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質問 # 166
He used his understanding of statistics to design tools to respond to variation. Following his arrival at Western Electric Co. in 1924, Shewhart introduced the concepts of common cause, special cause variation and statistical control. He designed these concepts to assist Bell Telephone of repairs within its transmission systems.
Who is he?
- A. Armand Shewhart
- B. Walter Shewhart
- C. Joseph M Juran
- D. W Edwards Deming
正解：B
質問 # 167
During a risk assessment, It Is noted that a unit manager and start feel there Is a high risk of aggressive patient behavior toward unit start.
Which of the following steps should a healthcare quality professional take first?
- A. Organize a staff focus group to explore perceptions.
- B. Review the facility's restraint policy.
- C. Continue to survey staff to assess perceptions of risk.
- D. Discuss with administration the need for increased staff.
正解：A
解説：
The question is about the first step a healthcare quality professional should take when there is a perceived high risk of aggressive patient behavior towards unit staff.
Identify the Risk: The first step in any risk assessment process is to identify the risk1. In this case, the risk identified is the high risk of aggressive patient behavior towards unit staff.
Analyze the Risk: Once the risk has been identified, the next step is to analyze the risk1. This involves understanding the nature of the risk, its potential impact, and the factors contributing to its occurrence.
Organize a Staff Focus Group: Given the options provided, the best first step would be to organize a staff focus group to explore perceptions (Option A)1. This allows for a deeper understanding of the staff's perception of the risk, which is crucial in formulating an effective response strategy.
Discuss with Administration: While discussing with administration the need for increased staff (Option B) could be a potential step, it would not be the first step. It's important to fully understand the risk and its implications before making staffing decisions.
Continue to Survey Staff: Continuing to survey staff to assess perceptions of risk (Option C) could be a part of the ongoing risk management process1, but it would not be the first step after the risk has been identified.
Review the Facility's Restraint Policy: Reviewing the facility's restraint policy (Option D) could be a step taken later in the process, especially if the focus group or surveys indicate that the current policy is inadequate or not being properly implemented.
In conclusion, organizing a staff focus group to explore perceptions is the most appropriate first step after identifying a high risk of aggressive patient behavior towards unit staff. This aligns with the principles of risk assessment which involve identifying, analyzing, and controlling hazards and risks present in a situation1.
質問 # 168
Administrative databases are an excellent source of data for reporting on clinical quality, financial performance, and
certain patient outcomes. Use of administrative database is advantageous for the following reason EXCEPT:
- A. The incorporate transaction system already used in the daily business operations of a healthcare organization
(frequently referred to as legacy system) - B. data reporting tools are available as part of the purchased system or through third-party add-ons or services.
- C. The volume of available indicators is 1000 times greater than that available through other data collection
techniques - D. They are less expensive source of data than other alternatives such as chart review or prospective data collection
正解：C
質問 # 169
Recognition of the formal and informal structure of an organization is necessary when implementing a quality improvement program because
- A. organizational structure should have low variability.
- B. quality improvement programs must consult all levels before recommending policies.
- C. teams need to be self-directing.
- D. informal leaders can be influential.
正解：D
解説：
Recognizing the formal and informal structure of an organization is essential when implementing a quality improvement program because informal leaders can be influential in the success or failure of such initiatives. Here's why:
* Role of Informal Leaders: Informal leaders, who may not hold official titles or positions of authority, often have significant influence over their colleagues due to their experience, expertise, or personality.
They can sway opinions, encourage participation, and foster a culture of cooperation, or conversely, they can resist changes and discourage others from engaging with new initiatives.
* Building Consensus and Support: To ensure the success of a quality improvement program, it is crucial to identify and engage these informal leaders early in the process. By gaining their support, the program can benefit from their influence in motivating others, addressing concerns, and ensuring buy-in from the wider workforce.
* Navigating Organizational Dynamics: Understanding the informal structure helps in navigating the complexities of organizational dynamics. It allows the program leaders to anticipate potential resistance, address it proactively, and leverage the existing informal networks to disseminate information and encourage adoption of new practices.
* Complementing Formal Structures: While formal structures define the official hierarchy and processes, the informal structure often represents how work actually gets done on the ground.
