CPHQ Certification Exam Test With Complete Solution 2024 Latest Update

CPHQ Certification Exam Test With Complete Solution 2024 Latest Update Triple Aim - ANSWER 1. Ensure quality of care for individual 2 Improve health of the population 3. Control costs Critical components of a leadership team - ANSWER Understand the concepts of organizations as complex systems, culture, strategic planning, change, innovation and creativity IOM definition of healthcare quality - ANSWER The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality Management definition - ANSWER A strategic, integrated management system, which involves all managers and employees and uses quantitative methods to continuously improve an organization's processes to meet and exceed customer needs, wants and expectations IOMs 6 aims for healthcare improvement - ANSWER Safety Effectiveness (avoid overuse and underuse) Patient-centeredness - ensure patient values guide all clinical decisions Timeliness - reduce waits and sometimes harmful delays Efficiency - avoiding waste Equity - providing care that does not vary in quality with respect to personalcharacterisitics, ethnicity, geographic location or socioeconomic status system definition - ANSWER A regularly interacting or independent group of items forming a unified whole Benefits of system thinking - ANSWER Aiding in identifying and understanding the big picture Facilitating the identification of major components Identifying important relationships and providing proper perspective Avoiding excessive attention to a single part Allowing for a broad-scope solution Fostering integration Providing a basis for redesign Healthcare organizations are ... - ANSWER Complex Adaptive Systems (CASs) Making change in one process or dept naturally requires changes in other processes, functions and depts. Effectiveness is dependent on alignment of parts of the system. InterRelationships (between individuals is a critical component of the model)Not linear Characteristics of leaders in CASs - ANSWER Value persons and relationships Use loose coupling Complicate or link Diversify Make sense Think about the future Are collaborative Listen and learn Are adaptable Offer alternatives Characteristics of Leaders in CASs - ANSWER Value persons and relationships Use loose coupling Complicate or link Diversify Make sense Think about the future Are collaborative Listen and learn Are adaptable Offer alternativesCharacteristics of Leaders in traditional systems - ANSWER Value positions Use tight structuring Simplify Socialize Make decisions Do planning based on forecasting Are controlling, in charge Know Are self-preserving Repeat the past True or False The HCQP assists organization leaders and employees in understanding the principles and common frameworks for healthcare quality strategies. - ANSWER True Which evidence based framework model for studying systems is best? - ANSWER Donabedian Baldrige Performance Excellence Any, as long as the manager uses it to properly recognize, understand and anticipate how the parts of the system interact as a whole Who is the founder of the quality assurance field and the first to describe an approach to assessing quality through a systems framework? - ANSWER Avedis Donabedian Donabedian's framework - ANSWER Focus on structures (resources available for care delivery) processes (involves the care, how diagnoses and treated) and outcomes (resultsof the care, increased satisfaction, decreased morbidity, improved QOL) for patient care evaluation Limitations of the Donabedian framework - ANSWER Very basic and does not sufficiently describe interrelationships What is a required component of quality performance? - ANSWER Interrelationships Baldrige Performance Excellence Framework - ANSWER Displays principles of quality management and shows interrelationships among factors relating to structure, process and outcome 6 elements of Baldrige Performance Excellence Framework - ANSWER Important connection between Leadership and Results Leadership triad: leadership, strategic planning and customer focus Results triad: results, workforce focus and operations focus What are key components of a foundation for effective organizational management? (Baldrige) - ANSWER Measurement, analysis and knowledge management Rules for the 21st-Century Healthcare system (from IOM's report Crossing the Quality Chasm) - ANSWER Preference is given to professional roles over the system Care is customized according to patient needs and values The patient is the source of control Knowledge is shared and information flows freelyDecision making is evidence based Safety is a system priority Transparency is necessary The system anticipated needs Waste is continuously decreased Cooperation among clinicians is a priority What is necessary for high reliability performance? - ANSWER Strong leadership and skilled management Leadership - ANSWER Coping with change by developing a vision and aligning the subsystems of the organization. Ability to influence an individual or group toward achievement of goals. Determines the correct direction or path. Management - ANSWER Coping with complexity through planning and budgeting; setting goals; organizing, staffing and creating a structure to foster goal attainment; setting up mechanisms for monitoring and controlling results. Doing the correct things to stay on the path. True or False Change is not so much about overcoming resistance as it is about creating attraction. - ANSWER True Different leadership styles - ANSWER Autocratic Participative Empowering TransactionalTransformational autocratic leadership - ANSWER Directive and controlling. Employees have little discretionary power in their work Participative leadership - ANSWER Allows employees some degree of autonomy in completing their work while maintaining some control of the group and the decision-making process; seeks input from employees and serves as facilitator Empowering leadership - ANSWER Shares power and decision making with employees; enabling others by providing the necessary resources and support Transactional leadership - ANSWER Views the leader-follower relationship as a process of exchange where compliance or performance is achieved through the process of giving rewards and punishment Transformational leadership - ANSWER Able to inspire others to change expectations and motivations to work toward common goals 5 important general principles of exemplary leaders - ANSWER 1. Challenge the system 2. Inspire a shared vision 3. Enable others to act 4. Mode the way 5. Encourage the heart Challenge the system - ANSWER Question status quo and lead the way as an early adopter of innovation; recognize good ideas and demonstrate a willingness to stretch and grow to improve quality of care; adoption of core values as a learning organizationAsk what should be instead of accepting what is! Inspire a Shared Vision - ANSWER For change to be a success, provide and influence others to share vision; develop a strong culture for QPI; requires more than just telling others what needs to be done; communicates vision in a manner that causes others to embrace it Enable others to act - ANSWER Share decision making and power in a way that enables others to move toward the direction of the vision. Share power and enable by having appropriate structural design and the appropriate resources to support quality management initiatives Model the Way - ANSWER Model desired behaviors as a role model. Actions speak louder than words. "On-stage behavior" Encourage the Heart - ANSWER A critical component. Recognize the contributions that employees make and celebrate the core values and victories. Reward desired behaviors. Framework for Leadership for Improvement (5 steps - IHI) - ANSWER 1. Set direction: mission, vision and strategy. 