-
Name 5 major characteristics that differentiate institutional providers as well as healthcare organizations
- types of services provided
- length of direct care provided
- ownership
- teaching status
- accreditation status
-
Name the two types of services provided
-
How does AHA define acute care verse chronic care
- acute: <30 days
- Chronic: >30 days
-
Name 3 basic ownership forms of healthcare organizations
- public
- private
- for-profit & non-profit
-
Who does Public institutions provide health services to
individuals under support of local, state, federal government
-
Name 4 examples of groups of people covered under the federal level of health care
- Veterans
- Military
- Native Americans
- Inmates
-
What is the purpose of Accountable Care organizations (ACO) and what population does it serve
- coordinate care
- chronic disease management
- improve overall quality of care
medicare recipients
-
5 quality measures targeted by ACO
- experience of care
- care coordination
- patient safety
- preventative health
- frail elderly health
-
What two types of ownership are exempt from taxes
-
Difference between teaching institution and teaching hospital
- TI: School or medicine & 1 other school
- TH: Only clinical portion
-
What are 3 issues with hospitals wanting to have a teaching program
- Salaries of physicians to supervise
- Duplicated tests/procedures
- Delays in processing patients
-
What is economic performance like for teaching verse non-teaching hospitals
weaker
-
Name some programs that the Joint Commission accredits
- Ambulatory care
- behavioral health
- Acute care/Critical access hospitals
- Lab services
- Long-term care
- hospital-based surgery
-
Name 5 levels of consolidated systems
- Large national hospitals
- Large voluntary systems
- Regional hospital
- Metropolitan-based
- Special interest groups
-
Name 3 organizational models for health networks
- Public utilities
- For-profit businesses
- Loose affiliations
-
How does managed care help reduce cost of expensive acute hospital care
- combine care delivery with financing
- provide comprehensive services at fixed prepaid fee
- Focus on preventative care and follow-up
-
What criteria needs to be met for HMO to be federally qualified
- offer inpatient/outpatient care
- treatment/referral for drug & alcohol
- lab/radiology
- preventative dental children <12
- preventative health
- physician services
-
What is IPA
group practice in which physicians in private offices are paid on fee-for-service
-
What is PPO
Fees are discounted for patients in return for physicians getting prompt payment
-
Name some examples of free-standing organizations
- Surgicenters
- Urgent Care
- Primary Care
- Imaging centers
-
What are funds used for that are supplied to public health departments from local, state, or federal budgets
- maternal/child care
- communicable diseases
- children with birth defects
- mental health
- bioterrorism investigation
- Environmental services
-
What is the fastest growing segments of health care
home care
-
Name 5 examples of regulatory organizations
- Medicaid/Medicare
- FDA
- OSHA
- Equal employment
- State licensing boards
-
What is the country's largest and most influential health insurance program
medicare
-
Who is the primary payer of healthcare costs in the US
federal government
-
What is the approval, recognition, or certification by an official review board that an organization has met certain standards
Accreditation
-
What is deeming authority
an organization that is surveyed and accredited by a national accrediting body for CMS
-
What is it called when organizations that provide similar services come together
horizontal integration
-
What is it called when organizations align to provide a full array or continuum of services
vertical integration
-
What is the difference between acquisitions and mergers
- A: one organization buys another
- M: combining 2+ organizations to form new entity
-
Name the 3 major driving forces for the evolution of healthcare organizations
- economic
- social
- demographics
-
Name 2 types of systems in the systems theory
- Closed (self-contained)
- Open (interacting with internal/external forces)
-
Name 3 things comprising the framework for systems theory
-
Name 4 elements of systems theory
- Structure
- Technology
- People
- Environment
-
Difference between open and closed systems in system theory
- Open: continual process of adaptation
- Closed: sufficient to self, not affected by what happens around it
-
What theory sees the universe as filled with unpredictable and random events; requires organizations to be self-organizing and adaptive to survive
Chaos theory
-
What is a systematic analysis of how organizations and their component parts act and interact
Organizational theory
-
What 3 things does organizational theory look at
- culture
- technology
- structure/development
-
Difference between mission and vision
- M: Reason for existence
- V: Articulated goal, future, purpose
-
What is included in the mission statement
- Customers
- Types of service
- Technology/human resources
-
What does the mission focus on for hospitals? Ambulatory Care? Long-term? Nursing centers?
