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NURS6204 MIDTERM EXAM 2024 LATEST EXAM WITH RATIONALE CAPELLA UNIVERSITY ADVANCED HEALTH A, Exams of Nursing

Capella UniversityNursing

NURS6204 MIDTERM EXAM 2024 LATEST EXAM WITH RATIONALE CAPELLA UNIVERSITY ADVANCED HEALTH ASSESSMENT Quality -Perceived degree of excellence -meeting or exceeding customer expectations -dynamic - expectations can change -can be improved Reliability The measurable capability of a process, procedure, or health service to perform its intended function in the required time under commonly occurring conditions

Typology: Exams

2024/2025

Available from 07/09/2025

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NURS6204 MIDTERM EXAM 2024 LATEST EXAM WITH
RATIONALE CAPELLA UNIVERSITY ADVANCED HEALTH
ASSESSMENT
Quality
-Perceived degree of excellence
-meeting or exceeding customer expectations
-dynamic - expectations can change
-can be improved
Reliability
The measurable capability of a process, procedure, or health service to perform its intended
function in the required time under commonly occurring conditions
Value
A relative measure that describes a product's or service's worth, usefulness, or importance
Healthcare quality
"Degree to which health services for individuals and populations increase the likelihood of
desired health outcomes and are consistent with current professional knowledge
Quality assurance
Evaluation activities aimed at ensuring compliance with minimum quality standards
IOM Crossing the Quality Chasm - 6 dimensions of quality
STEEEP - (safe, timely, effective, efficient, equitable, patient-centered)
1. safety - care intended to help patients should not harm them
2. effective - care should be based on scientific knowledge and provided to patients who could
benefit. Care should not be provided to patients unlikely to benefit from it. In other words,
underuse and overuse should be avoided
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NURS6204 MIDTERM EXAM 2024 LATEST EXAM WITH

RATIONALE CAPELLA UNIVERSITY ADVANCED HEALTH

ASSESSMENT

Quality

  • Perceived degree of excellence
  • meeting or exceeding customer expectations
  • dynamic - expectations can change
  • can be improved Reliability The measurable capability of a process, procedure, or health service to perform its intended function in the required time under commonly occurring conditions Value A relative measure that describes a product's or service's worth, usefulness, or importance Healthcare quality "Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality assurance Evaluation activities aimed at ensuring compliance with minimum quality standards IOM Crossing the Quality Chasm - 6 dimensions of quality STEEEP - (safe, timely, effective, efficient, equitable, patient-centered)
  1. safety - care intended to help patients should not harm them
  2. effective - care should be based on scientific knowledge and provided to patients who could benefit. Care should not be provided to patients unlikely to benefit from it. In other words, underuse and overuse should be avoided
  1. patient centered - care should be respectful of and responsive to individual patient preferences, needs, values, and patient values should guide all clinical decisions
  2. timely - care should be provided promptly when the patient needs it
  3. efficient - waste, including equipments, supplies, idea, and energy, should be avoided
  4. equitable - the best possible care should be provided to everyone, regardless.of age, sex, race, financial status, or any other demographic variable high-value healthcare low-cost, high-quality healthcare IHI Triple Aim Framework better care, health people/ healthy communities, affordable care Quality management A way of doing business that continuously improves products and services to achieve better performance Overuse Provision of healthcare services that do not benefit the patient, are not clearly indicated, or are provided in excessive amounts or in an unnecessary setting Underuse Failure to provide appropriate or necessary services or provision of an inadequate quantity or lower level of service than required Misuse Incorrect diagnoses, medical errors, and other sources or avoidable complications Deming 14 points
  • continuous quality improvement
  • credentialing, report cards, benchmarking, clinical pathways Implementation strategies for changing provider behavior detailing, decision support, checklists, incentives, new models of delivery Quality planning Setting quality objectives and specifying operational processes and related resources needed to fulfill the objectives Juran Quality Trilogy - framework for linking finance and management
  1. quality planning - define customers and how to meet their needs
  2. quality control - keep processes working well
  3. quality improvement - learn, optimize, refine and adapt Core Values and Concepts in Baldridge Performance Excellence Framework
  • systems perspective
  • visionary leadership
  • patient focus
  • valuing people
  • organizational learning and agility
  • focus on success
  • management for innovation
  • management by fact
  • societal responsibility and community health
  • ethics and transparency
  • delivering value and results Baldridge Framework Deming 14 points
  1. Create constancy of purpose toward improvement
  1. Adopt the new philosophy
  2. Cease dependence on inspection to achieve quality
  3. End the practice of awarding business on the basis of price tag
  4. Improve constantly and forever
  5. Institute training on the job
  6. Institute leadership
  7. Drive out fear
  8. Break down barriers between departments
  9. Eliminate standards for zero defects, quotas, and management by objective, lead instead
  10. Remove barriers that rob the hourly worker of his right to pride of workmanship
  11. Remove barriers that rob people in management in engineering of their right to pride of workmanship
  12. Institute a vigorous program of education and self-improvement
  13. Put everybody in the company to work to accomplish the transformation Deming Chain Reaction Improve quality, decrease cost, improve productivity, decrease prices, increase market, stay in business, provide jobs and more jobs, return on investment Donabedian model for measuring quality structure, process, outcomes (includes patient experience) Structure measures used to judge the adequacy of the environment in which patient care is provided Process measures Used to judge whether patient care and support functions are properly performed Outcome measures Used to judge the results of patient care and support functions PROMS
  • experience of care
  • utilization and risk adjusted utilization
  • health plan descriptive information
  • measures reported using electronic clinical data systems
  • NCQA is measurement and accreditation for health and payors Risk adjustment Taking factors into consideration to standardize and risk adjust Patient centered medical home puts patients first, emphasize team-based care, specific criteria to meet in order to get credited as a PCMH National Quality Forum (NQF)
  • sets standards
  • recommends measures for payment and public reporting
  • advances electronic measurement
  • provides information and tools to help healthcare decision-makers
  • independent group of experts
  • have a measure incubator Quality Landscape - summary systems, stakeholders, cost, quality, access, dynamic, clinical, administrative, policy, environment/context Root Cause Analysis - 5 Whys
  • to explore and display all causes of a problem
  • can overcome the issue of 5 whys that may only highlight a single cause
  • clearly define the problem
  • identify who is involved
  • can also be used as process-type cause tool

