Exam 2 Flashcards
(159 cards)
1
Q
quality def
A
measuring performance against standards
2
Q
quality focus
A
improved pt outcomes
shift focus from assurance and provider to
improvement and patient
3
Q
six sigma def
A
quantitative data driven
ALMOST error-free environment
improves outcomes by measuring errors
(developed by Motorola)
4
Q
six sigma themes
A
customer focus
data driven
process emphasis
proactive management
boundary less collaboration
aim for perfection
5
Q
Team STEPS def
A
EB framework
purpose- optimize team performance
6
Q
Team STEPS- leadership
A
coord. activities
ensure access to resources
7
Q
Team STEPS- situation monitoring
A
used to gain understanding or maintain awareness
8
Q
Team STEPS- mutual support
A
anticipate o/ needs
9
Q
Team STEPS- communications
A
standardization (ex. SBAR)
10
Q
Team STEP- 4 a’s
A
assess Status of pt
assess lvl of Team member
assess Environment
assess Progress towards goal
11
Q
LEAN
A
most value w/ least resources
eliminate wasteful processess
dev by Toyota
12
Q
LEAN principles
A
listen to customer
map processes (value stream map)
identify waste
create pull system (refresh resources after use)
use standard work
13
Q
quality management def
A
philosophy
defines helathcare culture
emphasis on customer satisfaction, innovation and employee involvement
14
Q
quality management 3 P’s
A
paitent not provider
prevention not inspection
process not person (quality should remain same regardless of staff change)
15
Q
quality management principles (IGCFD)
A
involvement (democratic structure)
goal (improve systems w/o blame)
customers (define quality- internal (employees) and external( pts, insurance))
focus (on outcomes)
decisions (based on data)
16
Q
PDSA
A
plan
do
study
act (adapt, adopt or abandon)
17
Q
QM benefits (3)
A
greater efficiency= inc quality
dec malpractice lawsuits= dec costs
inc customer satisfaction
*pt centered care not direct benefit
18
Q
focus of QI v QM
A
QM-customer satisfaction
includes everyone
QI- focus on identification and prevention of problems
ex. inc ICU transfers
19
Q
quality improvement def
A
prevention of problems
ongoing process
monitors care through valid and reliable measures
20
Q
QI steps (6)
A
identify needs
assemble multidis. team
collect data
establish measurable outcomes/quality indicators
select and implement plan
collect/eval plan
21
Q
QI collect data ex
A
number of occurrences on e/ unit
type of meds
22
Q
QI select/implement plan ex
A
policy and procedures
23
Q
QSEN
A
quality and safety education in nursing
24
Q
QSEN safety compentencies (PTEQSI)
A
patient centered care
teamwork/collab
EB practice
quality improvement
safety
informatics
25
standards def
written value statement
(3)
26
structure standards
organizational resources
physical environment
ex. omnicell for e/ unit
27
process standards
beh of nurse
concerned w/ actual delivery of care
ex. VS q4h
28
outcome standards
reflect desired outcome of care
physical health and function of client
ex. breath sounds are clear
29
sources that est. standards
JCAHO
american nurses association (ACA)
governmental and regulatory agencies (CDC), state boards of nursing, nurse practice acts
organizational internal policies and procedures
EB practice research
national quality foundation
30
methods of standard assessment (8)
peer review
chart audits
observation
checklists
fishbone, flow chart
histograms
questionnaires (pt satisfaction survey)
benchmarking
31
standard assessment- chart audit
most common technique of quality assurance
32
standard assessment- chart audit types
retrospective
concurrent
prospective
33
standard assessment- chart audit
retrospective
after DC
does documentation reflect quality care
34
standard assessment- chart audit
concurrent
real-time
ex. critical pathway
door to balloon time for MI
35
standard assessment- chart audit
prospective
BEFORE care begins
anticipated problems
ex. neuro assessment q1h, fall precautions
36
standard assessment- benchmarking
measuring practices/products against the BEST performing organizations
37
risk management def
interdiscip. process designed to protect financial aspects of organization and maintain high quality medical care
38
risk management characteristics
goal is prevention
takes corrective action against potential risks
an extension of quality management
39
TeamSTEP characteristics
leadership
situation monitoring
mutual support
communication
40
nurse v risk manager
the same
nurses are required to identify and report unusual occurrences and pot. risks
41
adverse event reduction
strategy to reduce mortality and morbidity
42
adverse event reduction parts (ASNR)
adverse event
sentinel event
near miss
root cause analysis
43
adverse event reduction- sentinel event
serious, unexpected occurrence= death or serious harm
ex. suicide, infant abduction, wrong surgery site
*JCAHO requires organizations to respond to these events in a formal way
44
adverse event reduction- near miss
can result in NO harm
highlights problem that must be fixed
45
adverse event reduction- root cause analysis
retrospective review of incident
id sequence of events
leads to dev of specific risk-reduction strategies
