Flashcards in Part 1 Focus Q&A Deck (90):
PLANS can best be said to be statements of the _____.
1-Hopes of the Administrator
2-Hopes of the Owners
3-Prediction of the NEXT steps needed.
4-Organizational Goals of the facility
4-Organizational Goals of the Facility
**The purpose of planning is to provide an integrated decision system that, based on the changes forecast by the administrator, establishes the framework for all facility activities. Plans, in essence, are statements of the organizational goals of the facility**
In order to SURVIVE, each facility must _____.
1-Deal with the outside world
2-Have immeasurably more income than expenses.
3-Know what the future will bring years in advance.
4-Write enough policies to cover all contingencies.
1-Deal with the outside world.
**events beyond the control of the nursing home will shape the range of options available to the facility and set the context within which it will be obliged to function**
A major advantage associated with carefully developed plans is making it possible
1-Control the future
2-Not repeat past mistakes
3-Compare what happens to what was predicted
4-Compare what happens to past experiences
3-Compare what happens to what was predicted
**A plan is a prediction of what the facility’s decision makers believe they must do to cope with the future. A carefully developed plan makes it possible to compare what actually happens to what was expected to happen.**
When external conditions change, plans___.
1- Should remain in place
2. Can be altered to meet the changed conditions
3- Should be monitored, but not radically altered
4- Are of decreased value
2- Can be altered to meet changed conditions
BREAK It THINKING says: It is Important to have a PLAN but SOMETIMES it is even more important to abandon it.
What is Strategic Planning?
Strategic management is conceiving and implementing the pattern or plan that integrates the facility’s major goals, policies, and action sequences into a cohesive whole.
Strategic Planning It is the process of
1-analyzing the facility’s competitive position,
2-developing the strategic goals,
3-devising a plan of action, and
4-allocating the resources that will best achieve those goals
The observation about the idea that it "if it anit broke don't fix it is _____.
1-That this is functionary valuable conventional wisdom
2- That if it aint broke today, it will be tomorrow
3. That to few managers understand this good advice
4. That this is a solid insight one can depend upon
2- That is if aint broke today, it will be tomorrow.
Part of "Break it thinking" It is Important to have a PLAN but SOMETIMES it is even more important to abandon it.
What is SWOT, in planning?
What is a NEEDS ASSESSMENT?
Needs Assessment is part of the planning process where you take into consideration the GAPS in your current conditions, and your WANTS. Distance between the two and how to get there is a NEEDS ASSESSMENT. You must think about how to GET where you want to GO by looking at how to get there.
Competition / Expansion Plans of others / Government Hurdles / Future Econ Trends / Third Party vendors / Demographics of population.
When planning a new nursing facility, the goal of being in operation with in 4 months is best described as a_____.
3-Short Range Objective
Any thing OVER a year is a Long Term Goal
so because 4 month is under a year it is a SHORT Term GOAL.
What is the MOVMENT of the Planning process like?
It MOVES from BROAD GENERALIZATIONS towards DETAILED INSTRUCTIONS.
GENERAL to DETAILED.
What is ALWAYS TRUE about the Planning Process?
1-The FUTURE will always change our PLANS?
2-Keeping a carefully though out plan is essential for success?
3-Planning produces a REASONABLE degree of certainty?
4-Plans, once in place , will keep us on track towards our GOAL.
1-The future will ALWAYS change our plans.
** Although every statement is True about planning, the thing that will ALWAYS be true every time is the FUTURE that is uncertain will always change our PLANS, regardless of TIMING or how well they are put together will Change. **
When the unexpected hits this should be looked at as a_____?
Opportunity, when the unexpected happens, this is the BIGGEST area for innovation.
Organizing is a method of ensuring that the work necessary to achieve a goal is broken down into segments, each of which can be handled by one person.
Organizations are SYSTEMS of interactions among the three available INPUTS/PEOPLE/MATERIALS & MONEY.
What is the first step in fulfilling a PLAN?
What are the parts to a JOB ANALYSIS?
2-Meathods and Techniques
3-Machines Tools and Equipment
4-What is MADE/Accomplished
5-What knowledge and Skill is needed.
It can be argued that every Nursing Home Administrator organizes their facility according to______.
3-Some Theory of Organization
4-The Same Theory of Organization.
