Chapter 14 Managing Quality Improvement Teams and Projects PDF

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Chapter 14 concepts, short answers, and multiple choice practical questions...

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Chapter 14 Managing Quality Improvement Teams and Projects 82) Why is knowledge work important in managing businesses today? Answer: Knowledge work, or work that involves the development and transmission of knowledge and information, implies a greater amount of ambiguity, searching, researching, and learning in the job environment. Knowledge work is effective when workers are given a certain amount of autonomy and decision-making authority.

83) What are the responsibilities of leaders? Answer: Leaders are responsible for setting team direction and seeking future opportunities for the team. Leaders reinforce values and provide a system for achieving desired goals. Leaders establish expectations for high levels of performance, customer focus, and continuous learning. Leaders are responsible for communicating effectively, for evaluating organizational performance, and for providing feedback concerning such performance. 84) Briefly explain the situational leadership model. Answer: An important aspect of leadership is the organization's preparedness to follow the leadership. The situational leadership model clarifies the interrelation between employee preparedness and effectiveness of leadership. According to Hersey and Blanchard, situational leadership is based on interplay among the following: • The amount of guidance and direction a leader gives (task behavior) • The amount of socioeconomic support a leader provides (relationship behavior) • The readiness level that followers exhibit in performing a specific task, function, or objective Therefore, effective leadership helps employees become competent and instills confidence in employees that they can do the job. 85) Differentiate between little s or big S self-directed work teams. Answer: Self-directed work teams are identified as either little s or big S teams. Little s selfdirected work teams are made up of employees empowered to identify opportunities for improvement, select improvement projects, and complete implementation. Big S self-directed teams are involved in managing the different functions of the company without a traditional management structure. These types of teams contain totally self-directed employees who make decisions concerning benefits, finances, pay, processes, customers, and all the other aspects of running the business. Often big S self-directed work teams hold partial ownership of the companies they work for so that they participate in the benefits of their teamwork. 86) Discuss the importance of meeting management in quality improvement of teams and list the steps required for planning a meeting. Answer: Effective meeting management is an important skill for a facilitator of quality

improvement teams. Often quality improvement involves a series of meetings of team members who meet to brainstorm, perform root-cause analysis, and carry out other activities. Tools for successful meeting management include an agenda, predetermined objectives for the meeting, a process for running the meeting, processes for voting, and development of an action plan. Using these tools requires outstanding communication skills as well as human relations skills. The steps required for planning a meeting are: 1. Defining an agenda 2. Developing meeting objectives 3. Designing the agenda activity outline 4. Using process techniques

87) Discuss the differences between soft costs and hard costs when evaluating projects. Answer: Soft costs are costs not easily recovered in project savings. This is usually because the benefits of the project add to organizational slack without resulting in actual dollar savings. Hard costs are just that–the reduction of rent, equipment costs, or labor direct costs–hard savings. It is best to justify savings based on hard costs that accrue to the bottom line. 88) Perform a cost-benefit analysis with payback period calculation for a project where indirect costs are $40,000, direct costs are $15,000, and annualized benefits are $55,000. Answer: indirect costs $40,000 direct costs $15,000 Total costs $55,000 annualized benefits

$55,000

Payback period

1 year

89) Perform a cost-benefit analysis with payback period calculation using the following data: Direct Costs • 25 networkable PCs–$1,700/each • A server–$2,700 • Peripherals–$2,200 • Network installation–$5,800 • Sales system software–$11,500 Indirect Costs • Training–$14,500 • Lost time–30 days × $150/day • Sales-related losses during implementation–$21,000 Annualized Benefits • Increased sales capacity–$190,000 • Improved customer retention–$250,000 • Improved follow-up sales opportunities–$180,000 Answer: Total costs, Ct = Cd + Ci = $64,700 + $40,000 = $104,700 Benefits, Ba = $620,000 per year Payback period, PP = Ct/Ba = $104,700/$620,000 = 0.17 years 90) List the steps to perform force-field analysis. Answer: The following are the steps to perform force-field analysis: 1. List all forces for change in the first column and all forces against change in the third column. 2. Assign a score for each force, where 1 = weak and 5 = very strong. 3. Sum the forces for and against the change and draw a diagram showing the forces.