46
policy and procedure def
provide order, stability and guide decision making
47
policies def
formalized guideline
inc consistency in decisions and actions
directs action
ex. all nurses should provide quality care
48
policy requirements
written, cover all employees
readily avaliable
can be implied/unwritten
49
area ex. for policy development
confusion about responsibilities
protection of pt/family rights
personnel management and welfare (DNR)(vacation leave)
lack of guidance can cause negligence (ex. med errors)
areas where all staff should adhere to same pattern of decision making (ex. low blood sugar)
50
procedure def
step by step directions
how to carry out specific activity
51
procedure requirements
statement of purpose
identify who is to perform the activity
52
policy and procedure similarities- purpose
means for accomplishing goals and objectives
written rules that are extensions of mission statement
53
policy and procedure differences
policy-gen. guideline
procedure- more specific
give directions for actions
54
crossing the quality chasm (SEPTEE)
safe
effective
pt centered
timely
efficient
equitable
55
DMAIC method
define (From the customer perspective)
measure (w/ system)
analyze
improve (id reasons for variability)
control
56
Essay question 1:
what are the 5 rights of delegation
-name and define
57
essay question 2:
name and define and provide an example of the 4 levels of change
58
change agent def
person skilled in theory and implem of PLANNED change
59
planned v unplanned change
planned- deliberate action
unplanned (accidental)- adaptive response directed towards re-estb balance
60
change- lvl 1
alt in knowledge
ex. pt satisfaction survey
61
change- lvl 2
alt in feelings/attitudes
ex. survey results alert manager that floor moral is low
62
change- lvl 3
alt in behavior
ex. manager changes leadership style
63
change- lvl 4
alt. of multiple forces affecting an entire social system
ex. resurvey after leadership style change
64
lewin theory
driving forces have to be greater than restraining to ensure change
purpose- create future that is more desirable than current state
65
lewin phases- unfreezing
creating motivation for change
gather data, assess and analyze
build trust and recognition for change
complete when ppl accept need for change
66
lewin phases- movement
develop a plan and implement (use strategies for ovrcmng resistance)
set objectives/goals
include everyone in planning
eval and modify if necces
67
lewin phases- refreezing
reinforcement of new beh
practice beh repeatedly
68
lippitt's focus
actions of change agent (not change agent itself)
69
lippitt A-G (DAADCMT)
diagnose problem
assess motivation for change
assess change agent's motiv/resources
dev action plan and eval criteria
choose a change agent (role expert, cheerleader or facilitator)
maintain change
terminate the helping relationship
70
everett rogers
diffusion of innovations
71
diffusion of innovations purpose
how, why and @ what rate new ideas/tech spreads
72
diffusion def
process where an innovation is communicated over time among ppl in a social system
73
rogers- 4 main elements (same as def of diffusion)
innovation itself
communication channels
time
social system
74
diffusion of innovations relies on
human captial
must be widely adopted to self sustain
an innovation should reach critical mass
75
rogers diffusion of innov.-adopter categories
innovators
early adopters
early majority
late majority
laggards
76
rogers diffusion of innov- 3 phases
1- invention of the change
2- diffusion (communication) of info
3- consequences of change (adoption or rejection)
77
rogers- 2 key considerations
ppl must be interested in the change and committed to making it happen
78
rogers process step (kpdic)
knowledge- ideas are presented to group showing that innov is available
persuasion- interest in innov begins (can be - or +)
decision- adopt or reject innovation and eval
implementation
confirmation- eval innovation- seek reinforcement that decision was correct
79
chaos theory
quantum physics
stephen hawking
changes occur at random
must be able to self organize, adapt and accept that change is inevitable
permanent organizational structure is not possible
80
empirical rational assumption
if ppl believe info is rational and makes sense they are more apt to make change
*use if little resistance is expected
NOT incl. social/emotional response to change
ex. dangers of smoking
81
power-coercive assumption
use if great resistance is expected and little participation
ppl less pwr have to comply to higher pwr
ex. getting assignment from charge nurse
82
normative reeducative assumption
time consuming
**take into account- norms, feelings, attitudes and commitment
ppl will change if actively involved in the process
group problem solving
BEST OPTION
ex. discussion on how to change psych final
83
response to change- + v -
(+) further growth
(-) resistance to change, threatened self interest, fear of losing control
84
response to change- active v passive
active- attack idea, argues against
passive- ignores, avoids, agrees but does not assist
85
level of resistance to change
