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The dimension of quality/performance that is addressed by introducing a rapid response team in a hospital is

When an employer contracts with a health plan or directly with a provider, this employer should be concerned about which of the following perspectives:

Which of the following is an example of patient-centered care?

What is the most important relationship between structure, process, and outcome as types of indicators of quality?

Which of the following is the BEST definition of process?

Which of the following does an outcome indicator measure?

Which of the following best describes the successful outcome of the quality improvement process?

If a hospital has a problem with multidisciplinary teams performance during CPR , what is the best method to assess the problem?

In health care organization, the quality department developed an indicator to measure the commitment of the staff to Myocardial infarction guidelines .This indicator measure:

Outcomes as used as indicators of quality are defined as any of the following except:

Nurse to patient ratio is an example of what type of measures?

The quality improvement team finds high needles sticks in emergency department. Who should the team share this information with?

Which of the following monitors provides patient outcome information?

Effectiveness of performance improvement program best assessed by:

Preliminary data shows increase medical errors in a unit. What should be initially done?

The primary goal of quality/performance improvement is to improve

In developing a program to evaluate the effectiveness of physician care, a primary care clinic would select which one of the following indicators?

All of the following is positive patient outcome except:

There were a large number of late visits for home care. The quality professional wants to talk to the home care nurse at this problem. What is the best approach?

Which of the following is example of outcome measure:

Customer survey gives score of 1-5 (1 dissatisfaction & 5 very satisfied) found that customer satisfaction of pain management is 1.4, the benchmark score is 3.2, what the healthcare quality professional should recommend:

The medical record manager reports that authentication of verbal orders occurs 25% of the time , as compared to a reported 85% in situations ,which of the following is the initial action for the manager to take ?

A policy for time-out in the OR was initiated in the first quarter. In the second quarter the data has 40% compliance with all elements of the process. The first step the quality council should take is to:

Review of the timeliness of high risk screening for diabetes addresses which focus?

In implementing a care bundle for the management of acute myocardial infarction, the recording of the extent to which smoking cessation counseling is provided is a measure of

The performance indicator, “Total unscheduled inpatient admissions following ambulatory procedure (within 48 hours)” is a measure of

The number of designated women receiving breast cancer screening (mammograms) in the reporting year measures

Measuring the time it takes a nurse to perform a procedure addresses which of the following aspects of care?

One of the aims in the treatment of severe community-acquired pneumonia is to maintain an oxygen saturation of >94% (or 88 – 92% in patients with chronic obstructive airway disease). Ensuring adequate oxygenation for this condition is a

In health care organization, the quality department developed an indicator to measure the commitment of the staff to myocardial infarction guidelines .This indicator measure:

In an improvement project to reduce the wait times in an Emergency Room, the time taken to be assessed by a physician is

Monitoring phlebitis associated with IV insertions by nurses in the Surgical Intensive Care Unit addresses which focus?

Monitoring the specific organization and content requirements of a medical record system is a review of which focus?

Complaint analysis is most useful identifying which of the following?

After defining “internal” and “external” customers, your organization is making a master-list of each type of customer before initiating a major change process. Of the following, which is the best next question to ask of staff?

For which aspects of care are patient-reported measures most credible?

Healthcare purchasers and payers are demanding that providers demonstrate their ability to provide high quality patient care at fair prices. Specifically, they are seeking:

Information about customers can be obtained from all of the followings except:

The primary purpose of the survey is to measure

An organization that is committed to a culture of team-work, collaboration, and adaptability is referred to as having

The chief executive officer “CEO” of healthcare organization has requested a recommendation for the most effective method of assessing the organization’s readiness to adopt CQI, which of the following methods should CPHQ recommend:

To allow change to be maintained, you should ensure the change in:The culture within the organization

Evidence of strong organization culture

The most effective role of a healthcare quality professional as a facilitator of change to quality culture in the organization is:

Education and training of all employees in quality management principles must be done continuously in order to:

When there’s uncertainty about the outcome of the process with presence of guidelines and experienced staff, the process is considered as

Mortality reviews are a critical element of risk management and quality improvement, conducted to determine

To achieve excellence of care under TQM philosophy, healthcare organizations must ensure:

Which of the following management approaches would be MOST likely to harm-quality improvement initiatives?