3-Some Theory of Organization.
** There are no local, or Governmental laws or requirements that tell s you how to ORGANIZE your work force. // The Owner could care less about how you get the JOB done as long as it gets done --- Organizing is the first step in fulfilling the plan, making sure work can get done by breaking it down // No two administrators will have the same approach to how they specifically organize***
Viewing organizations as systems has the advantage of offering the manager a framework for VISUALIZING the ______ of the organization.
3-Internal and External environment
3-Internal and External environment
** Inputs and Outputs and Restraints are all parts of the SYSTEM.
What is the SYSTEMS CONCEPT?
An ORGANIZED or COMPLEX whole, an assembling or combining of things or parts forming a complex or single whole.
** One of the best things about systems concept is it lets you see how all the INTERNAL pieces work together inside the organization and how the Organization works with other OUTSIDE forces and organizations
A primary advantage of systems theory is that it serves as a tool for making sense of the world by making clearer ___
1. How people interact
2. Interrelationships within and outside the organization
3. Interrelationships among the staff
4. Interrelationships between the staff and residents and their responsible parties
2- Interrelationships within and outside the organization
* It is not just the Outside organizations, or the internal pieces, it is the whole system and how it works together.
1 is to vage / 3 and 4 are INTERNAL relationships only**
If the outputs of the organization do not meet the administrators expectations he takes ______ actions to bring Outputs into line with those planned.
1. Results Oriented
Control is part of the Systems model. Control is the corrective action taken after evaluation of outputs by the organizational decision makers. Think Quality CONTROL, after a OUOTPUT (event) happens, if it is SUBPAR, you correct the action through Quality Control.
In the systems Model, what is an INPUT? What is an example of an INPUT in a Nursing Home?
Ex: Residents that come into the facility, the Money that is Made OFF the Residents Stay, is an INPUT
Inputs are elements the facility administrators can change and use to their advantage.
In the systems Model, what is an OUTPUT? What is an example of an OUTPUT in a Nursing Home?
Output is the RESULT of work.
Ex: Output in a nursing Home is RESIDENT CARE.
The patient care (outputs) that is given by the facility _____.
1. Is usually good
2. Can Range from good to unacceptable
3. Achieved cures for the residents
4-Meets federal and state requirements.
2-Can range from good to unacceptable.
**Because every facility, (and every system) is different the OUTPUTS will also be different, this why we have controls in place to correct the outputs**
The administrator uses_____ as guidelines to Compare the output with the expected results.
1. The facilities' policy's and plans of action.
3. Stated Objectives
4. External Judgments
P.19 (Policy and Plans of Action)
1- The facilities policy's and plans of action.
**Policy's and Plans of actions are the written directions of how WORK is to be DONE. From a Q/A standpoint if the OUTPUTS are bad look at IF the workers are following HOW something is to be done, if the ARE then the policy is bad, not the worker. --- This is the comparison.**
In the systems Model, what is Feedback? What are some different types of feedback?
Feedback is a FORM of control. , in a systems Model refers to OUTSIDE controls.
Types: Government Regulations, New Laws, Resident Council, News Media
What is the difference of a CONSTRAINT and a OPPORTUNITY?
(1) Does it relate meaningfully to my objectives? If, so it is an opportunity?
(2) Can I do anything about it? If not, it is a constraint.
** CONSTRATINTS and OPPORTUNITY have to deal with the OUTSIDE ENVIROMENT with in the Systems model.
Systems analysis is most OR equally useful to ______.
3-Head of House Keeping
4-The Administrator, director of nursing, and head of housekeeping
P.22 (Define the System)
4-The Administrator, director of nursing, and head of housekeeping.
** The system applies to whom ever DEFINES it** you can have he same SYSTEM in place at the lowest level
Typically , the OUTPUT of the nursing home as a STSTEM becomes the INPUT for _____.
2-Managed Care Organizations
3-Health Maintenance Organizations
4-The Hospital or the residents home.
P.21 (ID Systems)
4-The Hospital or Residents Home
**Because every at every level, inside and outside of an organization can be viewed as its OWN system, OUTPUTS can become INPUTS for other SYSTEMS. **
The nursing home receives its INPUTS from Hospitals , the community, Assisted livings** In addition a Nursing home Output is another SYSTEMS INOUT like Hospitals, and the community or HOMES.**
In 2010 what systems did CMS find to be functioning the LEAST well. (Most F-Tags)?