- H: treatment
- A: treatment, prevention, diagnosis
- LT: maintenance, social support
- NC: promote optimal health status
-
What is the guiding framework for decision-making
mission
-
What is the reflection of the norms or traditions of an organization
organization culture
-
What two ways is culture demonstrated
- mutually reinforcing
- conflict-producing
-
To most people, what reflects the true organizational culture
lived experience
-
What defines how work is organized, where decisions are made, and the authority and responsibility of workers? Provides map for communication
Organizational structure
-
What theory today best explains nursing organizational development
Chaos theory (nonlinear, complex, quantum)
-
What is a tool that consumers can use to access a searchable database of information describing how well hospitals care for patients
Hospital Compare
-
Name 3 factors that influence structural design
- Federal mandates
- Consumerism
- Competition
-
Name 3 techniques in redeveloping structural designs
- Redesign
- Restructure
- Re-engineer
-
What technique is used to analyze tasks to improve efficiency
redesign
-
What technique is used to enhance organizational productivity
restructuring
-
What involves the total overhaul of an organizational structure
Re-engineering
-
What is an example of redesigning the work environment from the bottom up?
Transforming care at the bedside
-
What 3 characteristics classify organizational designs
- complexity
- formalization
- centralization
-
What concerns the division of labor, specialization of labor, number of hierarchical levels, and geographic dispersion of units
Complexity
-
What is the separation of processes into tasks that are performed by designated people
division of labor and specialization
-
Difference between hierarchy and chain of command
- H: line of authority/responsibility
- COC: Vertical dimension of hierarchy
-
What is span of control
# of subordinates a supervisor managers
-
What is the degree to which an organization has rules stated in terms of policies that define a members function
Formalization
-
What is the location where a decision is made
centralization
-
Difference between centralized and decentralized institutions
- C: Hierarchy makes decisions
- D: lower level makes decisions (direct care nurse)
-
What is the centralization of authority in administrative bureaus or government departments
Bureaucracy
-
Benefits verse risk of bureaucracy
- Benefit: consistency
- Risk: limit autonomy, treatment delays
-
What could be assessed to determine the level of bureaucracy present in an organization
- Labor specialization
- Centralization
- Formalization
-
How is labor specialization assessed to determine the level of bureaucracy present in an organization
degree to which patient care is divided into highly specialized tasks
-
How is centralization assessed to determine the level of bureaucracy present in an organization
level of organization on which decisions regarding carrying out work and remuneration for work are made
-
How is formalization assessed to determine the level of bureaucracy present in an organization
% of actions required to deliver patient care that is governed by written policy and procedures
-
Difference between line functions and staff functions
- Line: direct responsibility, decision making
- Staff: support, advice, council
-
Name 4 types of organizational structures
- Functional
- Service
- Matrix
- Flat
-
What structure arranges departments and services according to specialty
functional
-
Benefit verse risk of functional structures
- Benefit: support expertise, encourage advancement
- Risk: Discontinuity of pt care services
-
What structure has a single manager or executive
Service-line
-
benefit verse risk of service-line structure
- B: coordination of services, expedited decision making, clarity of purpose
- R: duplication of services, loss of professional/technical affiliation, lack of standardization
-
What structure has a complex design that reflects both function and service in an integrated organizational structure? Manager of unit reports to functional and service-line manager
Matrix
-
What structure eliminates hierarchy by allowing delegation of decision making to the professionals doing the work
Flat
-
What are benefits and risks of Flat structures
- B: autonomy, speedy car
- R: inconsistency, loss of growth opportunities
-
4 inherent characteristics of culture