Total quality management philosophy assumes that

The major difference between traditional “quality assurance” activities and the expanded quality improvement/performance improvement activities is the QI/PI focus on

Management using quality improvement principles should emphasize the importance of

Under the quality improvement paradigm, which statement is incorrect?

Incorporating TQM key concepts, compartmentalization of QM/QI activities by organizational structure, i.e., by department or discipline, is

The paradigm shift is:

Organizational culture is best defined as:

Health care organization is complex system. In complex system all of the following are right except

All of the following leads to powerful culture for quality improvement except

The Pareto rule is which of the following?

All of the following conditions contribute to system improvement except Measuring

Which of the following is most important to the successful implementation  of quality improvement activities?

A hospital generally has a unique structure comprised of a “triangle.” Which three entities make up the triangle?

The leadership style that is said to motivate employees, and that optimizes the introduction of change, is

The authority and responsibility of each level of the organization with respect to quality management mechanisms must be specified in the

In participative management the manager

In a crisis situation, when a manager must make a rapid decision, the most effective leadership style is

Which of the following is the major responsibility of senior management regarding continuous quality improvement?

The quality professional can best facilitate the development of a “quality culture” in the organization by

The responsibility to promote organizational values and commitment among the staff lies within:

After in-depth data analysis, there is evidence of over utilization of computerized tomography to diagnose acute appendicitis. A team has been formed to develop a performance improvement plan for emergency department physicians. Which of the following leadership style is most effective to implement best practice guidelines?

Within the context of total quality management philosophy, communication of quality is

Success of QI process depends on commitment of

Commitment of the governing body to quality improvement is essential for the success of quality improvement activities. Quality professional can enhance the board’s commitment to quality by:

Impressed by what he saw at a healthcare conference, the Chief Executive Officer decided to adopt Lean Six Sigma as the hospital’s new approach to process improvement. If the desired results are not achieved, which of the following is the most likely reason for this?

Which of the following is the FIRST step in facilitating change in an organization?

A healthcare organization wants to adopt concurrent review process instead of retrospective review. To facilitate this changes the first to be inspired are

The Quality Management Cycle, based on Juran’s Quality Trilogy (quality planning, quality control, quality improvement)

Quality improvement plan must be first

In deciding to submit an application for an external quality award the first step to determine if award criteria:

A quality professional in a home health agency is charged to develop a quality management/ quality improvement strategy. Of the following steps, which should be done first?

Patient safety officer developing safety plan and the following information was provided:

• Incident report data,
• Performance indicator,
• Customer complain data

Which of the following addition data need to write the safety plan:

Hospital leader asked the CPHQ to develop patient safety program, what should he do

“Organization-wide functions” refer to

Customer suggestions for new service are best used by the organization in developing:

The mission statement of the organization describes

Ask staff recall of the appropriate use of safety behavior in which level

To enhance coping of the desired behavior by the employee, you should

In order to introduce performance improvement concepts throughout the organization, a healthcare quality professional should consider implementing all of the following steps except

Measurement of effectiveness of a seminar delivered to the staff on new methods for training asthmatic patients to use metered dose inhaler is best done by:

An organization hires a quality professional to pass quality improvement concepts to the staff. The first thing the quality professional should do

Medication is ordered for a diabetic patient. Its capacity to improve health status, as a Dimension of quality or performance, is it

The perception of quality by a patient receiving care in an ambulatory healthcare center is influenced most by

If in the continuous improvement process, we increase our emphasis on customer satisfaction and outcomes of care, which two dimensions of quality/performance must be incorporated into all quality management activities?