91) The following tasks were identified for a major project using a WBS. Optimistic, most likely, and pessimistic task completion times for each task were also identified. Compute task times, task variances, project variance, and project standard deviation for this project. Task A B C D E F G H I J K L

Predecessor — A A A B,D C,D D E,G F H I,J K,L

a 2 1 4 7 9 4 12 1 12 11 2 5

m 3 2 5 10 11 7 17 4 15 12 8 9

b 5 3 6 13 13 22 22 16 17 14 15 14

Answer: Expected time = (a + 4m + b)/6 The task variance is computed as σt2 = [(b - a)/6]2 The project variance is computed as σT2 = ∑σt2, t = 1, 2, ..., n The project standard deviation is σT = √σT2

do the right thing quality for the right person quality at the right time quality with the best possible results quality safe quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] effective quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] patient-centered quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] timely quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] efficient quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] equitable quality improvement to make healthcare [IOM broad objectives for quality in US healthcare system] ASHRM American Society for Healthcare Risk Management (1980) IOM Institute of Medicine many preventable errors causing patient death IOM 1992 "To Err is Human" identify risk risk management processes evaluate risk risk management processes control risk risk management processes risk exposure identification key component of risk management program risk analysis key component of risk management program risk treatment key component of risk management program risk evaluation key component of risk management program

organization's claims experience data to help identify risk databases complied from local and national claims experience data to help identify risk incident reports and patient complaints data to help identify risk probable frequency of occurrence of the loss risk analysis possible severity of the loss risk analysis effect that any potential loss would have risk analysis risk control risk treatment risk financing risk treatment claims management program risk management tools incident reporting risk management tools policies for incident reporting risk management tools insurance policies claims management program system to identify potential losses quickly claims management program ability to accurately estimate liability claims management program should not be filed in patient record incident reporting medical record should not refer to incident reporting facts should be in the medical record incident reporting policies identifying which errors to report organization's policies for incident reporting to whom report should be made to organization's policies for incident reporting steps required to complete the report organization's policies for incident reporting objective documentation of incidences concise documentation of incidences present only the facts documentation of incidences

what risk management documentation when risk management documentation where risk management documentation who acted and who witnessed risk management documentation why (cause) - if state has strong work product protections against discovery risk management documentation determine the deviation from standard of care role of health record in RM extent of party's injury role of health record in RM cause of injury role of health record in RM sequestration of the record in the case of an adverse event role of health record in RM unexpected occurrence involving death or serious injury sentinel event (SE) reviewable or nonreviewable sentinel event (SE) organizations develop their own definition JCo Stds for mgmt of SEs use RCA JCo Stds for mgmt of SEs use FMECA JCo Stds for mgmt of SEs root cause analysis RCA develop action plan part of RCA implement improvements part of RCA monitor effectiveness part of RCA prospective look at risk FMECA failure mode FMECA effect FMECA criticality analysis FMECA use of two patient identifiers JCo and annual National Patient Safety Goals

final verification JCo and annual National Patient Safety Goals read back JCo and annual National Patient Safety Goals standardized abbreviations, acronyms, and symbols JCo and annual National Patient Safety Goals improve timeliness of reporting, test results and values JCo and annual National Patient Safety Goals federal agencies like CMS and AHRQ QI processes guided by federal laws like Patient Safety and Quality Act of 2005 QI processes guided by American Hospital Association (Patient Care Partnership, aka Patient Bill of Rights) common source of patient rights CMS Conditions of Participation common source of patient rights HIPAA common source of patient rights JCo standards common source of patient rights Facility policies common source of patient rights Right to admission/right to treatment common source of patient rights Hill-Burton (indigent care) common source of patient rights EMTALA and anti-patient dumping common source of patient rights Right to self discharge common source of patient rights Safe keeping of property common source of patient rights Patient obligations common source of patient rights Peer review and NPDB common source of patient rights ADA common source of patient rights Restraints/seclusion common source of patient rights illegibility an indicator of problems in the medical record vague terminology an indicator of problems in the medical record criticism an indicator of problems in the medical record

omission of date or time an indicator of problems in the medical record missing countersignatures an indicator of problems in the medical record abbreviations an indicator of problems in the medical record opinions that are not based on provider's observation of fact an indicator of problems in the medical record delayed entries an indicator of problems in the medical record inconsistencies an indicator of problems in the medical record poorly made corrections an indicator of problems in the medical record lack of evidence of informed consent an indicator of problems in the medical record improper alteration of records an indicator of problems in the medical record PQRI physician quality reporting initiatives PQRS physician quality reporting system QIOs Quality Improvement Organizations selected by CMS, one for each state with 3 year contract cycle improve the quality of care QIO activities protect the Medicare Trust Fund QIO activities protect beneficiaries QIO activities provide specific consultation and quality improvement resources to a wide range of providers QIO role Tenth Statement of Work QIO role report cards QIO role physician quality initiatives QIO role patient and family involvement National Quality Strategy for QIOs through 10th SOW effective communication and coordination of care National Quality Strategy for QIOs through 10th SOW effective prevention and treatment practices National Quality Strategy for QIOs through 10th SOW

