HCD FINAL Questions with Correct Solutions
Question:
1. 5 preventable adverse events
Answer:
errors of commission errors of omission errors of communication errors of context diagnostic
errors
Question:
2. Metacognition: This unconscious, automatic style relies on intuition and pattern
recognition to make quick decisions. It is susceptible to many unconscious biases and
cognitive errors.
Answer:
system 1 (fast) thinking
Question:
3. Metacognition: Analytical, deliberate and resource intense is less prone to error but can be
exhaustive and less efficient.
Answer:
system 2 (slow) thinking
Question:
4. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) giving weight + reliance on
initial info/impression, and not adjusting from this despite availability of new info. "Jumping to
conclusion" can cause missed/delayed dx
Answer:
anchoring
Question:
5. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) shaping decision-making based
on prior expectations. "Frequent flyers" w recurrent complaints can affect decision making
Answer:
ascertainment
,Question:
6. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) judging likelihood of a dx based
on the ease with which examples can be retrieved (more familiar, common, recent,
memorable) (dx a pt w a common condition like flu and not considering rare ones)
Answer:
availability
Question:
7. What type of bias: (anchoring/ascertainment/availability/confirmation) selectively
noticing/seeking info that confirms opinion/impressions versus seeking info that disconfirms.
Evidence in support/beliefs is given more weight
Answer:
confirmation
Question:
8. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) once a label (dx) has been
assigned, momentum takes hold and reduces ability to consider other alternatives. Can affect
future work up of pt and how handoffs are "framed"
Answer:
diagnostic
Question:
9. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) how information is presented,
and how a question is framed can impact future decisions. Source of info and context can
influence
Answer:
framing
Question:
10. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) crease looking for
findings/signals once something has been identified. Accepting a diagnosis before considering
all information and verifying diagnosis
Answer:
search
,Question:
11. 3 factors that predispose to cognitive errors
Answer:
person factors (cognitive loading = too many activities, fatigue, affective considerations) pt
factors (complex presentations, lack of complete hx) system factors (workflow, time
limitations, bad transfer of info, poor technology, poor teamwork)
Question:
12. 4 ways to prevent mitigation of errors
Answer:
improve personal knowledge/awareness of cognitive bias improve professional
reasoning/critical thinking enhance work conditions and design give organizational culture
Question:
13. institute of medicines 6 aims for improvement!
Answer:
safe effective patient-centered timely efficient equitable
Question:
14. Acknowledgment of the high-risk nature of an organization's activities and the
determination to achieve consistently safe operations =
Answer:
culture of safety
Question:
15. when to use swiss cheese model
Answer:
active failures + latent conditions
Question:
16. 7 steps of error response
Answer:
pt safety reporting systems investigation communication + disclosure apology + remediation
system improvement data tracking + performance eval education + training
Question:
17. finding the root cause of a problem (5 whys)
, Answer:
1. get group who are familiar with problem
2. define problem in clear language
3. define problem as pattern, not just an isolated event
4. ask why 5 times till u find root cause
5. explore way to solve prob and make changes to make sure it doesnt happen again
Question:
18. action hierarchy (5)
Answer:
1. review statements + contributing factors
2. for each statement, brainstorm actions to mitigate recurrence
3. rank strengths of actions (strong = less human reliance, weak = more human reliance)
4. present RCAA process results and rec to leaders to approve
5. assign tasks with timelines and methods to check implementation
Question:
19. 4 steps to making a reliable process
Answer:
segment visualization of flow (flow chart) standardize + simplify process develop backup plan
Question:
20. the ______ tool prompts teams to review, eval, record the following: steps in process,
failure modes, failure causes, failure effects
Answer:
FMEA
Question:
21. what is involved w huddles (5)
Answer:
safety + quality concerns/success of past day safety + quality issues for pts on todays
schedule review of tracked issues input on other safety/quality issues announcementss/info
Question:
22. if an error occurred, the next step is (2)
Answer:
tell pt explain what will be done to prevent future events (RCAA, policy change, education,
new equiptment)
Question:
1. 5 preventable adverse events
Answer:
errors of commission errors of omission errors of communication errors of context diagnostic
errors
Question:
2. Metacognition: This unconscious, automatic style relies on intuition and pattern
recognition to make quick decisions. It is susceptible to many unconscious biases and
cognitive errors.