2. Establish the foundation. 3. Build will. 4. Generate ideas. 5. Execute change. NQF endorsed safe practice of Leadership Structures and Systems (4 elements) - ANSWER 1. Awareness structures and systems2. Accountability structures and systems 3. Structures and systems 4. Action structures and systems Accountability structures and systems - ANSWER - enable leaders to establish accountability to governing body, senior mgmt, mid-level mgmt, physician leaders and frontline staff Patient safety program Patient safety officer Direct organization-wide leadership accountability Interdisciplinary patient safety committee External reporting activities Structures and systems-driving ability - ANSWER - allows leaders to assess the capacity, resources and competence necessary to implement change in culture and patient safety performance Patient safety budgets People systems Quality systems Technical systems Action structures and systems - ANSWER - enable leaders to take direct and appropriate action QPI programsRegular actions of governance, including confirmation of values, basic teamwork training and governance board competence in patient safety Regular actions of senior administrative leadership, including commitment of time to patient safety; culture measurement, feedback and interventions; basic teamwork training and team interventions; identification and mitigation of risks and hazards Regular actions of unit, service line, departmental and mid-level mgmt leaders Regular actions with respect to independent medical leaders Awareness structures and systems - ANSWER - provide leaders with continuous information about potential risks, hazards and performance gaps that may contribute to patient safety issues Identification of risks and hazards Culture mgmt, feedback and intervention Direct patient input Governance board and senior mgmt briefings and meetings Organization Structural elements of Infrastructure for Quality and Safety - ANSWER Governing body structures - ultimate responsibility for quality of care, either full responsibility or delegates Operational structures - manage the coordination of quality and improvement efforts Teams - work on 1 or more targeted improvement opportunities HCQP role is to evaluate the effectiveness of various structures, paying close attention to alignment, coordination and communication 3 categories of team membership (IHI) - ANSWER 1. Clinical leadership representation 2. Technical expertise3. Day to day leadership + a project sponsor or champion with executive authorities and serve as a liaison to other areas and senior mgmt Who bears ultimate responsibility for the setting of policy, financial and strategic direction and quality of care and service provided? - ANSWER Organization's governing body or board of trustees 6 categories of responsibilities for governing body - ANSWER Organization Public policy and external relationships Strategic planning Resource management Human resource development Education and research 5 core leadership activities to drive improvement (IHI Framework for leadership for improvement) - ANSWER 1. Establish the mission, vision and strategy 2. Establish the foundation 3. Build will 4. Generate ideas 5. Execute change 6 key areas of patient safety (Byers and White) - ANSWER Structure Environment Equipment and TechnologiesProcesses People Leadership and culture 6 basic elements that influence quality (Evans and Dean) - ANSWER 1. Focus on processes 2. Recognition of internal customers 3. Reduction of hierarchy 4. Creation of a team-based organization 5. Use of steering committee 6. Development of an agile organization Mission - ANSWER Organization's purpose or reason for existing. Answers why are we here?, whom do we serve?, what do we do? Provides a long-term direction Vision - ANSWER An organization's statement of its goals for the future, described in measurable terms that clarify the direction for everyone An organization's direction is built upon a mission and guided by vision Guiding principles and core values - ANSWER Facilitate development of leadership values and commitment to quality. Help direct the vision. Core values and concepts in Baldridge Criteria for Performance Excellence - ANSWER Visionary leadershipPatient-focused Excellence Organizational and personal learning Valuing workforce members and partners Agility Focus on the future Managing for innovation Management by fact Social responsibility andcommunity health Focus on results and creating value Systems perspective True or False - ANSWER In general, goals are broad, general statements specifying a purpose or desired outcome and may be more abstract than objectives. One goal can have several objectives. Goals describe accomplishments, not tasks or activities. True or False - ANSWER Objectives are relatively narrow and concrete. Specific statements that detail how goals will be achieved through specific and measurable action Which factor most influences strategy effectiveness? - ANSWER Effective leadership Goals need to be SMART - ANSWER Specific MeasurableAchievable and Attainable Relevant Time-related or time-bound 3 categories of team membership (IHI) - ANSWER 1. Clinical leadership representation 2. Technical expertise 3. Day to day leadership + a project sponsor or champion with executive authorities and serve as a liaison to other areas and senior mgmt Who bears ultimate responsibility for the setting of policy, financial and strategic direction and quality of care and service provided? - ANSWER Organization's governing body or board of trustees 6 categories of responsibilities for governing body - ANSWER Organization Public policy and external relationships Strategic planning Resource management Human resource development Education and research 5 core leadership activities to drive improvement (IHI Framework for leadership for improvement) - ANSWER 1. Establish the mission, vision and strategy 2. Establish the foundation 3. Build will4. Generate ideas 5. Execute change 6 key areas of patient safety (Byers and White) - ANSWER Structure Environment Equipment and Technologies Processes People Leadership and culture 6 basic elements that influence quality (Evans and Dean) - ANSWER 1. Focus on processes 2. Recognition of internal customers 3. Reduction of hierarchy 4. Creation of a team-based organization 5. Use of steering committee 6. Development of an agile organization Strategy - ANSWER The plans and activities developed by an organization in pursuit of its goals and objectives, particularly in regard to positioning itself to meet external demands relative to its competition Goals of strategic management - ANSWER Provide a framework for thinking about business Create a fit between organization and external environment Provide a process for coping with change and organizational renewal Foster anticipation, innovation and excellenceCreate organizational focus Prior to development of a strategic plann, leaders need to consider ... - ANSWER What organizations want to do, should do and can do Mistake Proofing - ANSWER Use of a process or design features to prevent errors or the negative impact of errors PDCA or PDSA cycle - ANSWER Also known as the Shewhart cycle Adapted by Deming Also known as Deming cycle or wheel PLAN: question the capacity or capability of a process. Pose theories on how to improve the process and predict measurable