Recognizing and integrating both aspects ensures a more comprehensive approach to implementing quality improvements, making the changes more sustainable and effective.
References: (Based on Healthcare Quality NAHQ documents and resources)
* NAHQ Leadership and Organizational Change Modules.
* CPHQ Study Guide, Section on Organizational Dynamics and Leadership.
* Quality Improvement in Healthcare, Article on the Role of Informal Leaders.
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質問 # 170
An organization recently lost its deemed status due to non-compliance with grievance process regulations.
Which of the following standards would the quality professional research to identify grievance process requirements to correct the cited opportunities for improvement?
- A. DNV GL Healthcare
- B. Centers for Medicare and Medicaid Services
- C. Federal Register
- D. The Joint Commission (TJC)
正解：B
解説：
Detailed Explanation:
The Centers for Medicare and Medicaid Services (CMS) set regulatory requirements for grievance processes that healthcare organizations must follow to maintain compliance and deemed status.
Option B: Centers for Medicare and Medicaid Services
CMS establishes federal requirements that healthcare providers must meet, including those related to patient grievance processes.
References:
CPHQ resources indicate that CMS standards must be adhered to for organizations to maintain their deemed status, as they are the primary authority on grievance processes for Medicare/Medicaid compliance.
質問 # 171
A recent Journal article has Identified three new patient safety Initiatives. When reviewing these Initiatives, the first action of a healthcare quality professional Is to
- A. Incorporate the initiatives into the organization's patient safety plan.
- B. assign owners to the identified initiatives.
- C. determine the applicability of the Initiatives to an organization.
- D. collect data on the three Initiatives.
正解：C
解説：
When a healthcare quality professional encounters new patient safety initiatives, their first action should be to determine the applicability of these initiatives to their organization12. This involves assessing whether the initiatives align with the organization's current goals, resources, and patient population.
This step is crucial because not all initiatives may be relevant or beneficial to every organization. For example, an initiative aimed at improving pediatric care may not be applicable to a healthcare organization that primarily serves adults.
Once the applicability of the initiatives has been determined, the healthcare quality professional can then proceed with other steps such as collecting data on the initiatives,incorporating them into the organization's patient safety plan, and assigning owners to the identified initiatives2.
This approach ensures that the organization's resources are used efficiently and effectively, focusing on initiatives that are most likely to improve patient safety within the specific context of the organization12.
質問 # 172
Analysis has shown that there Is a significant delay in receiving laboratory results In the emergency room. A cross-functional team Is assigned the task of Improving laboratory reporting time.
Which of the following Is the next step the team should take?
- A. Identify the responsible Individual.
- B. Plot a scatter diagram.
- C. Complete a fishbone diagram.
- D. Develop action plans.
正解：C
解説：
When a cross-functional team is assigned the task of improving a process, such as laboratory reporting time in the emergency room, the first step after identifying the problem is usually to understand the root causes of the problem. A fishbone diagram, also known as a cause and effect diagram or Ishikawa diagram, is a visual tool used to systematically identify and present all possible causes of a certain outcome1234.
In this case, the significant delay in receiving laboratory results is the problem that needs to be addressed. The team would use a fishbone diagram to identify and categorize potential reasons for this delay, such as equipment issues, process inefficiencies, human errors, etc. This step is crucial before developing action plans (Option D) because it ensures that the team's efforts are directed towards addressing the root causes of the problem, rather than just the symptoms1234.
Options A (Identify the responsible individual) and C (Plot a scatter diagram) are not the immediate next steps in this scenario. Identifying a responsible individual is more about accountability after the root causes have been identified and action plans have been developed. A scatter diagram is a graphical tool used to understand the relationship between two variables and is not typically the next step in process improvement after identifying the problem1234.
Reference: https://fellow.app/blog/management/cross-functional-collaboration-common-challenges-and- tips-to-make-it-work/\
質問 # 173
An emergency department's quality improvement report for the first quarter showed the following data:
Which of the following additional information should be included in this report for each month?
- A. number of incomplete medical records
- B. number of inappropriate admissions
- C. turnaround time for laboratory results
- D. number of X-rays performed
正解：A
解説：
To enhance the quality improvement report for the emergency department, adding the number of incomplete medical records for each month would be beneficial for several reasons:
* Completeness of Documentation: Incomplete medical records can significantly impact patient care quality and safety. They can lead to gaps in information, which may result in miscommunication, delays in treatment, or inappropriate care.