work with communities to achieve best practices National Quality Strategy for QIOs through 10th SOW make quality care affordable National Quality Strategy for QIOs through 10th SOW make care safer National Quality Strategy for QIOs through 10th SOW HealthGrades QIO report cards NCQA (National Committee for Quality Assurance) - health plans QIO report cards private quality watchdogs QIO report cards pay for performance QIO Physician Quality Initiatives PQRS QIO Physician Quality Initiatives beneficiary and family-centered care Tenth SOW @ state level for QIOs improving individual patient care Tenth SOW @ state level for QIOs integrating care for populations and communities (patient transition among care settings) Tenth SOW @ state level for QIOs improving health for populations and communities (immunization and screenings) Tenth SOW @ state level for QIOs decreased healthcare associated infections 10th SOW individual patient care goal decreased healthcare acquired conditions 10th SOW individual patient care goal decreased adverse drug events 10th SOW individual patient care goal provide technical assistance to improve inpatient and outpatient quality reporting 10th SOW individual patient care goal NHQI (nursing homes) - oversight by QIO public reporting of quality measures HHQI (home health) - Medicare website public reporting of quality measures HQI (hospitals) - Medicare website public reporting of quality measures physician focused QI (incentives) public reporting of quality measures HIQRP (hospital inpatient) - part of Deficit Reduction Act related to Medicare funding public reporting of quality measures HCAHPS (hospitals and h/c providers) - consumer assessments public reporting of quality measures Leapfrog

private quality watchdogs IHI (Institute for Healthcare Improvement) private quality watchdogs AHRQ (Agency for Healthcare Research and Quality) private quality watchdogs NCPS and NPSF (patient safety) private quality watchdogs CMWF (Commonwealth Fund) private quality watchdogs NQF (National Quality Forum) private quality watchdogs ISMP (Institute for Safe Medication Practices) private quality watchdogs AARP private quality watchdogs Center for Quality Assessment and Improvement in Mental Health private quality watchdogs National Institute for Children's Healthcare Quality private quality watchdogs admission for adverse results of outpatient management adverse patient occurrence readmission for complications adverse patient occurrence incomplete management of problems on previous hospitalizations adverse patient occurrence unplanned removal, injury, or repair of an organ or structure during surgery adverse patient occurrence Adverse Patient Occurrences-APO's An occurrence such as admission for adverse results of outpatient management, readmission for complications, incomplete management of problems on previous hospitalizations or unplanned removal,injury or repair of an organ or structure during surgery; covered entities must have a system for concurrent or retrospective identification through medical chart based review according to objective screening criteria Against Medical Advice-AMA When a patient discharges himself or herself before a physician has determined it to be medically appropriate Charitable Immunity A doctrine that shields hospitals (as well as other institutions) from liability or negligence because of the belief that donors would not make contributions to hospitals if they thought their donation would be used to litigate claims, combined with concern that a few lawsuits could bankrupt a hospital Darling Case Often credited as the landmark case for extending liability for negligence to hospitals (darling v Charleston community memorial hospital) Emergency Medical Treatment and Active Labor Act- EMATALA

a 1986 law enacted as part of the consolidated Omnibus Reconciliation Act largely to combat "patient-dumping"-- transferring, discharging or refusing to treat indigent emergency department patients because of their inability to pay. Hill-Burton Act a 1946 act that provided hospitals and certain other healthcare facilities money for construction and modernization as long as the facilities agreed to provide a reasonable volume of services to those unable to pay and to make their services available to all persons residing in the area of the facility Incident Reporting A process for identifying and responding to adverse events and other occurrences that are inconsistent with the standard of care Leapfrog Group A voluntary program founded in 2000 that is composed of consortium of major companies and other entities that are responsible for purchasing health care coverage for employees; the program encourages the public to report outcomes and runs a Hospital rewards program to reward providers for improving quality, safety and affordability National Patient Safety Goals A set of goals published each year by the Joint Commission and designated to improve patient safety in specific healthcare areas identified as problematic by the Sentinel Event Advisory Group National Practitioner Data Bank-NPDB A data bank created by the 1986 Health Care Quality Improvement Act that collects malpractice, disciplinary and credentialing information on physicians, dentist, and other facility-based practitioners Patient Rights A group developed by the American Hospital Association that helps patients understand their expectations, rights and responsibilities when receiving hospital services Pay for Performance Programs that reward quality and safety in hospitals and by providers in an attempt to align quality and outcomes with payment Quality Improvement Organizations Community-Based Organization selected by the centers for medicare and Medicaid services to conduct quality related activities Restraints and Seclusion Ways of managing behavior; the right of patients to be free from non-medically necessary restraints and seclusion in protected under the Medicare Conditions of Participation Risk Analysis The Process of Identifying which risks should be proactively addressed and which risks are lower in priority Risk Management The process in place to identify, evaluate and control risk; defined as the organizations risk of accidental financial liability Root Cause Analysis A tool designed to identify the basic underlying factors that contributed to a sentinel event Sentinel Events

An Unexpected occurrence involving death or serious physical or psychological injury or the risk thereof...