When JoEllen evaluates how many people in her facility’s managed care plan were able to receive the flu shot. She is evaluating, under Dimensions of Performance

When JoEllen evaluates how many people in her facility’s managed care plan were happy with the service received while receiving the flu shot, she is evaluating, under Dimensions of Performance,

Smith is determining how many clients still became sick from influenza after receiving flu shots at her facility. Under the Dimensions of Performance, she is evaluating

“Appropriateness” of care refers to:

That dimension of quality/ performance that is dependent upon evaluation by the recipients and/or observers of care is:

Avoiding waste, in particular waste of equipment, supplies, ideas, and time actualize which quality dimension:

Avoiding injuries to patient from care that’s intended to help them is:

Developing educational training program in quality improvement, what component should be included

After education of continuous quality improvement program to evaluate effectiveness of the program:

Barriers to effective communication include

A nurse receives a verbal order for medication from physician, the nurse should

The senior leaders of a hospital have decided to adopt Lean methodology, to which there is a large degree of resistance among the staff. Each of the following is an effective strategy for change management except

A poster contain information will most effectively convey outcome information to internal customers?

Strategic planning is best described as

The member or group responsible for continuous improvement of organization

The ultimate responsibility of implementation of quality relays on

Who is responsible for developing vision for change:

The person/group legally responsible for maintaining quality patient care is the

The first step in the design process of a QI plan is:

Performance improvement plan (Order or Arrange):

1. Gathering baseline data
2. Evaluate effectiveness & improvement
3. Make commitment
4. Implementation

After the team design the plan and implement it, and analyze data shows not reaching the target, what is the next step on PDCA cycle is now should follow

A continuous quality improvement team has proposed a major change in the billing process for home health service. Staff acceptance of the change is best facilitated by:

Lean strategy that means continuous incremental improvement:

When incorporating lean thinking into process improvement, the quality professional teaches the team to

The following criteria should be considered when selecting a measurement except

CPHQ try to improve care through accurate definition of indicators .which of the following indicators reflect performance of surgeons:

The ability of a data measurement tool to produce the same results over a period of time is known as

Sometimes, when developing indicators to measure performance, specific criteria must be written to fully define the measure. This type of criteria facilitates which step?

Which of the following is considered (0 % acceptance, 100 % analysis):

Assuming the measurement instrument is reliable, which of the following ensures that measurements are almost identical no matter who does the measuring?

In any quality management approach, how can you best evaluate the effectiveness of action taken?

Validity of measures is defined as:

When facility make development of clinical indicator criteria, Healthcare quality professional should:

The basic philosophy of benchmarking is

To effectively communicate performance indicator results, information should be disseminated to the

A performance improvement team aims to reduce the rate of post-surgical infection rates in a small rural acute care facility. Which of the following should the team use as a reference?

Healthcare quality program had prepared a balanced score card that displayed patient satisfaction was 98%, financial target has been met , medication error had been increased by 30% and heart surgery rate decreased 3% , what additional information the governing body may ask for?

As a performance measurement system, the key value of the “balanced scorecard” concept is its ability to

Negligence means a lack of proper care. In medical malpractice “proper care” is determined by:

To establish evidence based practice guideline, it is best to

In development of the practice guidelines, the following is involved except:

The following is important in development of practice guidelines except

Practice guidelines cannot help the physicians in:

Practice guidelines should be based on:

The key advantage of case management in managed care is

Failure to schedule a surgical date for the patient is considered

A patient not given enough instruction on the care plan this problem concerned with:

Discharge planning should begin:

In evaluating length of stay &outcome data on cardiac cathertization. HealthCare quality professional identified direct relationship between adverse outcomes & physician practice pattern. This integrated approach involves correlating:

Attempts to align financial incentives of purchasers, payers &providers with provider performance on clinical process &outcome measures encourages

The goal of an integrated service approach is to:

A radiology department regularly monitors x-ray repeat/reject, timeliness of report dictation, and patient waiting times. What component is missing in this department’s ongoing evaluation program?

