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management in health care third edition


By: Diane L. Kelly 




Quality Management: A Systems Approach






1. Which one of the following systems context models uses a contemporary triad and illustrates essential


elements of organizational effectiveness?


A. Socioecological framework


B. Three core process model


C. Baldrige performance


D. Systems model of organizational accidents


2. A quality manager asks why medical errors are increasing. By asking this type of question, you can


deduce that she’s most likely at which stage?


A. Going below the waterline for changes


B. Using information to identify essential systemic structure


C. Understanding how systemic structure isn’t readily available


D. Understanding how systemic structure influences behavior


3. When something fails to achieve the intended outcome, it’s called a/an


A. error.


B. latency.


C. violation.


D. adverse event.


4. You manage a department, and your main philosophy is to eliminate waste. In doing so, you’re using


which one of the following tools?


A. Six Sigma


B. Total quality management


C. Organizational design


D. Lean thinking


5. A systems manager comes to work in the morning after his night team had a long night of system issues.


The manager stops one employee in the hall to ask what happened during the evening shift. The employee


shouts, “I quit!” and storms out, slamming the door. This scenario is best described as an example of


A. history dependency.


B. change.


C. nonlinearity.


D. trade-offs.


6. When desired healthcare outcomes are consistent with professional knowledge, then the organization has




A. quality.


B. organizational management.


C. quality control.


D. continuum.


7. The CEO meets with hospital managers to ensure that each understands his or her responsibility in the


upcoming Joint Commission survey. In doing so, the CEO is supporting _______ structure.


A. organizational


B. intuitive


C. systemic


D. cognitive


8. A patient’s discharge status prognosis is “good.” This prognosis is an example of


A. an input.


B. an output.


C. a conversion process.


D. feedback.


9. You’re the health information manager and your best friend is a laboratory technician at the same


hospital. In which total quality customer focus category does your friend belong?


A. Stakeholder


B. External customer


C. Internal customer


D. Researcher


10. Which one of the following systems context models best explains how medical errors occur?


A. Systems model of organizational accidents


B. Baldrige peformance


C. Three core process model


D. Socioecological framework


11. Which one of the following systems context models provides a “big picture” look at healthcare across a


broad view of different influences on a system?


A. Baldrige performance


B. Socioecological framework


C. Three core process model


D. Systems model of organizational accidents


12. A manager was dissatisfied with the results of her study, so she reexamined and reframed the study. In


doing so, she practiced


A. cognitive psychology.


B. double-loop learning.


C. single-loop learning.


D. schema.


13. A manager fails to schedule enough nurses for a holiday weekend. Nurses who had to work double


shifts after a few nurses called in sick quit a few weeks later due to job dissatisfaction and being


overworked. This scenario is best described as a/an


A. latent error.


B. active error.


C. error of commission.


D. execution error.


14. An employee, Mac Smith, is servicing the imaging machine in the hospital. In doing so, he’s practicing


A. quality management.


B. quality control.


C. quality assurance.


D. total quality.


15. A nurse manager notices that surgical sponges were improperly manufactured, so she discards them


prior to a surgery. In doing so, she’s practicing quality


A. improvement.


B. assurance.


C. control.


D. management.


16. One of your employees tells you, “You always take the other employee’s side and never my side.” This


employee is illustrating which one of the following ways of thinking?


A. Double-loop learning


B. Schema


C. Cognitive psychology


D. Mental model


17. As a manager, how can understanding and becoming aware of your own mental model be beneficial?


A. It provide solutions based on only past experiences.


B. It makes you feel unsatisfied with results and consequences.


C. It undermines your efforts to achieve quality results.


D. It helps to successfully progress along the quality continuum.


18. Vertical organizational structures often prevent interaction across departments and sometimes make it


difficult to identify patterns. This is a downfall that falls under which system behavior lesson?


A. Understanding how systemic structure influences behavior


End of exam


B. Understanding how systemic structure isn’t readily available


C. Using information to identify essential systemic structure


D. Going below the waterline for changes


19. To have a more dynamic and mature quality approach, you should add which one of the following


choices to your model?


A. Conversion processes


B. Feedback


C. Inputs


D. Outputs


20. A patient comes to the respiratory therapy department for a breathing treatment. This is an example of




A. feedback.


B. conversion process.


C. input.


D. output.




Achieving Quality Results in Complex Systems: Part 1






1. Which part of the SMART goal system limits the opportunity for improvement?


A. Achievable


B. Measurable


C. Specific


D. Relevant


2. Increasing goal-setting skills to move along the quality continuum decreases


A. political pressure.


B. errors.


C. decision making.


D. alternatives.


3. Which of the following organizations is a private accreditation body for healthcare that provides direction


on sentinel events?