depends on type of change proposed
social/attitudinal changes have more resistance
ex. tech update v intermountain merger
86
overt v covert resistance & cause
overt- can be heard and addressed
convert- hidden, result of low trust and inadeq participation
87
steps for handling resistance
introduce change gradually
allow participation- facil ownership
provide ed- constant comm
dev and maintain trust
provide rewards/incentives
88
charac of effective change agents
respected membr of group
excellent comm skills
possess expert and legitimate power
takes risks
understands the change and its impact
89
who is a change agent
everyone
90
wider environment connection
critical for success
organizations must learn externally and internally
ex. billboards
91
4 components of management
planning
organizing
directing
controlling
92
organization def
collection ppl working together under defined structure to achieve predetermined outcomes
93
components of organization
process
people
structure
94
management- organizing
est formal structure
95
prereq to designing an organization
road map
vision
mission
philosophy
goals+objectives
96
vision statement
brief (1-2 sentences)
future oriented
id desired future of organization
inspire/motivate employees
97
mission
purpose statement
CRITICAL- enacts vision statement
detailed
organizations reason for being
id services provided, HR and identifies customers
influences dev of goals, policy and procedures
*impacts all lvls of organization
98
philosophy
value and beliefs that guide all actions of organization
abstract
99
goals v objectives
goal- main idea
objectives- specific actions (measurable, observable, and obtainable)
action plans
100
organizational theory
execution plan
101
classical theory 4 elements
efficiency through design
1-division/ specialization of labor
2- span of control
3- scalar process
4- ordering positions
102
classical theory- division of labor
specialization makes employees more efficient
est. Scope of practice
ex. cna v rn
103
classical theory- span of control
number of ppl manager can oversee is limited
3-50
based on managers abilities, experience, task complexity
ideal 15-20
104
classical theory- scalar process
chain of command
top to bottom
105
classical theory- ordering of positions
line positions- direct line hierarchial authority
authority for decision making
ex. rn, cna
staff positions- expertise and knowledge to assist line positions
advisory
no authority for decision making for pts
ex. staff dev, risk mgmt, dm educator
dm rn educator has to report to floor nurse
106
scientific management
adjusted classical approach
inc performance by maximizing individual productivity
107
scientific management 4 principles
1- standardize work- ex. central line dressing
2- select right workers
3- carefully train workers
4- support workers by planning work (ex. duties of CNA v RN)
108
bureaucracy
most efficient form of organization
dev organizational chart
actions of management to be fair and predictable
109
bureaucracy- characteristics
1- division of labor
2- hierarchy of authority
3- rules and regulations
4- emphasis on technical competence
110
bureaucracy- division of labor
specialty skills
emphasis on technical competence
ex. rn, cna
111
bureaucracy- hierarchy of auth
workers ranked according to degree of auth
pyramid shape- centralized
admin at top
VERTICAL comm- chain of command
112
bureaucracy- rules and regulations
policies, procedures
uniform actions, limit variance
communication written
113
bureaucracy- technical competence
premium for quickness and control
114
bureaucracy- pro v cons
pro- efficient
con- inc time to get approval, lots of levels, lack of input from lower levels, rigid, impersonal
115
systems theory
convert info into planned outcome for use within or outside of system
116
systems theory 4 elements
1- structure
2- technology
3- people
4- the environment (materials, resources)
117
systems theory- input ex
money, human
material, time, information
importation of energy
data collection, assessment
ex. pain lvl after surgery 10/10
118
systems theory- throughput ex
interventions
ex. medication
transformation of energy
119
systems theory- output ex
better health, LOS,
inc QOL
exportation of products
final outcome (was goal achieved)
NOT equal reass. of pain
120
organizational design- complexity
division of labor, number of hierarchial lvls, geographic dispersion of units
more dispersed= inc demands
121
organizational design- formalization (main idea)
degree to which org, has rules that define members role
ex. how many restrictions rn has
122
organizational design- centralization
location where decision is made
centralized= top- tall pyramid
ex. vp, DON
decentralized= flat, few levels
pt care lvl
ex. DON admits pt
123
organizational chart
visual display of formal structure
shows chain of comm. and who to report to
124
organizational chart formal v informal
formal- roles and functions defined
informal- friendship circles that are not on the chart
ex. coworker that ppl always go to for help
125
functional structure
departments and services arranged accord to specialty
dept w/ similar func report to same manager