Hospital Utilization Management Plan generally includes provision for

An effective risk management plan includes all of the following except:

On discharge, the patient refuses billing because 2 out of 3 days of his stay in the hospital is due to medication anaphylaxis. This occurrence is:

If your department has contract with another facility to provide a risky service this is considered as

“Occurrence reporting” is a type of

An effective risk-management program for a health care organization emphasizes:

Being immediately responsive and attentive to a family’s concerns following a patient’s fall in the subacute care facility is:

A patient using a large exercise ball in outpatient rehabilitation fractures three ribs when the ball bursts and she falls onto the floor. The risk manager tells the patient that all costs of care will be covered. Of the following, this action best represents risk

In a culture of patient safety, the most appropriate surveillance to assess the infection rate within the hospital is:

Most important in review physician profile:

Who is responsible for the FPPE and OPPE in a healthcare organization?

A facility has medical staff consists of 5 internists, 3 neurologists, 2 pediatricians, and 1 dermatologist, who should make the peer review for the dermatologist?

physician is asked to review the appropriateness of care provided by another physician. This process is called

A healthcare system has decided to centralize its credentialing departments. What is the main purpose for doing so?

When review clinical competency of surgeon at the time of reappointment:

Which of the following can demonstrate multiple aspects of a practitioners practice as required for renewal of clinical privileges?

A credentialing committee has determined that a practitioner has significantly higher rate of complications after surgeries than the practitioners peer. Which of the following the committees do next?

A hospital has found that the performance of one of its department is consistently below the expected standard. The hospital administration wants to locate the source of the problems and see improvement in the department within six months what is the health care Quality management professional role in this

Significant Deficiencies in the Provision of Care require:

The chart below shows the rate of Cesarean Sections in a hospital. The healthcare quality professional should

A recent review of the risk management process within a medical facility has revealed a number of serious failings. What is the healthcare quality management professional’s role in preventing future risk management errors from occurring?

It’s noticed that there is a significant increase in aggressive behavior  among psychiatric patients, what is the appropriate action:

In compiling and writing performance improvements reports, which of the following would not be included?

On presentation of the annual review to the governing body, the following is important to include the presentation:

What to report to governing body:

In a high quality community hospital, a group of quality professionals conducted a patient safety survey. As a hospital leader, you can guarantee that the survey report may not contain data about:

A quality director is evaluating effectiveness of training for a healthcare quality professional who recently attended a course on data analysis. Effective learning can be best demonstrated when the learner

For CQI to be successful who must be included in team

At one of its meetings, the team has digressed from its original discussion. Who is responsible for bringing the conversation back to the meeting agenda?

The responsibility for providing organizational direction for a facility continuous quality improvement program frequently rests with the quality

Team charted in mental & psychiatry health to improve level of care, the facilitator should be knowledgeable about

The healthcare quality professional’s role in a quality improvement team should least likely be

A facilitator`s best start with a team is to:

The Board and Chief Executive Officer have renewed their commitment to improving quality in Hospital X. Your primary role as the Director of Quality & Patient Safety should be

For continuous quality improvement team to be successful, who must be included in the team?

Facilitating a team in improvement of care level of health/ cognitive statue quality facilitator should:

Quality teams can be an important component in an organization quality improvement as avenue (a way) for:

The best way to evaluate any team is by:

Team members are divided about the next course of action in an important project. It appears that the conflict is severe enough to warrant intervention. Who is responsible for managing the conflict?

A meeting facilitator notices that the team has a tendency towards groupthink. What is one structural way to correct this problem?

In an organizationwide QI model, the person or group usually accountable for continuously assessing and improving performance at the department level is the

In order to perform a task for which one is held accountable, there must be an equal balance between responsibility and

Responsibility of quality improvement teams include all of the following except:

You lead one of the organization’s strategic quality initiative teams. One of your key members consistently arrives at least 15 minutes late. Your best approach is to

The role of a team facilitator is to focus on

In preparing for a meeting, what should be sent to the team members in advance?

Which of the following actions is the most appropriate for the team leader to take during the norming stage of team development:

When the team members start to interest in hearing each other and being on focus on goals and to respect each other, this is the stage of:

During patient focus group, the facilitator should do first:

When choosing an outside consultant to lead employee focus groups, what priority areas of expertise should CPHQ look for?

By forming a team After 1 month team attendance is declined , which stage of team development:

Which stage cause the team to dissolve prematurely?

Which of the following make a successful focus group?