ishikawa diagram/ fishbone diagram categories for causes

  • Machines
  • Mother Nature (Environement)
  • Methods
  • Manpower Failure Modes and Effects Analysis (FMEA) systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures, in order to identify the parts of the process that are most in need of change
  • includes review of: steps in the process, failure modes, failure causes, failure effects Steps for constructing measures
  • identify topic of interest
  • develop the measure
  • design data collection system
  • address the what, who, when, and how of data collection NQF criteria to assess measurement
  • importance
  • scientific acceptability
  • usability
  • feasibility Pareto principle The majority of results come from a minority of outputs (an 80/20 rule of thumb) SMART goal specific, measurable, achievable, realistic, time-bound statistical process control (SPC) application of statistical methods to identify and control performance
  • if changes were not successful, repeat the PDSA cycle
  • if changes were successful, implement on wider scale or modify
  • predict results FOCUS-PDCA
  • Hospital Corporations of American expanded on Shewart's model
  • Find a process that needs improvement
  • Organize a team of people knowledgeable about the process
  • Clarify the current process and changes needed
  • Understand the causes of variation
  • Select actions needed to improve the process FADE model
  • adaptation of original PDSA/PDCA
  • Focus
  • Analyze
  • Develop
  • Execute Lean principles
  • Lean is used to cut waste, focus on maximizing efficiency, minimizing waste
  1. Value - identify what is important to the customer and focus on it
  2. Value stream - ensure all activities are necessary and add value
  3. Flow - strive for continuous processing through the value stream
  4. Pull - drive production with demand
  5. Perfection - prevent defects and rework lena culture - McKinsey 4 disciplines
  6. establish clear direction through strategy and goals
  7. enable people to lead and contribute to fullest potential
  8. customer value delivered as efficiently as possible
  9. evolve continuously to find better ways of working

Value Stream

  • the series of activities that an organization performs such as order, design, produce, and deliver products and services
  • ofter starts from a supplier's supplier and ends at the customer's customer
  • wastes are both explicit and hidden along a value stream
  • 3 main components: flow of materials/resources, transformation of goods/services, flow of information Standard work
  • to make manufacturing methods and/or service processes consistent
  • by having standard work, equipment, methods, and materials are standardizes and thus reduce variation in processes
  • standard work aligns with the 5S step "standardize" 8 categories of Muda (waste)
  • excess movement
  • waiting
  • overprocessing
  • defects, errors or harm
  • inventories (incoming, in process, complete)
  • excess transportation of materials
  • design, underutilization of employees' brainpower, skills, experience and talents
  • overproduction of products and services The House of Lean
  • foundation - the goal of lean is the elimination of waste (muda)
  • floor - leveled production (Heijunka), scheduling patients and suppliers to meet demand, maximize throughput and eliminate bottlenecks, parts of the org or service delivery work in harmony
  • Pillars - Just in Time and Jidoka, JIT - delivering the service or supplies only when needed, where needed and in right amount, Jidoka - maximize consistency by empowering people - "stop the line", maximize people and machine activities The House of Lean - Inside the house

