Quiz Questions Part 2

Question 1

This organization accredits managed care organizations, managed behavioral health organizations, and credentials verification for physician organizations:

Answer 1

National Committee for Quality Assurance

Question 2

Community Hospital of the West has recently been accredited by the Joint Commission for a full three-year period. Based on its accreditation status, CMS assumes that the Community Hospital of the West meets the Conditions of Participation. The reason CMS makes this assumption is because the Joint Commission has been granted _____.

Answer 2

deemed status

Question 3

Before the on-site survey team leaves the healthcare facility they meet with the organization’s leadership team and provide a report of their findings. This meeting is called _____.

1. preliminary report
2. exit conference
3. closing meeting
4. convening conference

Answer 3

exit conference

Question 4

During a recent Joint Commission survey, one of the survey team members asked a nurse in the ICU about her patient. The surveyor asked the nurse about the medications that the patient was on and also asked for the nurse to explain how those medications were ordered and received from the pharmacy. After the nurse explained this process, the surveyor then went to the pharmacy and asked the pharmacist to explain his role in the medication process for this specific patient. The surveyor is utilizing what process?

Answer 4

tracer methodology

Question 5

Western States University Hospital has a contractual relationship with a municipal managed care health plan in its region. Each year, health plan quality management officials come to University Hospital to review cases against selected screens for health maintenance. What criteria are these health screens based on?

Answer 5

HEDIS

Question 6

Which type of data collection pertains to the care services provided to each patient?

Answer 6

Patient-specific

Question 7

Which of the following is a healthcare IT initiative that is designed to improve quality of patient care through the use of electronic health records?

Answer 7

Meaningful Use

Question 8

When healthcare organizations evaluate their core measure data with those of a similar organization, they are using what?

Answer 8

comparative performance data

Question 9

This type of healthcare organization review is conducted at the request of the healthcare facility seeking accreditation _____

Answer 9

Voluntary review

Question 10

This planning technique provides a structure that requires the project team to identify the order and projected duration of activities needed to complete a project:

Answer 10

PERT chart

Question 11

As part of the CARF accreditation process, reviewers examine policies and procedures, administrative rules and regulations, administrative records, human resource records, and the case records of patients. This process is called _____.

Answer 11

Document review

Question 12

At the beginning of a recent accreditation visit, the surveyors met with key leaders of the organization. During the meeting an outline of the schedule was discussed as well as key interviewees are identified. What is the term for this important accreditation meeting?

Answer 12

Opening conference

Question 13

At this stage in project management process, the status of the project is assessed regularly in reference to planned activities and their timeline. If the project is off target, a project manager would take action to bring it back on track.

Answer 13

Monitoring and controlling

Question 14

The change phase that is characterized by acceptance and hope for the future is called

Answer 14

beginning

Question 15

The change phase that is characterized by confusion and creativity is called

Answer 15

transition

Question 16

The change phase that is characterized by grief and letting go is called

Answer 16

ending

Question 17

During a recent strategic planning session, the board of directors listed the following items on the board: poor signage and limited parking for the clinics. The items listed by the board of directors represent which component of the SWOT analysis.

Answer 17

Weaknesses

Question 18

The forming stage of project team development in which team members tend to be very polite as they get to know one another is also called ______.

Answer 18

Cautious affiliation

Question 19

Healthcare organizations require that prior to conducting human subjects’ research; all researchers must submit an application to the ______.

Answer 19

IRB or privacy board

Question 20

The improper or negligent treatment of a patient, as by a physician, resulting in injury, damage, or loss is called:

Answer 20

Malpractice

Question 21

In his research on human reactions to change, Lewin determined three phases of change. The three phases are ___,____, and ____.

Answer 21

refreezing, changing, unfreezing

Question 22

The stage of project team development in which team members learn to communicate and collaborate is called ______.

Answer 22

Harmonious cohesiveness

Question 23

The stage of project team development in which team members work together easily is called

Answer 23

collaborative teamwork

Question 24

TRUE/FALSE: The organization’s leaders have a central role in initiating and maintaining the organization’s PI priorities.

Answer 24

TRUE

Question 25

The key to a healthcare organization’s success is the coordination and cooperation of three key groups as they work together to identify community needs and pursue organizational goals. These three key groups are _______________.

Answer 25

governance, management and employed staff

Question 26

This phase in the project life cycle indicates clear objectives, importance of the project and the expected outcome on the organization

Answer 26

planning

Question 27

Name three categories into which healthcare organizations’ data collection falls

Answer 27

patient specific, aggregated, and comparative

Question 28

The patient experience manager at a local hospital is initiating a PI project to improve overall patient satisfaction for all outpatient departments. This manager is providing the budget for the project as well as the vision for change. In this situation, the patient experience manager is considered to have what role in this project?

Answer 28

Sponsor

Question 29

This phase in the project life cycle is where the project shifts to become an integrated part of organizational operations:

Answer 29

Closure

Question 30

The term used to describe when information that is not shielded and can be introduced at a trial to support a patient’s malpractice action against a hospital or physician is _____.