* Compliance with Standards: Monitoring incomplete records helps ensure that the department complies with medical documentation standards, which are critical for legal, regulatory, and quality assurance purposes.
* Improvement Focus: Including this metric in the report highlights an area that may require attention, helping the department to focus on improving documentation practices. It can also identify trends or issues in the record-keeping process that need to be addressed.
* Support for Clinical Decisions: Complete medical records are essential for making informed clinical decisions. By tracking incomplete records, the department can take steps to ensure that all necessary information is available to healthcare providers when making decisions about patient care.
References: (Based on Healthcare Quality NAHQ documents and resources)
* NAHQ Modules on Clinical Documentation and Record Keeping.
* Quality Management in Health Care, Chapter on Importance of Complete Medical Records.
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質問 # 174
In order to make effective long-term changes, performance Improvement emphasizes the need to study and understand
- A. processes.
- B. statistics.
- C. outcomes.
- D. standards.
正解：A
解説：
* Performance improvement (PI) is the continuous study and improvement of processes with the intent to better services or outcomes, and prevent or decrease the likelihood of problems, by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems or barriers to improvement1.
* PI is based on the assumption that most problems are related to the processes rather than the people who perform them2. Therefore, studying and understanding the processes that deliver the services or outcomes is essential to identify the root causes of problems, the gaps between current and desired performance, and the potential solutions to improve them34.
* PI uses various methods and tools to analyze and measure processes, such as flowcharts, process maps, cause-and-effect diagrams, Pareto charts, histograms, control charts, run charts, and scatter diagrams5. These tools help to visualize the steps, inputs, outputs, and variations of a process, and to monitor and evaluate its performance over time6.
* PI also uses various models and frameworks to guide and accelerate improvement work, such as the Model for Improvement, Plan-Do-Study-Act (PDSA) cycles, Lean, Six Sigma,and Total Quality Management (TQM)7. These models and frameworks help to define the aim, the measures, and the changes for improvement, and to test and implement them in a systematic and iterative way8.
* Therefore, in order to make effective long-term changes, PI emphasizes the need to study and understand the processes that produce the services or outcomes, as this will help to identify and address the sources of variation, waste, and inefficiency, and to achieve better quality, safety, equity, value, and system sustainability9 . References: 1: QAPI Description and Background | CMS 2: Basics of Quality Improvement | AAFP 3: How to Improve: Model for Improvement | Institute for Healthcare Improvement 4: Performance Management and Quality Improvement - CDC 5: [Tools for Quality Improvement | NAHQ] 6: [Quality Improvement Tools and Methods | Agency for Healthcare Research and Quality] 7: [Quality Improvement Models and Frameworks | NAHQ] 8: [Quality Improvement Essentials Toolkit | Institute for Healthcare Improvement] 9: [Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development | NAHQ] : [The Financial Case for Quality as a Business Strategy | NAHQ] : [Tools for Quality Improvement | NAHQ] : [Quality Improvement Tools and Methods | Agency for Healthcare Research and Quality] : [Quality Improvement Models and Frameworks | NAHQ] : [Quality Improvement Essentials Toolkit | Institute for Healthcare Improvement] : [Healthcare Quality and Safety Workforce Report: New Imperatives for Quality and Safety Mean New Imperatives for Workforce Development | NAHQ] : [The Financial Case for Quality as a Business Strategy | NAHQ] : Tools for Quality Improvement | NAHQ : Quality Improvement Tools and Methods | Agency for Healthcare Research and Quality
質問 # 175
During a recent code blue situation at an organization, there was a delayinadministering the defibrillator's shock, A root cause analysis found the delay was due to the fact that defibrillator pads available on the unit were not compatible with the unit's defibrillator Which of the following applications of human factors engineering could have prevented this delay?
- A. checklists
- B. forcing functions
- C. resiliency efforts
- D. usability testing
正解：B
解説：
* Human factors engineering is a science that uses a systems approach to consider human psychological, social, physical, and biologic characteristics and applies the information to design equipment, processes, and environments to optimize human performance, health, and safety1.
