Chapter 20: Managing Outcomes Using an Organizational Quality Improvement Model My Nursing Test Banks

Chapter 20: Managing Outcomes Using an Organizational Quality Improvement Model

MULTIPLE CHOICE

1. The plan-do-study-act cycle begins with:

a.

three questions.

c.

five agendas.

b.

four stages.

d.

two concepts.

ANS: A

The plan-do-study-act (PDSA) cycle, a process improvement tool, starts with three questions: 1) What are we trying to accomplish?, 2) How will we know that a change is an improvement?, and 3) What changes can we make that will result in improvement?

PTS: 1 DIF: Comprehension

REF: THE PLAN DO STUDY ACT CYCLE

2. A staff nurse asks the nurse manager, What does the mnemonic FOCUS in FOCUS methodology stand for? The best response by the nurse manager is that it stands for:

a.

Focus, Organize, Clarify, Understand, Substantiate.

b.

Focus, Opportunity, Continuous, Utilize, Substantiate.

c.

Focus, Organize, Clarify, Understand, Solution.

d.

Focus, Opportunity, Continuous (process), Understand, Solution.

ANS: C

The FOCUS methodology uses a stepwise process for how to move through the improvement process. The five steps involved are 1) focus on an improvement idea, 2) organize a team that knows the work process, 3) clarifythe current process, 4) understand the degree of change needed, and 5) solution (select a solution for improvement).

PTS: 1 DIF: Comprehension

REF: THE FOCUS METHODOLOGY

3. The nurse manager recognizes that the goal of studying outcomes is to:

a.

determine staff needs.

c.

predict the quality of patient care.

b.

identify potential problems.

d.

incorporate change in nursing practice.

ANS: B

By studying outcomes, the nurse manager is able to identify potential areas of concern (problems). The outcomes can be short or long term and may lead to an investigation of the structure and process to determine any root causes for a negative outcome.

PTS: 1 DIF: Application

REF: GENERAL PRINCIPLES OF QUALITY IMPROVEMENT

4. An educator wants to determine if the nursing students know the work of W. Edwards Deming. Which statement by the students would indicate that the students know the focus of Demings work?

a.

Pioneer of the continuous quality improvement movement

b.

Quality expert known for his studies on surgical and ambulatory care

c.

Father of risk management

d.

Guru of the PDSA movement

ANS: A

W. Edwards Deming is one of the primary pioneers of the continuous quality improvement movement. Some of the contributions to the science of improvement made by Deming are appreciating a system, understanding variation, and applying knowledge and psychology.

PTS: 1 DIF: Application REF: INTRODUCTION

5. A local hospital is implementing a systematic process of organization-wide participation and partnership in planning and implementing improvement methods to test evidence-based practices at all levels of the services. The hospital is most likely implementing which of the following?

a.

QI

c.

QM

b.

QA

d.

TM

ANS: A

QI (quality improvement) is an organization (system-wide) process of organization-wide participation and partnership in planning and implementing improvement methods to understand and meet customer needs and expectations. It is proactive in its approach, and other terms that may be used interchangeably for QI are TQM (total quality management) and PI (process improvement).

PTS: 1 DIF: Application REF: INTRODUCTION

6. A nursing instructor is evaluating a students understanding of the primary difference between QA and QI. Which response by the student would indicate that the student understood?

a.

QI is reactive, and QA is proactive.

b.

QAs emphasis is on maintaining minimum standards of care, and QIs emphasis is upon identifying real and potential problems.

c.

QA documents quality, and QI reports incidents and errors.

d.

QI is more a single program, and QA is more a management approach.

ANS: B

The primary focus of QA (quality assurance) is upon maintaining the minimum standards of care, and it tends to be reactive rather than proactive. The main focus of QI (quality improvement) is on the identification of real and potential problems, and it tends to be proactive instead of reactive.

PTS: 1 DIF: Application

REF: THE EVOLUTION OF QUALITY IMPROVEMENT INITIATIVES

7. Which of these general principles of total quality management does not necessarily belong?

a.

Quality is achieved by the participation of everyone.

b.

Focusing on the work process develops improvement opportunities.

c.

Improving the service of quality is a continuous process.

d.

Decisions to improve or change a process are based on the majority rule.

ANS: D

Some of the general principles of quality improvement are that quality is achieved through the participation of everyone in the organization, improvement opportunities are developed by focusing upon the work process, the improvement of the quality of services is an ongoing (continuous) process, and decisions to change or improve a system or process are made based on data (not on majority rule).

PTS: 1 DIF: Comprehension

REF: GENERAL PRINCIPLES OF QUALITY IMPROVEMENT

8. A staff development trainer wants to determine if a group of nurses knows the primary difference between QA and TQM. Which response by the nurses would indicate that further teaching is needed?

a.