Answer 30

Discoverable

Question 31

TRUE/FALSE: The four basic elements of negligence that must be proven in a malpractice case are: duty to use due care, breach of duty, damages, and causation.

Answer 31

TRUE

Question 32

John presented to the emergency department with rectal bleeding. Earlier in the day, John had a colonoscopy the revealed a polyp. John’s physician used hot forceps to remove the polyp. After examination in the emergency department, John is taken back to the GI suite where it is revealed that during the polyp removal procedure, John’s physician inadvertently perforated his colon. The perforated colon represents which of the following?

Answer 32

Damages

Question 33

In a malpractice action, the issue is whether a physician exercised a standard of care that a reasonably prudent physician would have exercised under those circumstances. Failure to exercise due care is a ______.

Answer 33

Breach of duty

Question 34

In the scenario in question 11, the physician that performed John’s colonoscopy had an obligation to John to act reasonably, or a(n) ________.

Answer 34

Duty to use due care

Question 35

In the context of research, this term means that the results of the activity may be applied to populations outside the population being studied.

Answer 35

Generalized knowledge

Question 36

A privilege applies to discussions and correspondence between persons with a certain type of relationship that has been recognized as needing confidentiality. Privileged information is not admissible at trial unless _____.

Answer 36

The holder waives the privilege

Question 37

This phase in the project life cycle is where installation of equipment or construction begins, and any policy or procedure manuals should be prepared for distribution:

Answer 37

Execution

Question 38

This phase in the project life cycle begins with the determination that there is a gap between an organization’s performance and expected outcomes:

Answer 38

Initiation

Question 39

In the business intelligence tool (extract-transform-load), which step involves pulling the data from multiple sources, such as electronic health records, data repository, or other health information systems?

Answer 39

Extract

Question 40

The Joint Commission has categorized its performance measures into _______ and nonaccountability measures.

Answer 40

Accountability

Question 41

TRUE/FALSE: Peer review and performance improvement discussions, deliberations, records, and proceedings of the medical staff committees are considered “discoverable” in a court.

Answer 41

FALSE

Question 42

TRUE/FALSE: The process for ensuring qualifications for medical staff members in healthcare organizations is known as peer review.

Answer 42

TRUE

Question 43

In the context of research, _____ means that the results of the activity may be applied to populations outside the population being studied.

Answer 43

generalizable knowledge

Question 44

In a malpractice action, when there is evidence that failure to exercise due care is responsible for actual patient harm this is called _____.

Answer 44

causation

Question 45

TRUE/FALSE: It is not necessary to prove causation in a malpractice case.

Answer 45

FALSE

Question 46

TRUE/FALSE: One basic element that must be proven in a malpractice case is damages.

Answer 46

TRUE

Question 47

TRUE/FALSE: The process for ensuring qualifications for medical staff members in healthcare organizations is known as credentialing

Answer 47

FALSE

Question 48

TRUE/FALSE: A healthcare organization has the responsibility for disclosing a factual explanation of the circumstances surrounding an adverse event.

Answer 48

TRUE

Question 49

This private, not-for-profit organization is committed to developing and maintaining practical, customer-focused standards to help organizations measure and improve the quality, value, and outcomes of behavioral health and medical rehabilitation programs:

Answer 49

Commission on Accreditation of Rehabilitation Facilities

Question 50

The HIM Department has been receiving complaints about the turnaround time for release of information (ROI) requests. A PI team is created to investigate this issue. What data source would be appropriate to use to investigate this issue further?

Answer 50

ROI tracking system

Question 51

As part of ARRA, this Act requires that healthcare organizations and providers make significant investments in information systems to have a positive impact on the care that they provide:

Answer 51

HITECH

Question 52

Deploying this type of technology can be used to allow everyone in a healthcare organization to be informed of the current status of performance improvement projects:

Answer 52

intranet-based communication

Question 53

Data found on sites such as Hospital Compare use aggregated data to describe the experiences of unique types of patients with one or more aspects of their care. What is this data collection called?

Answer 53

comparative

Question 54

Which of the following organizations mobilizes employer purchasing power to promote healthcare safety, quality, and customer value and recognize improvements with rewards?

Answer 54

leapfrog

Question 55

The stage of project team development n which conflicts emerge is called?

Answer 55

Competitiveness

Question 56

In a PERT chart, the path with the greatest total duration time that represents the longest amount of time required to complete the total project is referred to as?

Answer 56

Critical path

Question 57

This stage in the PI process cycle provides positive closure for the team members and is a time to celebrate successes and recognize team members contributions and accomplishments.

Answer 57

Adjourning

Question 58

Before the on-site survey team leaves the healthcare facility, they meet with the organization’s leadership team and provide a report of their findings. This meeting is called _____________.

Answer 58

preliminary report

Question 59

Who can waive privilege?

Answer 59

Patient and hospital administration

Question 60

_______ is a civil action as opposed to a criminal act or breach of contract
A wrongful act committed against a person or a piece of property
One example of Tort Law is healthcare negligence

Answer 60

Tort law