outcome DO: make changes on an experimental, pilot basis CHECK / STUDY: measure outcomes compare to predicted outcomes ACT: implement the changes on a broad scale Who is the philosopher of quality? - ANSWER Edwards Deming Statistical process control techniques The 85/15 rule of TQM - ANSWER 85% of problems detected are process or system related whereas 15% traceable to individualsTheory of Bad Apples - ANSWER Berwick (and Batalden and James) 3 mds dissatisfied with traditional healthcare QA Who founded IHI? - ANSWER Berwick Not for profit organization that drives improvements in healthcare by supporting national projects that focus on safety, effectiveness, patient centeredness, timeliness, efficiency and equity Six Sigma - ANSWER A business mgmt strategy Uses data and statistical analyses to measure and improve performance through the reduction of variation. Based on the concept of normal distribution or curve and belief that there is a point, six standard deviations from the mean, where there should be almost zero defects. Error rates should not exceed 3.4 defects per million opportunities (DPMO) Characterized by obtaining the right measures (metrics) of quality, using rigorous statistical methods and possessing a customer-focused and data-driven philosophy When use Six Sigma approach? - ANSWER Resource utilization Patient safety Appropriate use of technology Increasing market share Six Sigma methodology - ANSWER DMAICDefine, measure, analyze, improve, control lean enterprise - ANSWER Reduce waste and focus on activities that add value for the customer Eliminate waste in 8 key areas: defects, overproduction, waiting, nonutilized talent, transportation, inventory, motion and extra processing A Total redesign Organization Structural elements of Infrastructure for Quality and Safety - ANSWER Governing body structures - ultimate responsibility for quality of care, either full responsibility or delegates Operational structures - manage the coordination of quality and improvement efforts Teams - work on 1 or more targeted improvement opportunities HCQP role is to evaluate the effectiveness of various structures, paying close attention to alignment, coordination and communication Distinction of lean enterprise approach - ANSWER Emphasis on investigating new ways of getting things done and making the changes in a short period of time True or False - ANSWER Organization's usually implement lean methods before considering six Sigma bc waste should be eliminated prior to fine tuning the system to deliver excellence How translate strategic goals into quality outcomes? - ANSWER Aligning improvement activities with strategic goalsEstablishing goals beyond benchmarks Developing and implementing dashboards and scorecards Communicating the goals Identifying and engaging key stakeholders Balanced Scorecard (BSC) - ANSWER A performance measurement and management methodology that helps translate an organization's financial, customer, internal process, and learning and growth objectives and targets into a set of actionable initiatives Norton and Kaplan Comprehensive view and not dependent on a few choice indicators Better links long term strategy with short term activities How to have a successful transformation with Change Management - ANSWER Leadership (70 to 90%): defines what the future should like like, aligns people with the vision and inspires them to make it happen despite obstacles Management (10 to 30%): involves a set of processes that can keep a complex system of people and technology running smoothly True or False - ANSWER All changes do not lead to improvement, but all improvement requires change. 2 factors to assess change in organizations - ANSWER 1. The limits of human performance in being able to respond to change 2. The actual capacity of the systems to handle changeLewin's Change Model - ANSWER unfreeze, change, refreeze Motivation and readiness for change must occur before the change can take place Force field of driving and restraining forces Driving forces must be stronger than restraining forces. Reduce # of restraining rather than add more driving forces to increase change of success Adding powerful drivers does not necessarily make change happen faster. Tool: Force field analysis Force Field Analysis - ANSWER A technique for determining which forces drive a proposed change and which forces restrain it. Diagram of 2 columns, Driving and Restraining Forces. Analyzes opposing forces related to a specific change. Shows # and significance of opposing forces by indicating relative weights with the size of the arrows. Brainstorming (verbal) and brain writing (written) formats Palmer's Change Model - ANSWER 7 key elements:1. Leading change 2. Creating a shared need 3. Shaping a vision 4. Mobilizing commitment 5. Monitoring progress 6. Finishing the job 7. Anchoring the change in systems and structure Key strategy is to first assess READINESS < 50% likelihood of success for change is low DeWeaver and Gillespie's Change Model - ANSWER Reductionist approach. HCPs objectively measure the system inputs and outputs for each part. Depends on an orderly system in which objects behave predictably and new information can fit into existing structures. 5 stages: awareness, curiosity, visualization, learning, use Not linear model, may not make it through all stages and can revert to previous stage Galpin's Human Side of Change Model - ANSWER HUMANISTIC APPROACH TO CHANGE Most important aspect of change is COMMUNICATION9 steps in which Change is a deliberate, planned process 1. Establish the need to change 2. Develop and disseminate a vision of change 3. Diagnose/analyze the current situation 4. Generate recommendations 5. Detail recommendations 6. Pilot-test recommendations 7. Prepare recommendations for rollout 8. Roll out changes 8. Measure, reinforce and refine changes 4 communication phases: build awareness (1 and 2), project status (3-7), communication plan rolled out (8), follow up with staff at end of Change process (9) Tool: Cultural screen Eliminate rules and policies that hinder change and develop new rules that reinforce desired approach or behavior Cultural Screening tool - ANSWER 1. Rules and policies 2. Goals and measurement 3. Customs and norms 4. Training 5. Ceremonies and events6. Management behaviors 7. Rewards and recognition 8. Communications 9. Physical environment 10. Organizational structure Kotter's Heart of Change Model - ANSWER Based on ensuring people fully accept and incorporate the change into their belief system 8 stage process by proactively addressing errors common to organizational change efforts: DEFROST a hardened status quo, introduce new practices and grounds the changes in culture 1. Increase urgency 2. Build the guiding team 3. Get the vision right 4. Communicate for buy in 5. Empower action 6. Create short term wins 7. Don't let up 8. Make change stick May go through multiple phases at onceA complex, adaptive system Change Management Models - ANSWER Lewis's Change Model Palmer's Change Model DeWeaver and Gillespie's Change Model Galpin's Human Side of Change Model Kotter's Heart of Change Model Prochaska's Transtheoretical Change Model Prochaska's Transtheoretical Change Method - ANSWER Stages of change that explain the individual's readiness to change behavior rather than a process change Assumes a person will not change behavior until ready For research purposes, not clinical use (eg smoking cessation or disease state mgmt)" 6 stages: 1. Precontemplation - no intention to take action within next 6 mths 2. Contemplation - intention to take