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Chapter 1 Healthcare Quality Management Introduction – Flashcards

Sara Edwards

8 July 2022

question

Accreditation Standards

answer

Statements of expectation set by a competent authority concerning a degree or level of requirement, excellence, or attainment in quality or performance.

question

Assessment

answer

Use of performance information to determine the degree to which an acceptable level of quality has been achieved.

question

Continuous improvement

answer

System in which individuals in an organization look for ways to do things better, usually based on understanding and control of performance variation.

question

Governing Board

answer

Individuals, groups, or agency with ultimate legal authority and responsibility for overall operation of an organization; sometimes called board of trustees

question

Healthcare Quality

answer

Degree to which health services for individuals and population increase like the likelihood of desired health outcomes and are consistent with current professional knowledge.

question

Improvement

answer

Planning and making changes to current practices so performance will be better in the future.

question

Measurement

answer

Collection of information for the purpose of understanding current performance and seeing how performance changes over time.

question

Medical staff executive committee

answer

Leadership group of a hospital's organized medical staff that exercises primary authority over activities of the medical staff and over performance of individuals with hospital clinical privileges

question

Misuse

answer

Health services misuse includes incorrect diagnoses as well as medical errors and other sources of avoidable complications

question

Overuse

answer

Overuse occurs when a health service is provided even though its risk of harm exceeds its likely benefit.

question

Patient safety

answer

Actions taken to reduce the risk of patients being unintentionally harmed by effects of healthcare services.

question

Processes

answer

Collections of actions following prescribed procedures for bringing about a result

question

Quality Management

answer

Way of doing business which continuously improves products and services to achieve even better levels of performance.

question

Quality management plan

answer

Written description of the organizational structure, responsibilities, procedures, processes and resources supporting an organization's quality management system

question

Quality Management System

answer

Organizational structure, responsibilities, procedures, processes and resources supporting the design, measurment, assessment and improvement of key functions and key processes, sometimes referred to as the quality program or performance improvement program

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Stakeholder

answer

Person, group, organization, or entity with a direct or indirect stake in an organization because it can affect or be affected by that organization's actions, objectives and performance

question

Underuse

answer

Occurs when a health service is not provided though it would have been medically beneficial

question

Providers

answer

Any organization or individual that is licensed or trained to give healthcare.

question

Purchasers

answer

Any organization or individual that pays for healthcare services either directly or indirectly.

question

Consumers

answer

Any recipient of healthcare services.

question

Key Dimensions of Healthcare Quality Identified by the Institute of Medicine

answer

Safe Effective Patient-Centered Timely Efficient Equitable

question

Three Primary Activities of Quality Management

answer

measurement assessment improvement

question

Quality is the responsibility of

answer

everyone working in healthcare

question

Case Manager

answer

this individual often a nurse or social worker, helps coordinate patient services among and between caregivers and provider sites.

question

compliance officer

answer

This individual helps assure the organization adheres to external regulations and accreditation requirements related to quality management

question

Health Data Analyst

answer

this individual gathers, evaluates and reports information in support of various quality management activities--may have clinical, health information management or informatics expertise

question

Infection control practitioner

answer

this individual collects and analyzes health data related to patient infections and disseminates information on prevention of infections--typically filled by nurse, physician, epidemiologist or medical technologist

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Patient representative

answer

this individual serves as a liaison and primary customer service contact for patients and family members--often gather patient and family complaint data for performance measurment purposes

question

Patient safety officer

answer

this individual oversees patient safety improvement activities which may include evaluation of patient incident data, facilitation of safety improvement projects and coordination of information flow about patient safety among relevant administrative and medical staff committees

question

Physician advisor

answer

this individual serves as a full or part-time quality management advisor-- works closely with the quality department and medical staff president to ensure appropriate physician participation in, and communication of, quality management activities--may serve as advisor for UM activities

question

Quality Director

answer

this individual serves as the administrative head of the quality department and performs or coordinates functions assigned to that department-- assists senior leadership in facilitating compliance with quality-related accreditation standards, government regulations and purchaser requirements

question

Risk Manager

answer

this individual provides guidance and assistance in support of liability control programs including reporting and analysis of patient and employee incidents and identification and control of liability risks throughout the organization

question

Utilization Coordinator

answer

this individual is involved in resource management activiites to prevent underuse and overuse of services--determine appropriateness of care--collect utilization-related data for quality management purposes

question

CMS and NCQA requires a quality management plan but

answer

TJC does not but is implied that it is desirable

question

Quality management is the means by which high quality patient care is maintained and improved in all levels of the system --

answer

individual, departmental and organizational

question

What involves gathering information to determine current levels of performance?

answer

Measurement

question

What involves finding the cause of performance gaps and implementing interventions to correct cause of undesirable performance?

answer

Improvement

question

What involves evaluating current levels of performance to determine if there are gaps between expected and actual quality?

answer

Assessment

question

What are the Core Elements of a quality management system?

answer

--leadership oversight and accounability --quality infrastructure, including routine meetings with cross-departmental representation --performance measurement of key clinical and service areas --activities aimed at improving performance in clinical and service areas --involvement of stakeholders and transparency of performance data

question

What is the range of groups involved in the quality management system of a healthcare organization?