F371- Store/Prepare/Distribute food sanitarily ; 35% of facilities were deficient in practice)
F281- Services provided meet professional standards; 27% were deficient
F323- facility is free of accident hazards; 21% were deficient
F431- proper labeling of drugs and biologicals
; 15% were deficient
F312- providing additional care for dependent residents; 11% were deficient
F329 -drug regimen is free from unnecessary drugs;19% were deficient
What is Entropic? and how does that apply to a NURSING HOME?
Entropic = a scientific term that explains a UNIVERSAL LAW that every organism moves towards DEATH.
** this relates because a NURSING HOME can acquire negative entropy , as LONG as receives more INPUTS than OUTPUTS.
The most predictable response of a nursing facility experiencing a "disruptive employee" is to_______.
1-Hold an In-Service
2-Counsel with the employee
3-Let the employee go
4-Contact EEOC and ask for action.
3-Let the employee go.
**the Key is "Most predictable" not how SHOULD a facility deal with** A facility SHOULD counsel, but in most cases, ANYONE who upsets the status que OR is difficult will be let go. It is HARD to let go of NORMS**
The training received in nursing school, medical school, and physical therapy school tends to _________
1-Create resistance to change
3-Open graduates to change
4-Focus on niches
1-Creates resistance to change.
**This is true because they IN school they are taught that ONE way is the best way, and new graduates are STUCK in that mindset, and in that BOX. Anything from what they have been taught is "WRONG"** (P.24) Today, anything that remains unchallenged or untouched for very long can become the sacred cow of tomorrow.
The movement of American Medicine from 80% general practitioners in 1870 to 20% general practitioners in the 1990's is an illustration of organizations ________.
1-Grow increasingly complex
1-Grow increasingly complex.
** The reason the answer is 1 is because the from 1870 to the 90's more doctors became specialists ,and not GENERAL.** Most systems all start out SIMPLE, but will move to more COMPLEX as time moves forward.
What is STAFFING? and who GENERALY HIRES new STAFF?
Staffing is: hiring the right persons for the jobs in the organization.
Department Heads are the ones who NORMALY hire new staff. (with the approval of the administrator.)
What is meant by UNITY of COMMAND?
One person is accountable to One Manager. ---- One person does not have many supervisors.
What is meant by SPAN of CONTROL?
How many people should ONE manager be in charge of
What is meant by SHORT CHAIN of COMMAND?
As few levels of management as possible, with a short chain of command, information can move upward much more easily.
In a Systems Model, before the administrator can "CONTROL" (Q/A) outputs, he must first _______ actual results with the goals.
** compare comes right before the actual control (Q/A) in a system**
Comparing is judging the extent to which actual results of the facility’s efforts achieve the outcomes proposed in the plans.
Controlling quality follows comparing. Controlling is successfully taking the steps necessary to adjust the policies and plans of action to more satisfactorily achieve stated goals.
What are the NINE Points for effective CONTROL of QUALITY?
1-Goals made into policy, procedures, and plans of action. These need to be KNOWN and measurable.
2-Use correct measurements to compare.
3-What are the LIMITS of Error? Ex: 5% medication error rate.
4-Information must be in a USEFUL form, and go to correct LEVEL of Management
5-What are the POLICIES of LIMIT ERROR?
6-Corrective Action to be taken
7-System must be set up for RENEWAL.
8-Q/A measures must be Functional and Valued , (if staff believes they are BS they will disregard them)
9-Limitation of the Scope of the Q/A system.
Doctors diagnose and treat patient illnesses; administrators diagnose and treat _______ illness?
This idea of treating the ORGANIZATION like a patient, and having the ADMINISTRATOR as the DOCTOR is known as "Organizational Pathology."
Managers gave always sought to achieve quality control in their organizations and_____________.
1-Clear success have been attained across the board.
2-The need for such control is a subject of controversy
3-This remains an elusive aspect of managing
4-This is largely behind us as we approach the turn of the century
3-This remains an elusive aspect of managing.
Having good quality control measures and program is one of the hardest things to do as a manager. But it is also vital
Deming had 14 points to Organizational success, what is meant by POINT 1 "Create and publish to all employees a statement of the aims and purposes of the organization. The management must demonstrate constantly their commitment to this statement."
