are rarely the result of just one error involving one person.

157
Q

What are human factors?

A

the study of all the factors that make it easier to do the work in the right way. This is about the interface between humans and machines (their environment)

158
Q

What are issues that impact human performance and increase the risk for error?

A
  1. factor that are in play between action takes place
  2. factors that directly enable decision making
  3. factors that directly enable decision execution
159
Q

What are some individual factors that lead to error?

A

mental and physiological states such as fatigue, stress, dehydration, hunger, boredom.

160
Q

What are some design principles that have been identified to help with human factors?

A
  1. simplify
  2. standardize
  3. use forcing functions and constraints
  4. use redundancies
  5. avoid reliance on memories
  6. take advantage of habits and patterns
  7. promote effective team functioning
  8. automate carefully.
161
Q

What are some technology examples in health care which help with error?

A
  1. CPOEs
  2. bar-coding systems
  3. intravenous med infusion pumps.
162
Q

When do alarms improve patient safety?

A
  1. when it activates only with a serious problem
  2. when clinician recognizes alarm
  3. necessary know how to address the problem exists.
163
Q

What are human factors?

A

interaction of humans and technical systems. Dissects tasks and considers each components in relation to anumber of factors specifically focused upon non-technical human interactions between people and at the interface between people working within system. Sometimes known as ergonomics. Good human factors design in health care accommodates the entire range of workers.

164
Q

What is SBAR?

A

situation, background, assessment, recommendation. It is a method for communicating critical information that requires immediate attention and action contributing to effective escalation and increased patient safety.

165
Q

What makes health care unique when it comes to errors?

A

a simple error can be a major problem such as death.

166
Q

What are some situations associated with an increased risk of error?

A

unfamiliarity, inexperience, no time, inadequate checking, poor procedures, poor human equipment interface (human factor)

167
Q

What are some individual factors that predispose to error?

A

limited memory capacity, farigue, stress, hunger, illness, language, hazardous attitudes

168
Q

Tell me about the relationship between stress and performance.

A

With too little stress, you have boredom. With too much stress you have burnout. there is a good amount of stress

169
Q

what about the PCA designs should we work towards?

A

you watn==nt the user to have to make the least number of decisions possible.

170
Q

How do you improve communication?

A

do not make assumption, say what you mean, pick your moment, close the loop by repeating back info, clarify ambiguity

171
Q

What is the mnemonic for communication?

A

ISBAR - identify, situation, background, assement, recommendation or request.

172
Q

What are some ways to apply human factors thinking to work environment?

A
  1. avoid reliance on memory
  2. make things visible
  3. review and simplify processes
  4. standardize common processes and procedures
  5. routinely use checklists
  6. decrease reliance on vigilance
173
Q

What is signal to noise ratio?

A

Signal-to-noise ratio is sometimes used informally to refer to the ratio of useful information to false or irrelevant data in a conversation or exchange. For example, in online discussion forums and other online communities, off-topic posts and spam are regarded as “noise” that interferes with the “signal” of appropriate discussion.[1]

174
Q

Understand the development of the Baldrige program.

A

Established by congress in 1987 as American’s highest honor for business excellence.

175
Q

Learn the value of baldridge criteria in healthcare

A

a

176
Q

Describe the criteria framework

A
  1. organizational profile - environment, relationships, strategic situation
  2. performance system
  3. system foundation
177
Q

Explain the malcolm baldrige national quality award.

A

a

178
Q

Review state based quality award programs

A

a

179
Q

What are 7 areas that the performance excellence framework looks at?

A

leadershp, strategic planning, customer focus, measurement, analysis, and knowledge management, workforce focus, operations focus, results

180
Q

Tell me about the specifics of the baldrige criteria.

A

Criteria is set of questions. 7 process and results items, non prescriptive. 200 items

181
Q

What is the ADLI systematic process?

A
  1. approach - what are the steps?
  2. deployment - Who uses the process or who is involved?
  3. learning - how do you evaluate effectiveness
  4. integration
182
Q

What is leadership about in the baldrige criteria?

A

senior leadership

governance and societal responsibilities

183
Q

What is strategic planning like when a baldrige criteria?

A

strategy develop - how do you develop your strategy. and what are your objectives. Therea re 7 steps to this.
Strategy implementation - how do you implement it?

184
Q

What is the customer focus criteria about/

A
  1. voice of the customer - how do you get that information

2. customer engagement - how do you serve them and engage them?

185
Q

What is the measurement, analysis, knowledge management criteria about?

A

how do you measure, analyze, and then improve organizational performance
knowledge management, information, and information technology - they want to know how you manage this.

186
Q

What is the workforce focus for the baldrige criteria?

A

how do you build an effective and supportive workforce environment.
workforce engagement

187
Q

What does ht eoperation focus criteria mean?

A
  1. work processes - how do you design, manage, and improve health care services and work processes
  2. operational effectiveness - how does the organization ensure effective management of its operatiosn on an ongoing basis and in the future
188
Q

What is the results category of the baldrige award?

A
  1. health care and process outcomes
  2. customer focused outcomes
  3. workforced focused outcomes
  4. leadership and governance outcomes
  5. financial and market outcomes
189
Q

What is the Oklahoma Quality Award?

A

administered by Oklahoma Quality Foundation with 3 award levels:

  1. commitment
  2. achievement
  3. excellence
190
Q

What is harm?

A

unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalization, or that results ind eath

191
Q

What is the difference between an error and an adverse event?

A

error is process focused and preventable. Adverse event is outcome fucsed and harm experienced by patient.

192
Q

What are some measures of harm?

A

voluntary reports, safety indicators based on billing codes, complications, morbidity and mortality reviews

193
Q

What are the categories of harm?

A 
E - temporary harm
F - temporary harm
G - permanent patient harm
H life sustaining intervention required
I - contributing to death
194
Q

Are we improving in harm?

A

harm remains common, little evidence of improvement

195
Q

What are some concerns and limitations when it comes to harm?

A

lack of universal harm definition, subjectivity, preventability, resources

196
Q

What are some future directions in the US when it comes to harm?

A
  1. elimination of harm - CMS partnership for patients
  2. value based purchasing - score based on quality, improvement and outcome
  3. conditions not reimbursed
197
Q

How do we reduce harM?

A

measure and become more reliable - standardize, decrease complexity, address human factors, change culture

Public Health 2nd Semester (6 decks)

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