action within next 6 mths 3. Preparation - intention to take action within next 30 days and some behavioral steps taken 4. Action - behavior changes for period < 6 mths 5. Maintenance - behavior changed for period > 6 months 6. Termination - behavior will never return and ability to cope without fear of relapseTrue or False - ANSWER No single Model will fit every type of change or organization. Common elements of change models - ANSWER Readiness for change, communication of change, leadership for implementing change True or False - ANSWER All changes do not necessarily lead to improvement, but all improvement requires change 9 change concepts - ANSWER Fit the PDSA improvement cycle and introduce creative or innovative approaches to change and improvement: Eliminate waste Improve work flow Optimize inventory Change the work environment Enhance producer-customer interface Manage time Manage variation Design error-proof systems Focus on the product or service 4 factors that affect speed of change for High Performing Organizations - ANSWER Leadership, culture, structure, techniques 5 practices leaders use to keep systems aligned - ANSWER Inspire a shared vision, challenge the system, enable others to act, model the way, encourage the heartPrioritization Matrix - ANSWER Organizes tasks, issues or actions and prioritizes based on agreed upon criteria. Combines the tree diagram and the L shaped matrix diagram which displays the best possible effect Lean Enterprise method - ANSWER Identifying value, Eliminating waste, establishing flow, enabling pull systems, pursuing perfection. and increases financial stability. Preferred over reengineering. Improve flow in the value stream and eliminate waste to improve efficiency and speed Delphi Method - ANSWER Combination of brainstorming, multivoting and nominal group techniques. Used when group members are not in 1 location and conducted via email if meeting not feasible. Spaghetti Diagram - ANSWER Layout diagram, graphic representation of flow of traffic or movement Checklist - ANSWER Standard way to ensure completion of critical tasks for process or activity 5-S - ANSWER Lean tool that represents sort, straighten, scrub/shine, systematize/sustain and standardize Value Stream Mapping - ANSWER Map of the process in which only value-added steps for the customer are retained and other waste removed Voice of the Customer - ANSWER List of needs, wants and desires of the customer of a process output. Specifications or requirements.SIPOC (supplier input process output customer) - ANSWER A tool in process management to identify key drivers of a process 5 step process is Six Sigma method - ANSWER DMAIC: define, measure, analyze, improve, control Eliminate defects and reduce variations in processes to improve effectiveness structural measures - ANSWER Measures of infrastructure, capacity, systems and processes process measures - ANSWER Measures of process performance. Tell whether parts or steps in the system are performing as planned outcome measures - ANSWER Results of overall process or system performance Balancing measures - ANSWER Measures that tell what happened to the system as the process or outcome measures improved (unintended consequence) Benchmarking - ANSWER a process by which a company or an individual compares its performance with that of high-performing organizations. The reference point should be demonstrated to be a best practice. Performance or outcomes must always stay the same however the expected value can change. Goal is to identify how to improve outcomes. Enables an organization to set a target or goal for its performance improvement activities Can be internal, external or zero-incidenceEvidence based practice (EBP) - ANSWER More appropriate than evidence based medicine from a healthcare quality perspective. Complements principles of continuous quality improvement (CQI) Promotes patient safety through provision of effective and efficient healthcare Results in less variation and fewer unnecessary interventions Outcome evaluation at individual and aggregate level is essential step in evaluating impact of EBP USPSTF recommendations - ANSWER Often basis for rating of evidence for EBP. Has levels and grading system. Common sources for EBP Guidelines and National Measures - ANSWER AHRQ, Cochrane, speciality professional organizations (ie ACA), leapfrog group (hospital based measures), NQF Evidence based quality mgmt is based on 2 types of research - ANSWER Clinical research - evaluate impact of interventions on patient outcomes. Outcome measures may include clinical outcomes, functional outcomes and patient satisfaction. Assists HCP in determining clinical evidence based best practice Health Services research - evaluates the health system at micro and macro levels. Guide HCP in improving work processes and systems of care clinical guidelines - ANSWER Consensus statements developed to assist in clinical management decisionsclinical pathways - ANSWER Tools to manage quality outcomes and cost of care based on clinical guidelines and current evidence The use of clinical pathways and guidelines reduces variation of clinical practice to optimize patient outcomes - ANSWER True or False Steps for development of a Clinical Pathway - ANSWER 1. Select the topic. 2. Select a mutlidisciplinary team including representatives from all groups affected 3. Evaluate and map the current process of care for the condition or procedure to identify current variation and create an idealized process 4. Evaluate current evidence in the literature 5. Determine the pathway form. 6. Educate all users on how to use the tool and implement it. Critical to define roles. 7. Document and analyze variances that do not meet expectations of the pathway. Key to process improvement. Baldrige National HC Criteris for Performance Excellence Framework - ANSWER A model that displays the QPI principles and shows the relationships between the structural, process and outcome factors QPI Teams - ANSWER An important structural element for QPI Have many different types depending on purpose/mission, tine, degree of autonomy, authority structure, physical presence Teams gave leaders, facilitators and coaches core members - ANSWER the members of a team who bear primary responsibility for the success of a project and who stay with a project from inception to completion. Often havecomplementary skills needed for the desired work output Resource members - ANSWER Critical only for a specific phases of the project and may move in and out of the team Natural Work Teams - ANSWER Involve the people in a given work setting who share responsibilities for a process, workflow or type of work self-directed work team - ANSWER A type of natural work team that shares management responsibilities Process Management Team - ANSWER Focuses on sharing responsibility for monitoring and controlling a work process, such as new product development. virtual teams - ANSWER Typically use technology supported communications rather than face to face interactions to accomplish tasks Steering Committee - ANSWER Permanent QPI teams consisting of cross functional members. Self managed teams that provide direction and focus by identifying and prioritizing improvement opportunities in the organization. Role of the steering committee - ANSWER To sustain, facilitate and expand QP initiative based on the strategic plan Main responsibilities of quality council or steering committee - ANSWER Lending legitimacy go QPI efforts, maintaining organization focus on identified goals and priorities, fostering teamwork for