There is no difference between QA and TQM since the primary focus of both is doing it right.

b.

The primary focus of TQM is doing the right thing.

c.

The primary focus of QA is doing it right.

d.

The primary focus of QA is doing it right. The primary focus of TQM is doing the right thing.

ANS: A

The primary focus of quality assurance (QA) methods is upon doing it right, and it involves such methods as chart audits, reviewing incident reports, and determining whether performance conforms to standards. Quality improvement (also called total quality management TQM) focuses on doing the right thing, and it uses such methods as building quality performance into the work process and meeting the needs of the customer proactively.

PTS: 1 DIF: Application REF: TOTAL QUALITY MANAGEMENT

9. An effective nurse manager adopts several quality improvement methods in the management of the ICU. The managers approach is based on the understanding that some of the primary benefits to this approach includes which of the following?

a.

Empowers staff and provides an outlet for critical theory

b.

Views every problem as an opportunity to improve and to improve staff satisfaction

c.

Decreases necessary expenses from lost business and helps customers think you care about them

d.

Involves staff in how work is planned and done and increases the customers perception that you care by designing processes that meet the providers needs

ANS: B

Some principle benefits of adopting quality improvement methods include viewing every problem as a possible opportunity for improvement; involving staff in how the work is designed and delivered (improves staff satisfaction); empowering staff to identify and implement improvement, resulting in increased patient outcomes; and increasing the customers perception that you care by designing health care processes to meet customer needs, as opposed to the health care providers needs.

PTS: 1 DIF: Application

REF: GENERAL PRINCIPLES OF QUALITY IMPROVEMENT

10. A set of causes and conditions that repeatedly come together in a series of steps to transfer inputs into outcomes is called:

a.

CQI.

c.

QA.

b.

a process.

d.

a movement.

ANS: B

This definition of a process (Bandyopadhyay and Hayes, 2009) provides a means for understanding how work processes encompass steps and result in outcomes. Deming (2000) also noted that every activity, every job is part of a process. CQI and QA are all comprised of different work processes aimed toward obtaining improved outcomes to specified concerns.

PTS: 1 DIF: Comprehension

REF: FOCUS ON IMPROVEMENT OF THE HEALTH CARE WORK PROCESS

11. A group of nurses is working with the Quality Assurance Department to improve the quality of care in the hospital. These nurses would recognize that one of the hospitals external customers would include which of the following?

a.

Staff nurse

c.

Joint Commission (JC)

b.

Pharmacist

d.

Hospital chaplain

ANS: C

External customers are those people who are outside the (health care) organization and receive the output of the organization such as patients, regulatory agencies (Joint Commission, the Department of Health), the community the organization serves, and private practitioners. Internal customers are those people who work within the organization and received output of other employees such as nurses, pharmacists, hospital chaplains, and therapists.

PTS: 1 DIF: Application REF: CUSTOMERS IN HEALTH CARE

12. An independent group of items, people, or procedures with a common purpose is called a(n):

a.

process.

c.

system.

b.

goal.

d.

organization.

ANS: C

Systems are independent groups of people, processes, or items with a common purpose or goal. Organizations are made up of various systems such as different departments (i.e., radiology, laboratory, and cardiology) or processes (i.e., QI or risk management departments).

PTS: 1 DIF: Knowledge REF: IMPROVEMENT OF THE SYSTEM

13. The credit for the cycle of continuous improvement is given to:

a.

W. Edwards Deming.

c.

Joseph M. Juran.

b.

Philip B. Crosby.

d.

Walter Shewhart.

ANS: D

Walter Shewhart, the director of Bell Laboratories in the mid 1920s, has been credited with the concept of the cycle of continuous improvement, which advocates that the process of quality improvement (QI) is an ongoing process because it is linked to customer needs and judgments. W. Edwards Deming, Philip B. Crosby, and Joseph M. Juran are all well-known pioneers of the continuous quality movement, and all have made important contributions to the science of improvement.

PTS: 1 DIF: Knowledge REF: A CONTINUOUS PROCESS

14. The nurses on your unit want to ensure that the care provided to patients has value to both the patients and the hospital. In this situation, value involves which of the following?

a.

Philosophy

c.

Beliefs about something

b.

Function of quality outcomes and cost

d.

Price for a particular item or service

ANS: B

The repercussions of quality improvement for patient care can be measured by the overall value of that care. Value itself is a function of both quality outcomes and cost; for example, outcomes can be a patients return to functional status (or mortality/morbidity), and the cost is a combination of both the indirect and direct patient care needs.

PTS: 1 DIF: Application REF: IMPLICATIONS FOR PATIENT CARE

15. The nurse manager poses the following question to a group of staff nurses, What changes can we make that will result in improvement? The nurse managers question is an integral part of which of the following?

a.