* One of the applications of human factors engineering is forcing functions, which are design features that prevent users from making errors or performing unsafe actions2. For example, a forcing function can prevent a user from inserting a wrong key into a lock, or plugging a wrong device into a socket.
* In the case of the defibrillator pads, a forcing function could have prevented the delay by making the pads incompatible with the wrong defibrillator, or by alerting the user of the mismatch before attempting to use the device. This would have ensured that onlythe correct pads were used with the correct defibrillator, and avoided the potential harm to the patient.
* The other options are not applications of human factors engineering, but rather methods or strategies that can be used to improve quality and safety in health care. Checklists are tools that help users remember and follow a series of steps or tasks3. Resiliency efforts are actions that help users cope with and recover from adverse events or situations. Usability testing is a process that evaluates how easy and effective a product or system is to use by the intended users. References: 1: Human Factors in Healthcare | SpringerLink 2: Human Factors Engineering | PSNet 3: Checklist Use in Healthcare: A Practical Guide to Improving Quality and Safety : Resilience in Healthcare: A Systematic Review and Synthesis of the Literature : Usability Testing of Medical Devices
質問 # 176
In general, as the amounts spent on providing services for a particular condition grow, diminishing returns set in
meaning that each unit of expenditure yield ever-smaller benefits until a point where ________________.
- A. There is displacement of more useful care
- B. Additional benefits are too small to justify the added costs
- C. No additional benefits accrue from adding more care
- D. perfection is within the reach of all individuals
正解：C
質問 # 177
A healthcare quality professional receives complaints from numerous patients that the registration process is inefficient.
Which of the following should be used to best identify customer expectations, perceptions, and improvement opportunities?
- A. telephone survey of patients
- B. interviews with registration staff
- C. written survey of registration staff
- D. focus group with patients
正解：D
解説：
To address complaints about the inefficiency of the registration process, it is crucial to accurately identify patient expectations, perceptions, and potential areas for improvement. Here's a step-by-step rationale for why a focus group with patients is the best option: Understanding Customer Expectations and Perceptions:
Focus groups allow for in-depth discussions where patients can express their experiences, expectations, and perceptions in a more detailed and nuanced manner than surveys.
This method encourages dialogue, enabling the facilitator to probe deeper into issues that patients might not think to mention in a survey.
Interactive Feedback and Clarification:
Unlike surveys, which are typically more rigid and can limit the depth of feedback, focus groups provide a platform where participants can clarify their thoughts, build on others' comments, and discuss their ideas interactively.
This interaction helps to uncover insights into patient frustrations, misunderstandings, and areas that might need improvement in the registration process. Opportunity Identification:
Focus groups are excellent for identifying actionable improvement opportunities as they reveal not only what the issues are but also why they are problematic from the patients' perspectives. Through facilitated discussions, common themes and specific suggestions for improvements can emerge, which might not be captured in more quantitative approaches like surveys. Comparison with Other Methods:
Telephone Surveys: While they can reach a broad audience, they may not capture the depth of feedback necessary to truly understand patient expectations and perceptions.
Written Surveys: These can collect a large amount of data, but often lack the richness of qualitative data needed to identify nuanced patient experiences and improvement opportunities.
Interviews with Registration Staff: While important for understanding internal perspectives, they do not directly capture the patient's voice, which is essential for customer-centered improvements.
In summary, the focus group method is best suited to gain deep insights into customer expectations, perceptions, and to identify specific areas for improvement in the registration process due to its interactive and exploratory nature.
Reference: NAHQ Healthcare Quality Competency Framework: Customer Expectations and Patient Engagement NAHQ Guide to Performance and Process Improvement in Healthcare
質問 # 178
A performance improvement coordinator is having difficulty keeping a new team focused on its goal of decreasing patient waiting times.
To understand why the team process is not working, the team leader should initially assess the
- A. composition of the team.
- B. attendance at team meetings.
- C. amount of data collected.
- D. method of data collection.
正解：A
解説：
When a performance improvement coordinator faces challenges in keeping a team focused on its goal of decreasing patient waiting times, the first step should be to assess the composition of the team. The effectiveness of a team largely depends on having the right mix of members with the necessary skills, expertise, and perspectives to tackle the problem at hand.