The role of the corporation, he argued, rather than making money, is to stay in business and provide jobs through innovation, research, constant improvement, and maintenance. The nursing home chain goal, then, is to stay in business and to provide jobs. This is to be accomplished through:
innovation (discovering current health care needs and foreseeing future health care needs);
research (finding out how effective current care is, finding new ways to give better care);
constant improvement (of the experience of being a resident in their facilities);
maintenance (keeping everything in working order).
Deming had 14 points to Organizational success, what is meant by Point 2 "Learn the New philosophy; Top management, and everybody."
If what you sell is high Quality Care with a customer SERVICE attitude then everyone must learn that you:
Don’t tolerate poor caregiving and sullen service to residents.
Mistakes, negativism in approaching residents, and other staff are not acceptable.
Deming had 14 points to Organizational success, what is meant by Point 3 "Understand the purpose of inspection, for improvement of processes and reduction of cost"
1-With Quotas you will make your numbers, but quality of care will SUFFER because employees will get numbers at any cost.
2-Take Time to PUT good in every day. Focus on the Residents DAILY experience. IF not you will PAY TWICE. First, poor quality of care, then ACTIONS to correct BAD care.
3-Quality comes from the PROCESS not in how good the doctors notes are written. Keep focus on the CAREGIVING PROCESS
Deming had 14 points to Organizational success, what is meant by Point 4 "End the practice of awarding business on the basis of PRICE TAG ALONE"
Buying the LOWEST PRICED item many many times is BUYING the lowest QUALITY.
The goal should be to identify a single quality supplier for any one item in a long-term relationship.
Example, food service should be having ONE company who delivers HIGH QUALITY , time food every week.
Deming had 14 points to Organizational success, what is meant by Point 5 "Improve constantly and forever the system of production and service
Management’s job is to continually look for ways to reduce waste and improve quality; that is, don’t use expensive medicine cups as water cups while doing medication rounds.
Deming had 14 points to Organizational success, what is meant by Point 6 "Institute Training"
Workers who were never trained properly often are Training other workers. Workers are forced to follow poor instruction sets, and cannot do their jobs because no one told them how.
Example: Too often nursing assistants, licensed practical nurses, and even the directors of nursing learn their job from workers who were never trained properly.
Deming had 14 points to Organizational success, what is meant by Point 7 "Teach and Institute leadership"
It is the JOB of a SUPERVSIOR/MANAGER to LEAD NOT to punish. A leader will help the employees do a better job. LEAD by objective methods those who need individual help (i.e., sort out the nursing assistants whose work is not in an acceptable range). This will pay real dividends in safer resident care and reduce risks at a facility.
Deming had 14 points to Organizational success, what is meant by Point 8 "Drive out fear. Create trust. Create a climate for innovation."
This has to do with communication FLOWING upward. The more lower level employees feels safe enough to ask questions and be creative, and have thoughts they want to share then THEY WILL also admit Errors, and ASK how can I do this better of others and themselves.
In turn Upper management can LEARN from employees.
Deming had 14 points to Organizational success, what is meant by Point 9 "Optimize toward the aims and purposes of the company the efforts of teams, groups, staff areas."
Who does what in a NURSING HOME?
Facility staff often compete or have goals that conflict: nursing vs. dietary, nursing vs. housekeeping (who cleans up the spill?), dietary vs. activities—who is responsible for the resident’s afternoon bingo?
Deming had 14 points to Organizational success, what is meant by Point 10 "Eliminate exhortations for the workforce."
Get rid of TELLING workers what they should believe, instead let them come up with there own MOTOS and SLOGANS.
Deming had 14 points to Organizational success, what is meant by Point 11 "Eliminate numerical quotas for production. Instead, learn and institute methods for improvement. Eliminate Management by Objectives. Instead, learn the capabilities of processes, and how to improve them."
Quotas usually guarantee inefficiencies and high cost. Employees become focused on attaining these quotas themselves.
Achieving the numerical goal becomes the employees’ goal and focus, not improving the resident’s daily experience.