answer

Board Senior Leaders Second Tier Groups Third Tier Groups Quality Management Support Services

question

Who is responsible for ensuring continuous quality improvement and for establishing and cultivating a culture of safety?

answer

The Senior Leaders (president, chief operating officer, vice presidents, medical director)

question

Quality management oversight committees or councils: coordinates quality management activities, evaluate the performance of physicians involving credentialling, privileging, and PPEs

answer

Second Tier Groups (Medical staff executive committee in hospital)

question

Any number multi-disciplinary committee or group formed to support various areas of quality management:

answer

3rd tier groups (cancer committee) Medical staff and administrative committees

question

Quality Management Support Services: vary considerably among organizations:

answer

Case Manager Compliance Officer Health Data Analyst Infection control practitioner Patient representative Patient safety officer Physician advisor Quality Director Risk Manager Utilization Coordinator

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question

Accreditation Standards

answer

Statements of expectation set by a competent authority concerning a degree or level of requirement, excellence, or attainment in quality or performance.

question

Assessment

answer

Use of performance information to determine the degree to which an acceptable level of quality has been achieved.

question

Continuous improvement

answer

System in which individuals in an organization look for ways to do things better, usually based on understanding and control of performance variation.

question

Governing Board

answer

Individuals, groups, or agency with ultimate legal authority and responsibility for overall operation of an organization; sometimes called board of trustees

question

Healthcare Quality

answer

Degree to which health services for individuals and population increase like the likelihood of desired health outcomes and are consistent with current professional knowledge.

question

Improvement

answer

Planning and making changes to current practices so performance will be better in the future.

question

Measurement

answer

Collection of information for the purpose of understanding current performance and seeing how performance changes over time.

question

Medical staff executive committee

answer

Leadership group of a hospital's organized medical staff that exercises primary authority over activities of the medical staff and over performance of individuals with hospital clinical privileges

question

Misuse

answer

Health services misuse includes incorrect diagnoses as well as medical errors and other sources of avoidable complications

question

Overuse

answer

Overuse occurs when a health service is provided even though its risk of harm exceeds its likely benefit.

question

Patient safety

answer

Actions taken to reduce the risk of patients being unintentionally harmed by effects of healthcare services.

question

Processes

answer

Collections of actions following prescribed procedures for bringing about a result

question

Quality Management

answer

Way of doing business which continuously improves products and services to achieve even better levels of performance.

question

Quality management plan

answer

Written description of the organizational structure, responsibilities, procedures, processes and resources supporting an organization's quality management system

question

Quality Management System

answer

question

Stakeholder

answer

Person, group, organization, or entity with a direct or indirect stake in an organization because it can affect or be affected by that organization's actions, objectives and performance

question

Underuse

answer

Occurs when a health service is not provided though it would have been medically beneficial

question

Providers

answer

Any organization or individual that is licensed or trained to give healthcare.

question

Purchasers

answer

Any organization or individual that pays for healthcare services either directly or indirectly.

question

Consumers

answer

Any recipient of healthcare services.

question

Key Dimensions of Healthcare Quality Identified by the Institute of Medicine

answer

Safe Effective Patient-Centered Timely Efficient Equitable

question

Three Primary Activities of Quality Management

answer

measurement assessment improvement

question

Quality is the responsibility of

answer

everyone working in healthcare

question

Case Manager

answer

this individual often a nurse or social worker, helps coordinate patient services among and between caregivers and provider sites.

question

compliance officer

answer

This individual helps assure the organization adheres to external regulations and accreditation requirements related to quality management

question

Health Data Analyst

answer

this individual gathers, evaluates and reports information in support of various quality management activities--may have clinical, health information management or informatics expertise

question

Infection control practitioner

answer

question

Patient representative

answer

this individual serves as a liaison and primary customer service contact for patients and family members--often gather patient and family complaint data for performance measurment purposes

question

Patient safety officer

answer

question

Physician advisor

answer

question

Quality Director

answer

question

Risk Manager

answer

question

Utilization Coordinator

answer

question

CMS and NCQA requires a quality management plan but

answer

TJC does not but is implied that it is desirable

question

Quality management is the means by which high quality patient care is maintained and improved in all levels of the system --

answer

individual, departmental and organizational

question

What involves gathering information to determine current levels of performance?

answer

Measurement

question

What involves finding the cause of performance gaps and implementing interventions to correct cause of undesirable performance?

answer

Improvement

question

What involves evaluating current levels of performance to determine if there are gaps between expected and actual quality?

answer

Assessment

question

What are the Core Elements of a quality management system?

answer

question

What is the range of groups involved in the quality management system of a healthcare organization?

answer

Board Senior Leaders Second Tier Groups Third Tier Groups Quality Management Support Services

question

Who is responsible for ensuring continuous quality improvement and for establishing and cultivating a culture of safety?

answer

The Senior Leaders (president, chief operating officer, vice presidents, medical director)

question

Quality management oversight committees or councils: coordinates quality management activities, evaluate the performance of physicians involving credentialling, privileging, and PPEs

answer

Second Tier Groups (Medical staff executive committee in hospital)

question

Any number multi-disciplinary committee or group formed to support various areas of quality management:

answer

3rd tier groups (cancer committee) Medical staff and administrative committees

question

Quality Management Support Services: vary considerably among organizations:

answer

Chapter 1 Healthcare Quality Management Introduction – Flashcards

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