A. National Patient Safety Goals


B. National Quality Forum


C. Centers for Medicare and Medicaid Services


D. Joint Commission


4. Which of the following actions is a mature goal on the quality continuum?


A. Measuring and tracking progress on key strategic and operational goals


B. Addressing key strategies of the entire organization


C. Reacting to problems as they occur


D. Defining goals for the organizational departments


5. Which part of the SMART goal system requires perspective and context to be useful?


A. Measurable


B. Relevant


C. Achievable


D. Specific


6. When an unexpected death occurs in a healthcare facility, accredited hospitals are required to conduct


A. root cause analysis.


B. a sentinel event.


C. service quality study.


D. patient perception measurement.


7. What does the purpose principle aid managers in doing?


A. Developing a reason for “being”


B. Creating an identity


C. Promoting disease intervention


D. Identifying issues to address


8. Policies established by organizations that oversee and guide the healthcare industry are _______ policies.


A. private


B. public


C. regulatory


D. allocative


9. Which part of the SMART goal system can limit innovations or breakthroughs?


A. Specific


B. Achievable


C. Measurable


D. Relevant


10. Which part of the SMART goal system can make an organization stay at the current ability levels of




A. Specific


B. Measurable


C. Relevant


D. Achievable


11. Creating new positions and conducting training for new employees instead of identifying the underlying


cause of problems is an example of


A. setting improvement goals.


B. gaining results.


C. reformulating.


D. repair service behavior.


12. For managers to explain why their organizations exist, they must provide the organization’s


A. purpose.


B. mission.


C. context.


D. vision.


13. When private policies aren’t in place, which of the following types of policies may pick up the slack?


A. Regulatory


B. Allocative


C. Private


D. Public


14. The policy that may allow the use of public funding to ensure that public objectives are met is the


_______ policy.


A. public


B. allocative


C. regulatory


D. private


15. If a nurse correctly starts an IV line in a patient, her action is best classified as a/an


A. patient perception.


B. technical quality.


C. implicit goal.


D. service quality.


16. “Getting new furniture for the obstetrics unit waiting room within the next year” is an example of a/an


A. result.


B. organization goal.


C. objective.


D. strategic goal.


17. A physician who’s granted permission by the state to practice is working under


A. licensure.


B. accreditation.


C. certification.


D. compliance.


18. Regular mammogram screenings for healthy women is best described as an example of _______




A. primary


B. tertiary


C. purpose


D. secondary


19. Improving nursing customer service is an example of a/an _______ goal.


A. negative


B. unclear


C. positive


D. clear


20. Which of the following scenarios illustrates the best example of managing context?


A. A manager setting expectations about communications among departments


B. Promoting a biller to supervisor because of his or her excellent managerial skills


C. An employee making a decision about her job responsibilities when the manager isn’t around


D. A nurse calling in sick for the day




Achieving Quality Results in Complex Systems: Part 2






1. The CEO of a hospital tells the management team that she wants them to continuously review, evaluate,


and change requirements. In doing so, she wants the managers to apply the quality model of the _______




A. performance management


B. Pareto Principle


C. Shewhart




2. Which of the following organization assessment reviews includes “threats” as part of the analysis?










3. A quality committee is reviewing health information data to identify nosocomial infections for a study. In


doing so, which step is the committee fulfilling in the Shewhart cycle?


A. Plan


B. Act


C. Do


D. Study/check


4. A department manager wishes to tackle the issue of high employee turnover and therefore schedules a


department meeting. A new employee starts the meeting by asking, “Exactly what are we trying to


accomplish here?” Unknowingly, the new employee is exhibiting a critical part of which quality cycle?


A. Shewhart cycle


B. DMAIC cycle


C. Pareto Principle cycle


D. Performance management cycle


5. You’re a manager observing your team for trends and patterns that reveal issues. In doing so, your


behavior falls under which aspect of performance management measures?


A. Testing strategy


B. Bias


C. Measurement aim


D. Measurement methods


6. Which one of the following choices can be defined as “the voice of the customer”?


A. Process measurement


B. Context


C. Process performance


D. Unbundled data


7. A manager is standardizing policies and sharing best practices in the departmental meeting. In doing so,


the manager is fulfilling which step in the Shewhart cycle?


A. Act


B. Do


C. Study/check


D. Plan


8. You notice that the emergency department response time increases considerably on Tuesday nights.


Upon further investigation, you find out that the department is short two staff members on Tuesday nights.


On your process and system performance chart, you would refer to this fact as


A. frequency distribution.


B. random variation.


C. assignable variation.


D. unbundled data.


9. Which one of the following umbrella terms describes methodologies, metrics, processes, and systems




A. Enterprise performance management


B. Process capability


C. Performance improvement


D. Framework implementation


10. If a manager wants a quick and complete overview of what is happening in the business, the manager


could use


A. balanced scorecards.


B. context reports.


C. enterprise performance management techniques.


D. bundled data.


11. Implementing any change first on a small scale represents part of the ______ cycle.


A. Shewhart


B. Pareto Principle


C. performance management




12. Which one of the following types of analysis requires a detailed investigation of past systems and


processes to understand causes?