- develops over time, responsive
- learn it and share it
- essential for survival/acceptance
- changes with difficulty
-
Difference between culture diversity and culture sensitivity
- D: differences
- S: affect (feelings)
-
3 themes involved in acculturation
- Socialization
- Acculturation
- Assimilation
-
What refers to adapting a a particular culture
Acculturation
-
What refers to individuals who now define themselves as members of the dominant culture
assimilation
-
3 things that could occur according to Spence when working with someone of a different culture
- Prejudice
- Paradox
- Possibility
-
describe the model of cultural competence
- Outer: global society
- Second: community
- Third: Family
- Inner: person
-
What is included in Transcultural Assessment Model
- communication
- time
- space
- social organization
- environment
- biological variations
-
What theory focuses explicitly on close relationships of the culture, emic and etic congruency
Sunrise model, Leninger theory of transcultural nursing
-
What is bridging of gaps between cultures
transculturalism
-
What was formed to bring together nursing stakeholders to develop shared vision, strategies, and specific actions for improvement in nursing practice, education, and delivery of patient care through the use of information health technology
TIGER
-
3 parts of TIGER
- basic computer competencies
- information literacy
- information management
-
name 4 things included in biomedical technology
- physiologic monitoring
- diagnostic testing
- IV fluid & meds
- Therapeutic regimen
-
How does knowledge technology assist in pt care
generates knowledge to provide clinical decision support
-
What is the set of standards defined by Medicaid/Medicare EHR incentive programs that govern the use of EHRs
Meaningful use
-
3 benefits of meaningful use of EHR
- Complete and accurate info
- Better access to info
- Pt empowerment
-
What includes annual records of medication errors
MEDMARX
-
What type of care delivery strategies has one nurse that provides total care of the patient? What setting is this seen
-
Benefits/risks of Case method
- B: consistent care, continuity, subtle changes easily noticed
- R: Very expensive, not enough resources
-
What delivery of care method involves providing patient care by each licensed/unlicensed staff member by performing specific tasks for a large group of pts
Functional
-
Benefits/Risks of Functional Model of nursing in delivery of care methods
- B: task efficiency, much work done in short time, fixed RN and large UAP
- R: Fragmentation of care, ineffective communication
-
What delivery of care model works best in disaster/emergency situations
functional
-
What is team nursing
- Team leader assigns staff in team, reports to charge nurse
- Provides care to a small group of patients
-
Benefits/risks of team nursing
- B: organizational decisions made at lower levels, cost-effectiveness
- R: team leader with poor communication skills, careful for it not to become functional like, potential for fragmentation high
-
What is primary nursing
1 RN assigned to patients for 24 hours, assistant RN reports changes and primary nurse makes adjustments
-
Where is primary nursing hybrid: partnership model appropriate
with other disciplines in close proximity
-
What is a critical pathway
standard plan of care for various diseases that outline a normal progression. If there are variances, treatment should be adjusted
-
Difference between case manager and nurse navigator
- CM: variety of conditions, long term
- NN: single health condition, acute
-
5 stages of Dreyfus model of skill acquisition
- novice
- advanced beginner
- competent
- proficient
- expert
-
How many years of work for a nurse to reach competency in Dreyfus model of skill acquisition
2-3 years
-
4 objectives of TCAB
- Reliability
- Vitality
- Pt-centeredness
- Increased value
-
What factors should be considered when developing a new model for delivery of care
- Trends in healthcare
- Wants/needs of people
- structural/process/outcome decisions
- Need to be sustainable over time and able to replicate
-
Difference between prototype and factor evaluation systems
- P: subjective and descriptive, single healthcare focus
- F: Objective, complex health issues
-
What is input and output for productivity in nursing
- Input: employees
- Output: # of beds
-
What is a comprehensive, national database that provides hospitals with nursing unit level comparison on 18 quality indicators that can be used in quality improvement plans to prevent adverse effects