improvement, providing necessary resources and formulating QPI policies regarding quality and safety priorities, participation, annual self assessments, and reward and recognition systems2 teams of great importance in QPI - ANSWER 1. QPI Teams 2. Steering committees (quality councils) How managers determine when to use a team - ANSWER Task complexity, interdependence and objectives (clear and time bound) Team charter - ANSWER An approach to make task objectives clear Contains the following info: Description of the process, why it needs improvement and who is affected Development of criteria to demonstrate that the process has improved Timeline for meetings Resources available Structure of leadership (self managed or leader directed) Expected communication of progress and results How do teams develop and grow? 4 stages of development - ANSWER Stage 1 - Forming - little accomplished Stage 2 - Storming - most difficult, conflict typically arises. Leaders need to manage the conflict by using it to energize the team. Leader delegates tasks. Stage 3 - Norming - shift from I to WE. Develop harmony. Leaders need to challenge team members to continue to grow and guard against too much conformity. Stage 4 - Performing - optimize goal orientation, highly task oriented and productive. Leader needs to develop mechanisms for sharing leadership responsibilities. Characteristics of effective teams - ANSWER Competent members with technical, problem solving, interpersonal and organizational skills; commitment to clear, commongoals; standards of excellence; contributions from every member; collaborative environment; leadership support; nonhierarchical structure and external support and recognition 4 key traits that predict a team's success (4cs) - ANSWER Cohesiveness Communication Clear roles Clear goals Facilitator - ANSWER Guides group process in an unbiased manner ensuring that the meeting agenda is carried out and decisions are responsibly reached with independent contributions from all team members 2 special team types that have patient safety as main focus and error reduction - ANSWER TeamSTEPPS CRM Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) - ANSWER A teamwork system designed for HCPs that is evidence-based and improved communication and teamwork skills. Team members learn 4 primary teamwork skills: leadership, communication, situation monitoring and mutual support. 3 types of team outcomes desired: performance, knowledge and attitudes. Crew Resource Management (CRM) - ANSWER Although team focused on patient safety, the effectiveness of team functioning is a first critical component. Additional elements include a focus on the patient safety mindset and high reliability functioning. Team learns skills in decision making under stressful situations through continued practice, simulation and use of checklists to embed teamwork behaviors into daily work and provide numerous opportunities to practice the desire behaviors (based on airline safety)Workout (six Sigma or lean QPI) - ANSWER A fast track change acceleration process, conducted by a group of team members in a short period of time (hours or days) Performance monitoring - ANSWER a continuous process of collecting and analyzing data to compare how well a project is working against expected results of the project based on performance indicators. the goal is use the indicators to achieve efficiency where possible General criteria for review / audit - ANSWER Was the intervention used? Was it performed properly according to specific criteria? Was it performed safely? Was there any adverse effect or outcome to the patient? Was staff competent to perform the intervention? Was it effective? Was there a better alternative to the intervention? Risk Management - ANSWER An organized effort to identify, assess and reduce, where appropriate, risk to patients, visitors, staff and organizational assets. Protect from financial losses as a result of risks to which the organization is exposed. Process of making and carrying out decisions that will minimize the adverse effects of accidental losses. Categories of risk in Enterprise Risk Management (ERM) - ANSWER Operational, financial, human capital, strategic, legal and regulatory, technology. Hazard Likert rating scale - ANSWER A common rating scale that provides numbers that are attached to descriptive phrases, such as 0 = disagree strongly, 1 = disagree slightly, 2 = neither agree nor disagree, 3 = agree slightly, 4 = strongly agree.Used to gauge customer feedback such as trainee satisfaction 4 important levels of QPI training evaluation - ANSWER Reaction, learning, behavior and results What is a 5th level of QPI training evaluation - ANSWER Return on Investment. Results (improves quality of care, reduced errors) compared with the overall training costs When does learning occur? - ANSWER when experience causes a change in a person's knowledge or behavior. Participants change attitudes, improve knowledge or increase skill as a result of the program How to measure learning - ANSWER Change in attitude, skills or knowledge and using pre and post tests, test performance, demonstrations or role play How measure behavior change - ANSWER Questionnaires and interviews Behavior needs to change Reward systems - ANSWER Critical to success of QPI work motivation - ANSWER The psychological forces that determine the direction of a persons behavior in an organization. A persons level of effort and a persons level of persistence Motivation Equation - ANSWER Need theories + Expectancy theory + Equity theory + Procedural justiceMotivators - ANSWER In Herzberg's theory of motivating factors, job factors that cause employees to be productive and that give them satisfaction. Including challenging work, achievement, recognition, growth and advancement hygiene factors (Herzbergs) - ANSWER factors that eliminate job dissatisfaction but don't motivate Include company policy and administrative issues such as supervision, working conditions, interpersonal relations, safety, salaries, morale and productivity Expectancy Theory - ANSWER The theory that motivation will be high when workers believe that high levels of effort lead to high performance and high performance leads to the attainment of desired outcomes. Useful for have valid performance appraisal systems Equity Theory - ANSWER a theory that states that people will be motivated when they perceive that they are being treated fairly Acknowledge different performance levels with different levels of rewards Periodically check employees perceptions about their own input and outcomes as well as those of others Know what outcomes are desirable and tie those to performance in a timely manner procedural justice - ANSWER Theory of motivation that focused on fairness with respect to processes or procedures used to allocate outcomesFollowing conditions: Employees have input into how decisions are made; opportunity for performance errors to be corrected; rules and policies for allocation of outcomes are applied consistently; decisions are made in an unbiased manner 7 fundamental steps of a reward system - ANSWER 2 strategies to achieve healthcare quality - ANSWER Total quality management Continuous quality and performance improvement Healthcare quality - ANSWER The extent to which health serviced provided to individuals and patient populations improve desired health outcomes Quality Circles (QC) - ANSWER Involve employee participation in decision making and problem solving to improve the quality of work Deming - ANSWER Philosopher of quality and the learning organization 