ex. diff nursing specialties all report to same nursing
126
functional structures cons
delays in decision making
ex. communication across grps must be raised to senior management lvl
127
service line structures
all units needed to dev specific product report to one manager
ex. cardiology service (center in ED, CCU, ICU tele unit, cath lab, cardiac rehab)
advantage- coord of services, faster decision making
con- fragment management on a floor
ex. 2 nurses on same floor have to report to diff managers
128
flat structures
decentralization
"participatory management"
removes hierarchial layers- low lvl formalization
authority at action lvl
power is at the bottom
129
flat structure- pro v con
larger the organization= mre need for decentralization
pro- faster response time, more creativity, inc job satisfaction
con- different skill lvls may not have auth
130
shared governance
professional practice model
philosophy- nurses practice is best determined by nurses
131
shared governance goals
shared decision making
accountability
inc autonomy and control for nurses
have authority to make decisions regarding all aspect of pt care
ex. budget, quality management, continuing ed, policy changes
RN is the core of the structure
132
shared gov- congressional model
nurses form committees have say in decision-making
ex. until counsel
133
shared gov- staff criteria
dev of interpersonal relationships
conflict resolution
acceptance of responsibility
134
shared gov pro v con
pro- inc efficiency and productivity
better pt care, cost effective
inc rn satisfaction and retention
cons-
inc time in meetings, lack of admin support, long term committment
135
hybrid model
flat and functional
136
magnet status- 5 criteria
appointed by American academy of nursing (AAN)
requires
decent and open management style
criteria
1- transformational ldrshp
2- structural empowerment
3- exemplary professional practice
4- new knowledge, innovation
5- empirical quality results
137
professional practice model- magent
autonomous nursing practice through
self gov
appropriate staffing
clinical expertise
clinical ladder opport.
138
delegation def
increases nurses responsibility
decisions r/t deleg must be based on protection of health, safety and welfare of public
139
assigning v delegating
assigning- distribution of work
based on # of staff or given time period
delegation- skill
requires nursing judgement
directing performance of ppl to get task done on nurses behalf
based on acuity. not # of pt's
140
delegation advantages
saves time
inc attention for pts
cost effective
empowering
141
delegation disadvantages
poor pt outcomes if task is wrongly delegated
liability- costly
time consuming
dec pt satisfaction
142
tasks NOT delegate
nursing process as a whole
nursing assessment
nursing dx, care goals, care plans
complex interventions
discipline of employees
LPN can contribute but NOT design
143
delegation- factors
potential for harm
complexity of task
need for problem solving
predictability of outcome
lvl of interaction w/ client (do not delegate teaching)
144
5 rights of delegation
task
circumstances
person
direction/communication
supervision
145
delegation circumstances
is the setting, resources appropriate?
146
delegation- right person
do they demonstrate competency in skills, is it in their SOP
147
delegation- direction/comm
are directions specific, and expectations pronounced
148
delegation- supervision
approp. monitoring, eval,
need to be available for delegatee
149
delegation steps
assess and plan (determine client needs)
communication (why, who, what, where, how)
surveillance and supervision (pt status, task complexity, are outcomes predicatable?)
eval/ feedback (outcomes acheived?)
150
delegation obstacles
unsupportive environment
hiearcheal organziation culture (do it yourself)
staff qualities (poor morale)
insecure delegator
unwilling delegates
151
insecure delegator
liability
loss of control
don't want to overburden others
fear of dec job satisf because less pt interaction time
fear of criticism/competition
152
unwilling delegates
fear of loss of autonomy
letting ppl down
inexperienced
confused about instructions
153
under delegating causes
fear that ppl think pawning off jobs bc don't know how to do them yourself
desire to do everything themselves
lack of experience w/ delgation
enjoyment of the work
fear of liability
154
over delegating causes
POOR TIME MANAGEMENT
insecurity about ability to perform task
155
improper delegating causes
wrong time, person, task, circumstance
not within persons SOP
decision making w/o providing adequate info
156
when to reconsider delegating
change in pt condition
failure to report
person does not follow instructions
additional work has already been delegated to person
157
delegation- BSN
designers, managers, coordinators of care
LPN cannot titrate, blood products, program inserted IV pump, manipulate central lines, perform arterial sticks,
158
delegation- LPN
provide care under specific guidelines
depends on state rules
159
delegation- UAP
cannot supervise or delegate tasks to other UAPs
ARE legally responsible for the care they provide