Importance of Team Composition: A well-composed team should include members who are directly involved in the process being improved (e.g., clinicians, administrative staff), as well as those with the expertise in data analysis, quality improvement methodologies, and patient flow management. If the team lacks key stakeholders or if there is an imbalance in expertise, it can lead to misaligned goals, ineffective problem-solving, and poor engagement.
Role of Other Factors:
B: Attendance at team meetings is important for maintaining momentum but does not directly address the underlying issues that could be affecting the team's focus or effectiveness.
C: Amount of data collected is crucial for making informed decisions, but excessive data without proper analysis can overwhelm a team. It is more of a secondary factor.
D: Method of data collection is important for ensuring data accuracy and reliability, but this would typically be assessed after ensuring the team is properly composed to analyze and use the data effectively.
Initial Assessment: By first evaluating the composition of the team, the team leader can ensure that all necessary viewpoints and skills are represented, which is fundamental for addressing any process improvement challenge effectively.
Reference: National Association for Healthcare Quality (NAHQ) resources emphasize the importance of team composition in successful performance improvement initiatives, noting that a well-structured team is essential for maintaining focus and achieving desired outcomes.
質問 # 179
A home health agency's Performance Improvement Committee has decided to base staff educational programs on aggregated occurrence report data. Due to budgetary and time constraints, not every area identified from the data can be addressed. Which of the following would be most useful to the committee in determining their educational targets?
- A. control chart
- B. force field analysis
- C. scattergram
- D. Pareto chart
正解：D
解説：
The Pareto chart is the most useful tool for the Performance Improvement Committee to determine educational targets based on aggregated occurrence report data. The Pareto chart helps to prioritize areas for improvement by showing the frequency or impact of different causes of problems, following the 80/20 rule (where 80% of problems often stem from 20% of causes). By identifying the most significant issues, the committee can focus its limited resources on the areas that will have the greatest impact on improving staff performance and patient outcomes.
* Force field analysis (A): This tool is used for decision-making by analyzing forces for and against a change, but it is less suited for prioritizing based on frequency data.
* Control chart (B): Used to monitor process stability over time, not for prioritization.
* Scattergram (D): Used to identify correlations between variables, not for prioritizing educational targets.
References
* NAHQ Body of Knowledge: Quality Improvement Tools and Techniques
* NAHQ CPHQ Exam Preparation Materials: Using Pareto Charts in Performance Improvement
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質問 # 180
Which of the following is the most effective method to identify adverse events that cause harm to patients?
- A. using patient satisfaction surveys
- B. conducting a failure mode and effect analysis
- C. employing tiiyu.fi tools
- D. benchmarking
正解：C
質問 # 181
The syndrome of stockpiling is proven to be ineffective and inefficient. It also creates quality issues. This approach provides little value to the data collection effort and is one of the biggest mistake quality improvement teams make.
Rather than provide a rich source of information, this approach unnecessarily derives up:
- A. The cost of data collection
- B. Overwhelms the quality improvement teams with too much information
- C. Create data management issues
- D. All of the above
正解：D
質問 # 182
A healthcare quality professional Is doing a study in the emergency room. Every other patient admitted to the department Is Included in the sample.
This sampling technique Is best described as
- A. stratified.
- B. quota.
- C. cluster.
- D. systematic.
正解：D
解説：
Systematic sampling is a probability sampling method where researchers select members of the population at a regular interval (or k) determined in advance12.
In this case, the healthcare quality professional is selecting every other patient admitted to the emergency room, which means the interval k is 2.
This sampling technique is simpler and more straightforward than random sampling, and can cover a wide study area13.
However, it also introduces some potential biases, such as over- or under-representation of certain patterns, depending on the order of the population13.
Therefore, systematic sampling should only be used when the population order is random or random- like, such as alphabetical or numerical12.
If the population order is cyclic or periodic, such as alternating between genders or age groups, systematic sampling may result in a non-representative sample12.
Reference: 1: Dimensions of service quality in healthcare: a systematic review of literature 2: Systematic Sampling | A Step-by-Step Guide with Examples 4: What is systematic sampling? 3: Systematic Sampling: Advantages and Disadvantages
質問 # 183
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