Answer:
system 1 (fast) thinking
Question:
3. Metacognition: Analytical, deliberate and resource intense is less prone to error but can be
exhaustive and less efficient.
Answer:
system 2 (slow) thinking
Question:
4. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) giving weight + reliance on
initial info/impression, and not adjusting from this despite availability of new info. "Jumping to
conclusion" can cause missed/delayed dx
Answer:
anchoring
Question:
5. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) shaping decision-making based
on prior expectations. "Frequent flyers" w recurrent complaints can affect decision making
Answer:
ascertainment
,Question:
6. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) judging likelihood of a dx based
on the ease with which examples can be retrieved (more familiar, common, recent,
memorable) (dx a pt w a common condition like flu and not considering rare ones)
Answer:
availability
Question:
7. What type of bias: (anchoring/ascertainment/availability/confirmation) selectively
noticing/seeking info that confirms opinion/impressions versus seeking info that disconfirms.
Evidence in support/beliefs is given more weight
Answer:
confirmation
Question:
8. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) once a label (dx) has been
assigned, momentum takes hold and reduces ability to consider other alternatives. Can affect
future work up of pt and how handoffs are "framed"
Answer:
diagnostic
Question:
9. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) how information is presented,
and how a question is framed can impact future decisions. Source of info and context can
influence
Answer:
framing
Question:
10. What type of bias: (anchoring/ascertainment/availability/confirmation/diagnostic
momentum-bandwagon/framing/search satisfying-premature) crease looking for
findings/signals once something has been identified. Accepting a diagnosis before considering
all information and verifying diagnosis
Answer:
search
,Question:
11. 3 factors that predispose to cognitive errors
Answer:
person factors (cognitive loading = too many activities, fatigue, affective considerations) pt
factors (complex presentations, lack of complete hx) system factors (workflow, time
limitations, bad transfer of info, poor technology, poor teamwork)
Question:
12. 4 ways to prevent mitigation of errors
Answer:
improve personal knowledge/awareness of cognitive bias improve professional
reasoning/critical thinking enhance work conditions and design give organizational culture
Question:
13. institute of medicines 6 aims for improvement!
Answer:
safe effective patient-centered timely efficient equitable
Question:
14. Acknowledgment of the high-risk nature of an organization's activities and the
determination to achieve consistently safe operations =
Answer:
culture of safety
Question:
15. when to use swiss cheese model
Answer:
active failures + latent conditions
Question:
16. 7 steps of error response
Answer:
pt safety reporting systems investigation communication + disclosure apology + remediation
system improvement data tracking + performance eval education + training
Question:
17. finding the root cause of a problem (5 whys)
, Answer:
1. get group who are familiar with problem
2. define problem in clear language
3. define problem as pattern, not just an isolated event
4. ask why 5 times till u find root cause
5. explore way to solve prob and make changes to make sure it doesnt happen again
Question:
18. action hierarchy (5)
Answer:
1. review statements + contributing factors
2. for each statement, brainstorm actions to mitigate recurrence
3. rank strengths of actions (strong = less human reliance, weak = more human reliance)
4. present RCAA process results and rec to leaders to approve
5. assign tasks with timelines and methods to check implementation
Question:
19. 4 steps to making a reliable process
Answer:
segment visualization of flow (flow chart) standardize + simplify process develop backup plan
Question:
20. the ______ tool prompts teams to review, eval, record the following: steps in process,
failure modes, failure causes, failure effects
Answer:
FMEA
Question:
21. what is involved w huddles (5)
Answer:
safety + quality concerns/success of past day safety + quality issues for pts on todays
schedule review of tracked issues input on other safety/quality issues announcementss/info
Question:
22. if an error occurred, the next step is (2)
Answer:
tell pt explain what will be done to prevent future events (RCAA, policy change, education,
new equiptment)