TQM

c.

FOCUS

b.

PI

d.

PDSA

ANS: D

This question is one of three that are utilized at the beginning of each application of the PDSA (plan-do-study-act) methodology for improvement. Other questions include What are we trying to accomplish? and How will we know that a change is an improvement?

PTS: 1 DIF: Application REF: IMPLICATIONS FOR PATIENT CARE

16. The goal of the local hospital is to increase the ability to predict the effect that one or more planned changes in the provision of patient care will have an impact. The hospital would most likely implement which of the following?

a.

FOCUS

c.

PDSA

b.

QA

d.

Risk Management

ANS: C

The PDSA (plan-do-study-act) methodology is used to analyze the potential effect of a certain change or changes if they had been implemented. It involves who will do what, when will they do it, and where will they do it in relation to the proposed change(s).

PTS: 1 DIF: Application REF: THE PLAN DO STUDY ACT CYCLE

17. The Quality Improvement Team has begun assessing and analyzing the care given to TB patients. This is an example of which organizational strategy for quality and process improvement?

a.

Benchmarking

b.

Identifying opportunities for system change following a sentinel event review

c.

Using a storyboard

d.

Meeting regulatory requirements

ANS: A

Benchmarking is a continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers, and it uses those best processes (practices) to improve work design and patient care delivery. It identifies gaps in performance and provides options for improvement. A benchmarking study can be clinical (reviewing outcomes of patient care such as in the case of the TB patients), financial(examining the length of stay), and operational (assessing the function of the ER or case management system). If a TB patient had died unexpectedly in the OR or ER and contaminated staff, then the analysis of this particular case could be termed a sentinel event, and a storyboard may have been used in the descriptive process. By reporting a sentinel event, one would be complying with regulatory requirements.

PTS: 1 DIF: Application REF: BENCHMARKING

18. A client is preparing for discharge after a month-long hospitalization for complications of his cardiac surgery and diabetes. He tells his nurse that he forgot to mention that he takes Viagra at home and asks if it is still okay to take it. His question is directly related to which of these four of the six National Patient Safety Goals set forth by the Joint Commission (formerly JCAHO)?

a.

Communication

c.

Medication safety

b.

Patient identification

d.

Medication reconciliation

ANS: D

The Joint Commissions Patient Safety Goal # 8 concerns medication reconciliation, which is accurately and completely reconcile medications across the continuum of care. Mr. Zs question concerning his Viagra use reveals his use of a medication that he neglected to mention to his health care provider. This information should be given to his health care provider and to the pharmacist before he is discharged, and he should be informed not to take his Viagra until he hears from his health care provider about what to do.

PTS: 1 DIF: Analysis REF: REGULATORY REQUIREMENTS

19. A sentinel event is:

a.

a major change in a patients status.

b.

an unexpected incident involving a death or serious physical or psychological injury to a patient.

c.

a way to identify processes for improvement based upon analysis of their care over a long period of time.

d.

an occurrence involving a sentinel or someone who is watching.

ANS: B

A sentinel event is an unexpected occurrence involving a death or serious physical or psychological injury to a patient. The results of the analysis of a sentinel event generally lead to process improvement, but they tend to be based upon the events surrounding the individual occurrence.

PTS: 1 DIF: Comprehension

REF: SENTINEL EVENT REVIEW

20. A nursing instructor evaluates the nursing students knowledge of the type of statistical graphs used to determine relationships and outcomes related to analyzing quality improvement data. Which response by a student regarding a method to use would indicate that further teaching is needed?

a.

Time series charts

c.

Histamine charts

b.

Pareto charts

d.

Fishbone diagrams

ANS: C

Some types of charts used by quality improvement initiatives to examine data are time series charts, Pareto charts, histograms (not histamine), fishbone diagrams, and pie charts.

PTS: 1 DIF: Application REF: INTERPRETING DATA

21. A nurse manager implementing a FOCUS process understands that each work process should be evaluated for which of the following?

a.

Redundancy and value

c.

Simplicity and frequency

b.

Clarity and simplicity

d.

Currency and researchability

ANS: A

The nurse manager implementing a FOCUS process would understand that each work process should be evaluated for redundancy and value. If a step of the work process is repeated or does not have any value for the customer, it should be eliminated.

PTS: 1 DIF: Application REF: THE FOCUS METHODOLOGY

22. Your patient was admitted for a minor elective surgery. Two hours after the patient was sent to surgery, you received a call that the patient died. The patients death would be considered which of the following?

a.

Accident

c.

Careless event

b.

Sentinel event

d.