85/15 theory - ANSWER Deming said that 85% of problems detected are process or system related and 15% are traceable to individuals Patients experience harm bc of 3 types of quality issues - ANSWER Underuse, overuse, misuse IOM report To Err is Human - ANSWER Showed the direct relationship btwn quality of care and patient outcomesSuggested an agenda for "crossing the chasm" by changing the healthcare delivery system 6 aims for improvement - ANSWER safe, effective, patient-centered, timely, efficient, equitable Patient values should guide all clinical decisions Care should be provided to avoid waste Keys to all QPI activities for quality of care outcomes - ANSWER Collection of meaningful data and the communication of useful information 7 step strategy/concepts for the Interpretation and use of quality of care Information - ANSWER 1. Planning and organizing for data collection, interpretation and use 2. Verifying and correcting data 3. Identifying and presenting potentially important findings 4. Continuing to study and develop recommendations for change 5. Taking action 6. Monitoring performance 7. Communicating results Communication is an integral component of each step 3 barriers to interpretation and use of information - ANSWER Human factors - fear of the data, resentment of external data, unrealistic expectations about data, lack of training related to planning, organizing and analyzing data Statistical factors - flawed data, untimely data, poorly displayed data and data difficult tointegrate with other organizational data organizational factors - data overload, a poor data retrieval system, lack of resources (time, people, money), poor relationships among administration, physicians and staff Final products of every QPI project - ANSWER High level presentation to discuss in meetings for overall findings and outlined suggestions for improvement 1 page executive summary - summarizes project, findings and improvement recommendations; share broadly Detailed report - describes what was done, features of all the analyses, tables and figures, interprets the findings and offers specific details about what needs to be done next. For chairs of depts, quality leaders and senior administrators Could also have quarterly or semi-annual events such as presentations and posters on recent QPI projects Or monthly newsletters and emails to staff QPI Initiative focus - ANSWER Core processes, high risk processes, high risk patients and populations, high risk medications, high risk actions/interventions. Level of risk based on potential consequences of injury or harm to patients. Managing high risk patients and processes will significantly affect morbidity and mortalityExs of core processes - ANSWER Admission, transfer, discharge Exs of high risk processes - ANSWER Medication delivery/administration, surgery Exs of high risk patients - ANSWER Reduced renal function, immunocompromised, neonates, critical care units Exs of high risk medications - ANSWER Heparin, insulin, chemotherapy, opiates Exs of high risk actions/interventions - ANSWER Blood transfusions, use of restraints, extracorporeal circulation 2 general types of data - ANSWER 1. Count / Categorical (nominal, ordinal) - least powerful statistically 2. Measurement / Continuous (interval, ratio) - most power statistically Method of sampling, data collection, analysis are different for each type or level of data. Nominal data - ANSWER Count, discrete or qualitative data (attributes) Binary data - only 2 possibilities Assign numerical values to each category as a label to facilitate data analysis; arbitrary, no quantitative value; no order to data Ordinal data - ANSWER Characteristics put into categories and rank-ordered; assignment to category is not arbitrary Continuous / Measured data - ANSWER Assigned scales that have no gaps; variablesInterval data - ANSWER Distance between each point is equal, no true zero Ratio data - ANSWER Distance between each point is equal, true zero Population - ANSWER The total aggregate or group Sampling - ANSWER Usually selected from the accessible population; makes research more feasible bc allows to sample a portion of the population to represent the entire population Provides logical way of making statements about a larger group based on a smaller group Allows inferences or generalize from sample to population if selection process is random and systemic (unbiased) Types of sampling - ANSWER probability - requires every element in population to have equal or random chance of being selected for inclusion non probability - no way of estimating the probability that each element will be included; only representative of the sample and cannot generalize to available population types of probability sampling - ANSWER simple random, systematic, stratified, cluster simple random sampling - ANSWER every member of the population has an equal probability of being selected for the sample (pulling a name out of hat)systematic sampling - ANSWER After randomly select first case, A procedure in which the selected sampling units are spaced regularly throughout the population; that is, every n'th unit is selected. stratified random sampling - ANSWER Population divided into subgroups (strata) and random samples taken from each strata (sex, ethnicity, diseases, living in certain parts of country) cluster sampling - ANSWER A probability sampling technique in which clusters (groups) of participants within the population of interest are selected at random, followed by data collection from all individuals in each cluster. convenience sampling - ANSWER using a sample of people who are readily available to participate; lack of randomization snowball sampling - ANSWER A subtype of convenience sampling; recruitment of participants based on word of mouth or referrals from other participants; recruits subjects difficult to identify Purposive or judgment sampling - ANSWER Selects a particular group(s) based on certain criteria; subjective expert sampling - ANSWER researchers identify experts on a topic and ask them to participate; used in the Delphi technique; goal to achieve fairly rapid group consensus (ie conference planning team) quota sampling - ANSWER a nonprobability sampling method in which elements are selected to ensure that the sample represents certain characteristics in proportion to their prevalence in the population; decide best type of sample to increase representativenesstypes of nonprobability sampling in quantitative research - ANSWER convenience, snowball, quota, expert, purposive SPC chart - ANSWER Helpful in understanding and interpreting a function or process Reliability - ANSWER consistency of measurement; extent to which an experiment, test or measuring procedure yields the same results on repeated trials An instrument that is reliable does not have to have validity! Reliability coefficient - ANSWER Comparing score results obtained during a test-retest reliability; the closer the coefficient is to 1, the more reliable the tool Reliability coefficients of 0.7 or greater are acceptable, 0.8 or greater is desired Reliability by equivalence - ANSWER Established by comparing scores from various versions of the instrument that have been developed Validity - ANSWER The degree to which an instrument measures what it is intended to measure; more difficult to establish than reliability An instrument that is not reliable can not be valid! Content/Face Validity - ANSWER The degree to which the instrument adequately represents the universe of content; necessary, yet not a sufficient indication that the instrument measures