A. Root cause


B. Failure mode and effects


C. Prospective


D. Pareto


13. A manager is reviewing the results of a coding study. In doing so, the manager is probably fulfilling


which step in the PDCA cycle?


A. Act


B. Do


C. Study/check


D. Plan


14. After listening to the complaints of overworked nurses, a nurse manager reviews schedules and then


devises a plan to successfully hire additional staff and provide more days off. In doing so, the manager


exhibited critical professional judgment known as




B. performance management.


C. critical thinking.


D. holding gains.


15. According to the aspects of performance management measures, how can you determine whether a


change is or isn’t an improvement?


A. Generate a hypothesis


B. Identify random and assignable variables


C. Determine whether there’s a free flow of information


D. Get feedback about system performance


16. If you’re working on the principle that a few causes result in many effects, you would most likely


illustrate it with a


A. cause-and-effect diagram.


B. Pareto chart.


C. process flowchart.


D. run chart.


17. A nursing manager makes a change in scheduling that creates undue stress on the nurses who work on


the weekend. Even though the nursing manager realized this, the manager continues with the same


schedule without asking how the changes will affect the upcoming weekend staff. In doing so, the nurse


manager made a


A. management planning error.


B. prospective analysis.


C. failure mode analysis.


End of exam


D. management execution error.


18. You’re the manager of a hospital laboratory department and you’re spending the day documenting


standard operating procedures. In doing so, you’re most likely using a


A. process flowchart.


B. cause-and-effect diagram.


C. run chart.


D. Pareto chart.




19. Improving a process by concentrating on the root of the problem is a critical part of the _______ cycle.


A. Pareto Principle




C. Performance management


D. Shewhart


20. Which one of the following types of analysis strives to prevent problems before they happen?


A. Root cause


B. Pareto


C. Failure mode and effects


D. Prospective






WRITING GUIDELINES Follow these instructions to format your paper:  1. Type your submission, double-spaced, in a standard, size 12 font. Use a standard document format with 1inch margins. Do notuse any fancy or cursive fonts.  2. Include the following information at the top of your paper:   a. Your name and address   b. Your student number   c. The course title and number (Quality Management Performance Improvement,HIT 201)   d. The research project number (51681400)  3. Read the assignment carefully and answer each question.  4. Be specific. Limit your submission to the questions asked and issues mentioned.  5. Include a reference page that lists Web sites, journals, and any other references you used to write your paper.  6. Proofread your work carefully. Check for correct spelling, grammar, punctuation, and capitalization. GRADING CRITERIA Your project will be graded based on the following criteria: n Content 60% n Written communication 30% n Format 10% Here’s a brief explanation of each of these points. Content The student n Provides a clear discussion of the assigned topic or issue n Addresses the subject in complete sentences, not just simple “yes” or “no” statements




Research Project52


n Supports his or her opinions by citing specific information from the assigned reading material and any other references used n Stays focused on the assigned issues n Writes in his or her own words and uses quotation marks to indicate direct quotations Written Communication The student n Includes an introductory paragraph, a body, and a concluding paragraph n Uses correct grammar, spelling, punctuation, and sentence structure n Provides clear organization by using words like first, however, on the other hand, and so on, consequently, since, next, and when n Makes sure the paper contains no typographical errors Format The paper is double-spaced and typed in font size 12, and includes the student’s n Name and address n Student number n Course title and number (Quality Management Performance Improvement, HIT 201) n Research project number (51681400)




Project Choice 2: Errors Part A. Review the exercise on pages 62–63 of Chapter 4 in your text. Review the case scenario presented and the list of errors. Create a table with the headings “Category/Type of Failure” and “Error,” like the table shown on page 63. Then, from the list of possible errors on pages 62–63, list each error by the type. If you need help, refer to your textbook and use




Research Project Research Project


Research Project50


the Web resources listed on page 64 of your textbook. Note: The Web resource listed for American Nurses Association (http://www.nursingworld.org/quality)is no longer valid. Please disregard this resource. Part B. Review Exercise 6 on page 217 from the practice lab section at the back of your text. Read the article as directed in question 1. Note: The Web path for the article listed in your textbook is incorrect. Follow these steps to access the article:  1. Go to http://www.katherineeban.com.  2. Hover over “Search” in the navigation menu to bring up the search box.  3. Inside the search box, type “Your Hospital’s Deadly Secret,” and then click Search.  4. Click on the hyperlinked article title and read the article. After reading the article, create a worksheet similar to the one shown on page 218 of your textbook. Then, follow the directions in questions 2 and 3 on page 217 of your textbook to complete the worksheet.