Faultless incident

ANS: B

When a patient dies while having a minor elective surgery, this would be considered a sentinel event. A sentinel event is an unexpected incident involving a death or serious physical or psychological injury to a patient.

PTS: 1 DIF: Application REF: SENTINEL EVENT REVIEW

23. You are a member of the hospitals Quality Improvement (QI) team. You are interested in determining how quality in the organization has improved over time. Which of the following would most effectively provide you with this information?

a.

Histograms

c.

Time series charts

b.

Pie charts

d.

Bar charts

ANS: C

Time series charts will allow you to see changes in quality over time. These charts will also allow you to determine whether a process is in control, meaning the process has normal variation rather than dramatic changes that are not predictable.

PTS: 1 DIF: Application REF: TIME SERIES DATA

24. A hospital is using the FOCUS methodology to exam issues related to quality improvement. If, during the step of clarifying, it is determined that resources are not in one service alone, which of the following approaches would be best?

a.

Ignore the issue

b.

Send ideas to the Quality Management department

c.

Continue to the next step of the process

d.

Ask a group of nurses and physicians to determine why this is occurring

ANS: B

If, during the step of clarifying, it is determined that resources are not in one service alone, the best approach would be to send ideas to the Quality Management department. The issue should be addressed before continuing with the steps in the FOCUS process.

PTS: 1 DIF: Analysis REF: FIGURE 20-3 FLOW DIAGRAM

25. A patient is admitted to the mental health unit because of suicidal ideations and several suicide attempts in the past. As the nurse manager, you realize that the patient is a safety risk, and you assign one of the staff members to do a 1 to 1 with the client. After lunch, the patient informs the staff member of the need to use the bathroom. After several minutes, the staff member knocks on the bathroom door, but there is no answer. The staff member immediately presses the emergency call light and pushes the door open only to find that the patient has hung herself. The patients death would be considered which of the following?

a.

Unfortunate accident

c.

Grievous error

b.

What the patient really wanted

d.

Sentinel event

ANS: D

The patients death would be considered a sentinel event. A sentinel event is an unexpected incident involving a death or serious physical or psychological injury to a patient. Because the staff member was assigned as a 1 to 1, the patient should not have ever been out of the staff members sight.

PTS: 1 DIF: Analysis REF: SENTINEL EVENT REVIEW

MULTIPLE RESPONSE

1. The nurse manager is conducting an in-service with the staff regarding quality improvement. Which principles of quality improvement would the manager most likely include? Select all that apply.

a.

The priority is to benefit patients and all other internal and external customers.

b.

Quality is achieved through the participation of everyone in the organization.

c.

Improvement opportunities are developed by focusing on the work process.

d.

Decisions to change or improve a system or process are made based on data.

e.

It is difficult to improve the quality of service in a health care facility that is financed by federal dollars

f.

Improvement of the quality of service should be implemented biannually.

ANS: A, B, C, D

Quality improvement is a continuous process and should be implemented by all health care organizations. Quality improvement benefits internal and external customers. Quality is achieved through the efforts of all individuals in the organization. Opportunities are developed by focusing on the work process. Organizational changes or improvements are based on obtained data.

PTS: 1 DIF: Comprehension

REF: GENERAL PRINCIPLES OF QUALITY IMPROVEMENT

2. Which of the following are the focus of quality improvement (doing the right thing)? Select all that apply.

a.

Meeting the needs of the customer proactively

b.

Building quality performance into the work process

c.

Employing a scientific approach and using data for assessment and problem solving

d.

Assessing the work process to identify opportunities for improved performance

e.

Reviewing only chart audits and incident reports

f.

Improving health care performance and changing the health care system continuously as a management strategy, not just when standards are not met

ANS: A, B, C, D, F

All of the options are part of the focus of quality improvement except option e. By only reviewing chart audits and incident reports, limited data would be obtained. Quality improvement requires obtaining data from numerous sources.

PTS: 1 DIF: Comprehension

REF: TABLE 20-1 DIFFERENCE IN FOCUS BETWEEN QUALITY ASSURANCE AND QUALITY IMPROVEMENT

3. Your hospital is using the Clinical Value Compass to determine quality. The hospital would most likely include which of the following indicators related to clinical status? Select all that apply.

a.

Mortality

d.

Morbidity

b.

Direct cost

e.

Infection rate

c.

Indirect cost

f.

Staffing cost

ANS: A, D, E

Using a Clinical Value Compass, indicators related to clinical status would include mortality, morbidity, and infection rate. Other indicators would include incidence of nursing sensitive outcomes such as cardiac arrest. Direct, indirect, and staffing are indicators of cost and not of clinical status.

PTS: 1 DIF: Comprehension

REF: FIGURE 20-5 CLINICAL VALUES COMPASS

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