IN THE END employee will “meet the quota” at any price, regardless of the damage to the facility
Deming had 14 points to Organizational success, what is meant by Point 12 "Remove barriers that rob people of pride of workmanship"
People are eager to do a good job and distressed when they can’t because of misguided supervisors, faulty equipment, or defective materials. Give them the Freedom, and Tools to do a good job, and they will try to do a good JOB.
Deming had 14 points to Organizational success, what is meant by Point 13 "Encourage education and self-improvement for everyone"
Always promote from the very bottom, to the very top education. This will foster creativity, pride, and a higher quality of person and Service.
Deming had 14 points to Organizational success, what is meant by Point 14 " Take action to accomplish the transformation."
Don't sit and THINK about what to DO, go and DO it.
Deming, like most others who prescribe quality improvement programs, emphasized a need to involve top management in any quality improvement effort, but emphasized that it takes both managers and the workers for success.
What are Demining's 7 DEADLY SINS that lead to ORGANIZATIONAL FAILURE?
1-Lack of Constancy of Purpose. --Workers need to feel that the ORGANIZATION has a PLAN and is preparing for the FUTURE
2-Emphasis on short Term Profits
3-Evaluation by Performance, Merit Rating, Annual Review of Performance.- Deming felt, these destroy teamwork and nurture rivalry. Builds fear, bitter and beaten** also encourages mobility of management.
4-Mobility of Management-Job Hopping, -- If people JOB HOP impossible to establish culture, and a good Q/A
5-Running on visible figures alone. Ex: the most important number is resident satisfaction. ** it is an invisible number
7-Costs of Warranty- fee. Successful malpractice suits against nursing facilities continue to raise the cost of required insurance.
What are the Deming's 14 Points ?
1-Mission Statement- Must be written , and given to all
2-Top management must embrace new philosophy--Don not Tolerate POOR care giving
3-Purpose of Inspection- Improve Quality PROCESS
4-Low Price often means Low Quality - Focus on LONG TERM dependability
5-Constaitly Improving - Reduce Waste , Improve Quality
6-Focus on Proper Training
7- Teach and institute leadership -- have your department HEADS LEAD.
8- Let communication FLOW UP- create a place where this can happen.
9-Optimize GROUPS working Together - Who cleans what? Dietary or Housecleaning
11-Get rid of Quotas, Focus on process.
12-Eliminate Barriers that stop people from doing a good JOB
13-Encourage education, and Self improvement
14-Take Action to Accomplish the TRASFORMATION
Benchmarking Seeks to implement what kind of strategy?
What are some of the QUALITY MEASURES that CMS puts out?
1-LTC Facility user Manuel
4-LTC enforcement procedures
What is Omnibus Reconciliation act of 1987?
A law that enacted reforms in nursing facility care and provided the statutory authority for the MDS
What is the State operations Manuel ?
guidelines to surveyors.
PPS? Prospective payment System?
A payment system developed for Medicare for skilled nursing facilities which pays facilities an all-inclusive rate for all MEDICARE PART A beneficiary services. Payment is determined by a case mix classification system (RUG-IV or current version).
What is RUG IV?
Version IV or current version of the Resource Utilization Group—A resident classification system that identifies the relative resource use of providing care for different types of residents in nursing facilities based on their resource use.
What is RAI? Resident Assessment Instrument?
Deals with the Assessment of the RESIDENT on ADMISSION-as part of the MDS- Mandated by CMS
What is meant by CASE MIX?
What services dose a group of residents use. It is a measure of the amount and intensity of care that will be required to serve and take care of a resident.
What is Case Mix index?
Deals with the RUG SOCRE for a person. What are we doing for them, how much do we get back. The more complex the case mix on a person, the Higher RUG Score, the higher the reimbursement.
What is Resident Assessment Protocol.
Deals with MDS. When the right sequence of MDS is filled out right will TRIGGER different plans of CARE that need to be addressed.
What is Quality Initiative Survey?
Move to have surveyors do survey on laptops using wireless technology.
In a facility who is responsible for innovation?
The Administrator is responsible for making sure that INOVATION happens, and not always or ever needs to be the one that INOVATES.
The role of innovator is ______.
1-Best assigned to the administrator
2-Avalible to all employees.
3-A skill employees are able to develop.