NDNQI
-
What is the Registered Nurse Safer Staffing Act
all acute care hospitals have to establish a committee made up of 55% direct care RNs
-
# of units of service for the reporting period
Volume statistic
-
# of beds or blocks of time available for providing services
Capacity statistics
-
5 communication patterns in response to stress
- attribution of blame
- placation
- Constrained cool-headedness
- immaterial irrelevance
- congruence
-
When human beings are in distress, what conditioned responses occur (3)
- blame (feelings)
- Judgement (thinking)
- Demand (unreasonable)
-
5 key behaviors of leaders building a high-performance team
- model
- inspire
- challenge
- enable
- encourage
-
5 guidelines for acknowledgement
- specific
- personal
- sincere
- public
- timely
-
What is it called when people work together to produce extraordinary results
synergy
-
What is dualism
things are black or white
-
what is reflective practice
learn from experience
-
what is the greatest deterrent to self-esteem and self-confidence
fear
-
What integrated program stresses teamwork and communication between physicians, nurses, and other healthcare personnel to increase pt safety
TeamSTEPPS
-
What 3 parts make up nursing informatics
-
What are the 3 most common reasons there are errors made r/t technology
- mislabeled bar codes
- mistakes at order entry
- issues with management of info
-
Name 5 phases of team development
- Forming
- Storming
- Norming
- Performing
- Adjoining
-
What phase of team development includes a period of confusion
storming
-
What phase of team development will some team members leave and some join
adjoining
-
3 things that kill synergy
- self-appointed expert
- someone who doesnt speak up
- loner
-
Characteristics of veterans
- support status quo
- accepts authority
- appreciates hierarchy
- loyal to employer
-
Characteristics of baby boomers
- workaholics
- struggle with new technology
-
characteristics of generation X
- adapts easily to change
- personal life/family important
- frequent job changes
- proficient in technology
-
characteristics of generation Y
- Optimistic & self-confident
- values achievement
- Technology way of life
- at ease with diversity
-
behavioral change strategy where the manager provides factual info to support the change
rational-empirical
-
When would rational-empirical be used
when resistance to change is minimal
-
behavioral strategy where the manager focuses on interpersonal relationships to promote change
Normative-reeducative
-
behavioral strategy where the manager uses rewards to promote change
power-coercive
-
When would power-coercive be used
individuals highly resistant to change
-
4 types of decision making styles
- decisive
- flexible
- hierarchical
- integrative
-
Treatment of inhaled anthrax
-
treatment of cutaneous anthrax
-
Treatment of botulism
- airway management
- antitoxin
-
treatment of ebola
- minimize invasive procedures
- supportive care
-
Treatment for plague
- antibiotics within 24 hours to prevent death
- Streptomycin, gentamycin, chloramphenicol
-
Treatment of smallpox
supportive (skin care, meds for pain/fever, prevent dehydration)
-
Treatment of Tulaermia
- streptomycin/gentamicin
- Mass: doxycycline or cipro
-
sore throat, fever, cough, SOB, muscle aches, severe dyspnea, meningitis, shock indicates:
inhalation anthrax
-
starts as lesion and becomes itchy, develops into vesicular lesion that becomes necrotic with formation of black eschar, fever, chills indicates:
Cutaneous anthrax
-
dysphagia, double vision, slurred speech, descending progressive weakness, n/v/abd cramps, dyspnea indicate what
botulism
-
sore throat, HIGH fever, n/v/d, internal/external bleeding indicate what
ebola
-
first signs fever, HA, weakness, rapidly developing pneumonia, bloody or water sputum, chest pain indicate what
pneumonic plague
-
swollen tender lymph glands, fever, HA, chills, weakness indicate what
Bubonic plague
-
fever, chills, prostration, abd pain, shock, bleeding into skin and other organs indicate what
septicemic plague
-
high fever, fatigue, severe HA, RASH, chills, vomiting, delirium indicate what
Smallpox
-
sudden fever, chills, HA, diarrhea, muscle aches, joint pain, dry cough, progressive weakness, if airborne can develop life-threatening pneumonia and systemic infection
Tularemia
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