what it is intended to measure; included judgments by experts or respondents about the degree to which a test appears to measure the relevant constructconstruct validity - ANSWER Refers to the degree to which an instrument measures the theoretical construct or trait that it was designed to measure criterion-related validity - ANSWER Refers to the extent that the score on the instrument can be related to a criterion (the behavior that the instrument is supposed to predict); can be predictive or concurrent concurrent validity - ANSWER If the criterion variable is obtained at the same time as the measurement under study predictive validity - ANSWER If the criterion measure is obtained at some future time (after the predictor instrument was used) measures of central tendency - ANSWER Statistical indexes that describe where a set of scores or values of a distribution cluster. Central = middle value Tendency = general trend of the numbers The type and distribution of the data determines which measures of central tendency are most appropriate - mean, median, mode mean - ANSWER The average; most widely used measure in statistical tests of significance; most sensitive to extreme scores the arithmetic average of a distribution, obtained by adding the scores and then dividing by the number of scoresUse for interval or ratio data when variables can be added and the values show a bell-shaped or normal distribution. Also with original variables that have an approximate normal distribution Median - ANSWER The point on a numerical scale above which and below which 50% of the cases fall; not sensitive to extreme scores or statistical outliers the middle score in a distribution; half the scores are above it and half are below it First arrange values in rank order. If the total of values is odd, count up (or down) to the middle value. If there are several identical values clustered at the middle, the median is that value. If the total number of values is even, compute the mean of the 2 middle values Use for ordinal, interval or ratio data but NOT for nominal data Mode - ANSWER The easiest to determine the most frequently occurring score(s) in a distribution Use a statistical package to run descriptive data frequencies and/or a stem-and-leaf plot Seldom the only measure of central tendency reported in research studies; quick and easy way to determine an "average" yet unstable - modes tend to fluctuate widely from sample to sample, even when drawn from same population; reported infrequently Descriptor for typical values on nominal data3 measures of variability - ANSWER Range, standard deviation, interpercentile Looks at the dispersion, how measures are spread out; the degree to which values on a set of scores differ range - ANSWER the difference between the highest and lowest scores in a distribution Best reported as the values themselves; quick estimate of variability and provided information about the 2 endpoints of a distribution. Disadvantages include instability because based on only 2 scores, tendency to increase with sample size and sensitivity to extreme values standard deviation - ANSWER a measure of variability that describes an average distance of every score from the mean Most frequently used statistic for measuring the degree of variability in a set of scores The larger the spread of distribution, the greater the dispersion or variability from the mean Standard bell curve illustrates this measure of variability. A histogram can be used to display data distribution and to determine if data are normally distributed Most appropriate with normally distributed interval or ratio scale data. Also doe broad ordinal scale.Homogenous (less variance) - larger SD Heterogenous (more variance) - smaller SD Interpercentile range - ANSWER a measure of the spread from one percentile division point to the next; may be used to indicate the variability around the median Determine by lining up the measures in order of size and then dividing the array into quarters. The range of scores that includes the middle 50% of the scores Interquartile range values often presented in "box plots" - ie growth charts, clinical pathways (avg patient or in middle quartiles) significance test - ANSWER A statistical technique used in inferential statistics to test the probability of an observed difference. Parametric or nonparametric parametric tests - ANSWER Used with data measures on a continuous scale (interval or ratio, variables data) T-test Regression analysis Multiple regressionanalysis nonparametric tests - ANSWER Used with categorical (attributes) and ordinal data, esp if ordinal categories have a small range of possible values or nonnormal distributionChi-square tests (X2) t-test - ANSWER Compares mean values of a continuous variable between 2 categories/groups to see if statistically different Can be independent (control and experimental group) or dependent (single group yields pre and post treatment scores) regression analysis - ANSWER Performed with intent to make predictions among phenomena Based on statistical correlations, or associations among variables. Used to evaluate the usefulness of a prediction equation There never are perfect correlations therefore never possible to make perfect predictions! - the higher the correlation between variables, the more accurate the degree of prediction - if no correlation between 2 variables, knowing the score of 1 would not help to estimate the score of the other Simple linear regression - 1 variable (x) used to predict a second variable (y) multiple regression analysis - ANSWER An analysis of association in which the effects of two or more independent variables (x) on a single, interval-scaled dependent variable (y) are investigated simultaneously. Chi-square test (X2) - ANSWER Measures the statistical significance of a difference in proportions; the most commonly reported statistical test; easiest to calculate manuallyCommonly used to compare observed data with data that one would expect to obtain according to a specific hypothesis Confidence Interval (CI) - ANSWER A range of values, calculated from the sample observations, that is believed, with a particular probability, to contain the true value of a population parameter. A 95% confidence interval, for example, implies that were the estimation process repeated again and again, then 95% of the calculated intervals would be expected to contain the true parameter value. Note that the stated probability level refers to properties of the interval and not to the parameter itself which is not considered a random variable. level of significance (p) - ANSWER The probability that a difference as great or greater than that observed would occur by chance if, in a larger population, there were no difference between the two means Small p = indicates a small chance that the null hypothesis is true; favors alternative hypothesis that there is a significance between the 2 groups (p < 0.05) Brainstorming - ANSWER Free flowing generation of ideas Technique works well to generate ideas for tools, including cause and effect diagram and tree diagram Multivoting - ANSWER Easy, quick method for determining the most popular or important items from a list Used a series of votes to cut the list in half each time, reducing the number of items to be considerednominal group technique - ANSWER Group decision-making process for generating a large number of ideas in which each member works by himself More structured than brainstorming or multivoting Delphi Method - ANSWER A combination of brainstorming, multivoting and nominal group