4-Best taught in in-service
2-Avaalible to all employees
The manager is not necessarily the innovator but does have the task of assuring that innovation occurs within the organization. To achieve this, the manager can develop new ideas, combine old ideas into new ones, borrow and adapt ideas from other fields, or stimulate others to develop innovations
**Deming's Point 8 create an ATMOSHERE of innovation**
One writer suggests that managers should ______ set specific objectives that will guide the organization over an extended period of time.
1-Avoid trying to
1-Avoid trying to
** The reason you don't what to be too specific is because when CHANGE happens the more specific you were the more resistance to change your workers will have**
**keep policies precise enough to guide employee decisions and at the same time continually introduce change into the facility—not an easy task**
Several years ago, the U.S. Supreme Court ruled any _____ self-imposed restrictions by health and other professionals against advertising services or prices that have the result of keeping the public
1-Ruled as permissible
2-Discouraged, but did not rule illegal
**Meaning that health care services could not RESTRICT advertising services... IE status on how well a hospital preforms, or how much something costs. ** This lead to Marketing in Healthcare.
The marketing of the nursing facility has special challenges because of________.
1-Special laws covering nursing facility marketing
3-Special costs to the nursing facility not borne by other providers.
**The nursing facility faces two special challenges:
(1) the requirement to maintain a societal marketing orientation AND
(2) public ambivalence toward the nursing facility itself**
What are all the parts of the SYSTEMS MODEL?
1-Inputs - $ / People / Materiels
2-Processor - How the WORK GETS done how work goes from INPUT to OUTPUT
3-OutPut - The care that given -- Good CARE / Bad CARE
4-Quality Control- Corrective Action of the OUTPUTS produced
5-Policies and Plans of Action- How the ADMIN compares the OUTPUT
6-Feedback-"How are we doing with our OUPUTS?" Resident Council/ Family Groups / State Investigators / State Ombudsperson / External feedback: like newpapers ect...
7-Enviroment - Opportunities and Constraints
Typically Who is in charge of maintaining an ACTIVE Resident Council?
The Social Worker.
What is the difference between PROCESS and STRUCTURE , and OUTCOME when it comes to resident care?
Structure measures the CAPACITY to give resident care
Process measures the way that CARE is GIVEN.
Outcome is the actual effort made.
** these are the 3 focuses of surveyors
Out of Structure, Process, and Outcome. What is the one strategy that CMS looks at first?
What are some of the QUALITY MEASURES that CMS puts out?
1-LTC Facility user Manuel
4-LTC enforcement procedures
What are the 6 Steps in Marketing?
1. The audit - process of identifying, collecting, and analyzing information about the external environment.
2. Market segmentation -audit information to divide the potential persons served into identifiable subgroups.
3. Choosing a market mix -what types of residents to approach and in what proportions.
4. Implementing the plan -Managing organizational behaviors and outreach activities --- doing the MARKETING --- events ect...
5. Evaluation of results -Need to find a way to define success or failure -
6. Control- so that you can measure and correct your evaluation
How can an ADMINISTRATOR create TRUST in a COMMUNITY?
By being VISIBLE and ACTIVE and PRESANCE in the COUMMUNITY.
Health Fairs // Picnics // Runs // 5K events
What is MARKET SPECIALIZATION?
SERVE ONLY ONE MARKET SEGMENT --
Ex:People who need REHAB & are expected to return HOME
Factors such as appearance, odors, how residents "look:, are KEY factors when the decision maker is visiting a facility. These Factors are______.
The five senses play a huge role when someone is deciding to send there loved one into a facility. If it SMELLS like PEE, if residents look beat down, who would send there MOM to a place like that?
** the best way to MARKET is to get decision maker to take a TOUR**
Normally one of the most effective marketing tools is ______.
3- tour through the facility
4-Hiring a consultant.
3- Tour through the Facility
What are the steps in CONSUMER decision making?
1-Problem recognition - A need comes UP
2-Infromation search - gather your info on NEED
3-Alternitive Evaluation -
4-Purchase Decision -
What is the difference between MARKET-SHARE & MARKET CREATION
Market share is trying to OBTAIN the people who are already out there.
Market Creation is trying to CREATE a MARKET that right now does not exist, and SERVE THEM.
More than ____ of hospice patients are ___ years or OLDER?
2/3's // 85 years
1-Father of Scientific Management
1-Know for Hierarchy of needs
1- Known for X & Y theroys