techniques. Utilized when group members are not in one location, frequently conducted by mail or email when meeting not feasible. Starts as anonymous process. Rate various ideas until have consensus. Activity Network Diagram (AND) - ANSWER Known as an Arrow diagram. Arrows connect articles (nodes) that represent a start and finish of activities. A sequence of events is depicted. Useful when several simultaneous paths must be coordinated Deployment chart / Planning Grid - ANSWER Used to project schedules for complex tasks and their associates subtasks. Usually used with a task for which the time for completion is known. Used to determine who has responsibility for the parts of a plan or project. Helps the group organize key steps in the project that enable members to reach the desired goal. Shaded boxes = indicate primarily responsible, Ovals = indicate an assistant or adviser Stratification chart - ANSWER Designed to show where a problem does and does notoccur or to demonstrate underlying patterns. Is / Is Not matrix. - organizes knowledge and information to identify patterns histogram or bar chart - ANSWER most commonly used frequency distribution tool that presents the measurement scale of values among the x axis (discrete category, each bar equal sized interval) and the frequency scale along the y axis (counts or percentages) Specialized bar graph type used to summarize groups of data to see distribution of values for each variable before further analyzing data sets. Bars should NOT be separated by gaps since continuous scale. frequencies are represented in vertical bars. Plotting the frequency of each interval reveals the data pattern, showing center and spread (including outliers) and whether symmetry or skewed. Important to reveal if problems with data and influences choice of measure of central tendency and spread. Pareto Diagram/Chart - ANSWER Displays a series of bars with which the priority for problem solving can easily be seen by the varying height of the bars. Tallest bar is most frequently occurring issue Always arrange bars in descending height 80% of the problems or effects come from 20% of the causes. Therefore by tackling 20% of the most frequent causes, an 80% improvement can be bone diagram - ANSWER Also know a as cause and effect or Ishikawa Used to analyze and display potential causes of a problem or the source of variation. Generally atleast 4 categories Common categories, the 4 Ms: manpower, methods, machines, materials Or the 5 Ps: patrons (system users), people, provisions (supplies), places to work (environment), procedures (methods and rules) Scatter diagram/plot - ANSWER Shows relationship between two continuous variables (quality effects or process causes) The extent to which the variables relate is called correlation. Often used in combo with fishbone or Pareto diagrams. Healthcare Failure Mode and effects analysis (HFMEA) - ANSWER A preventive approach to identify failures and opportunities for error. Used for processes and equipment. Affinity Diagram - ANSWER This technique allows large numbers of ideas to be sorted into groups based on natural relationships for review and analysis. Interrelationship diagram - ANSWER A tool / drawing that organizes numerous complex problems, issues, or ideas by sorting and displaying their interrelations. Requires multidirectional thinking when a straight-line, cause-and-effect relationship does not exist.Useful for operational and organizational issues. tree diagram - ANSWER Tool maps out the full range of paths and tasks in the process that must be accomplished to achieve a goal. Resembles on organizational chart. Matrix diagram - ANSWER Tool displays the connection between each idea or issue in one group to one or more groups. Shows the relationship between 2 items as well as the strength of the relationship. Most common is the L-shaped matrix. Others are T, Y, X and C-shaped. Prioritization Matrix - ANSWER Tool organizes tasks, issues or actions and prioritizes them based on agreed-upon criteria. Combines the tree diagram and the L-shaped matrix diagram, displaying the best possible effect. Often used before more complex matrices are needed. Applies options under discussion to the priority considerations of the organization. Flow or Process Flow chart - ANSWER A graphical display of a process as it is known to authors, owners or team. Outlined the sequence and relationship of the pieces of the process. Info discussed about the structure, the activity occurring and the outcome or results. Process Decision Program Charts (PDPC) - ANSWER used to understand a goal in relationto the steps for getting to the goal Tool maps the identified events and contingencies that can occur between the time a problem is stated and solved. Identified potential deviations from the desired process, allowing the team to anticipate and prevent the deviation. Use when the team is uncertain about a proposed implementation plan. Can be displayed in a graphic format combining a tree diagram and a flow chart or as an outline format. Run or Trend chart - ANSWER Graphic displays of data points over time. Control charts without the control limits. The user looks for trends in the data or a significant number of data points going in one direction or on one side of the average. Better to NOT analyze data too frequently! Control Chart - ANSWER Run charts to which control limits have been added above and below the center line (mean). Show the range of variation in the output of a process. Upper and lower control limits are determined by adding and subtracting 3 standard deviations to or from the mean. 99% of data points would be expected to fall between the UCL and LCL if normal distribution and no special case variation. Types of Control Charts - ANSWER variable and attribute dataVariable: 1 and range, median and range, x and s, XmR, moving average charts Attributes: P, NP, U, C charts XmR chart - ANSWER Presents individual values (X) and calculates limits based on the moving range (mR). Used when data obtained on a periodic basis. Common Cause Variation - ANSWER The source of variation in a process that is inherent within the process; normally expected. The root cause of the variation must be identified before trying to fix the problem. Points between the control limits in no particular pattern on a control chart Special Cause Variation - ANSWER An unusual source of variation that occurs outside a process but affects it; unpredictable. Points that fall outside the control limits or when inside the control limits, exhibit certain patterns, on a control chart RCA - ANSWER Must be identified to eliminate tampering with the effective components of the process when variation is inherent and reducing the variation is desired. ie - Joint commission and sentinel events Address the following: human factors - communications and information managementsystems, - training, - fatigue/scheduling; environment factors; equipment factors; rules, policies, procedures; leadership systems and culture Develop and implement an action plan to eliminate or minimize root cause of the variation Force Field Analysis - ANSWER A method to systematically identify the various forces that facilitate or increase the likelihood of success, and the opposite factors that decrease or restrain the likelihood of success or improvement in the process. List pros and cons of an action frequency distribution - ANSWER an arrangement of data that indicates how often a particular score or observation occurs Ex: Bell curves, histograms, 2x2 tables Bell curve - ANSWER normal distribution