defines what the process is capable of delivering variation

  • process output varies over time
  • mean and variation are related but different measures kaizen
  • continuous improvement
  • necessary as environments, tech, and customers change
  • small changes kaizen event
  • short term Lean project
  • usually involves small group of people familiar with process
  • focused, short-term project aimed at improving a particular process Six Sigma
  • to reduce variation
  • disciplined focus on quality, consistency and design
  • statistical approach
  • structured and disciplined methodology for improvement and problem solving
  • Six sigma quality is less than 3.4 defects per 1 million Six Sigma - Philosophy
  • views all work as processes that can be defined, measured, analyzed, improved and controlled
  • processes require inputs and produce outputs. If you can control the inputs, you can control the outputs, function of y Six Sigma - Methodology
  • recognizes the underlying and rigorous DMAIC approach
  • DMAIC: define, measure, analyze, improve, and control

Six Sigma - Set of tools

  • includes all the qualitative and quantitative techniques used to drive process improvement
  • tools including statistical process control charts, FMEA, and process mapping Six Sigma - Metrics Six Sigma quality performance means 3.4 defects per million opportunities The Six Sigma Roadmap
  1. recognize that variation exists in everything that we do; standardize your work
  2. identify what the customer wants and needs. reduce variation 3.use a problem-solving methodology to plan improvements
  3. follow the DMAIC model to deploy the improvement
  4. monitor the process using process behavior charts
  5. update standard operating procedures and lessons learned
  6. celebrate successes
  7. start over for continual improvement DMAIC
  • most Six Sigma steps include this
  • Define the problem
  • Measure key aspects of the process
  • Analyze the data
  • Improve the system
  • Control and sustain the improvement IHI Model of Improvement
  • 3 questions
  • PDSA cycle
  • small tests of change
  • continuous improvement rapid cycle improvement

Types of errors

  • repeatability - same person taking the readings
  • reproducibility - different people measuring the same process
  • bias (constant or varying) Inventory and Kanban
  • push system - driven by forecasting
  • pull system - demand or customer Deliverables of a lean six sigma team
  • business case - shows how the project will improve performance
  • project charter - describes project details
  • reports - describes progress and outcomes
  • process improvement plans and documents
  • monitoring and control documents Project management
  • PMI and PMBOK
  • project definition stakeholders
  • project managers
  • phase reviews/Tollgate review Charter
  • business case
  • requirements/needs that must be met/ VOC
  • scope what is in and out of the project
  • feasibility of the project
  • metrics
  • work breakdown structure
  • budget
  • schedule
  • risks and mitigation (accept/avoid/reduce/transfer)
  • financial analysis (cost/benefit)
  • team and stakeholder relationships and communication plan Value stream map
  • shows steps of an operational process
  • identifies productive (value added) and non-productive (non value added) activities process map
  • shows a detailed view of the process including actions and decisions
  • swimlane diagrams or cross departmental maps
  • can add/indicate details Process mapping
  • define the problem
  • identify start and end points
  • determine level of detail
  • observe if possible
  • draw
  • evaluate if necessary Spaghetti diagram
  • visual representation of motion of a resource, person, or activity in a specified layout over a specified period of time
  • W5H
  • incorporate key representatives and communicate
  • develop floor plan and trace movement (current state)
  • analyze movement
  • develop future state diagram in QI work
  • one continuous line
  • before and after spaghetti diagrams FMEA criticality score calculation frequency x severity x detection

Run charts

  • used to monitor the behavior of a variable over time for a process or system
  • graphically displays cycles, trends, shifts, or non-random patterns in behavior over time
  • identify problems and time when a problem occurred
  • monitor progress when solutions are implemented Run chart. - benefits
  • simple to create and maintain
  • does not require in-depth statistical training to use
  • displays data in straightforward, easy to analyze manner Run Chart - how to use
  1. determine the purpose of the chart and the data to be monitored, collected, and analyzed. Select the time interval (minute, hour, day, month, etc)
  2. collect the data that will be plotted
  3. plot the time on the horizontal axis
  4. Label the vertical axis and plot the data collected in step 2 on the vertical axis
  5. title the chart, indicating which direction is better with an up or down arrow may be helpful Run chart - shift Six or more consecutive points either all above or all below the median Run charts - trend Five or more consecutive points either all going up or all going down Run charts - runs a non-random pattern is signaled by too few or too many runs (crossing of the median line)
  • count the number of times the line connecting two points crosses the median line and add one Run charts - astronomical point Obvious outlier

Run table

  • allows you to determine if there are too few or too many runs in your chart
  • steps:
  1. calculate the number of runs in your chart
  2. compare to the table Control charts
  • measures variation
  • identifies whether a process is in control
  • type of variation present in the process
  • a control chart consists of two parts:
  1. a series of measurements plotted in time order
  2. the control chart "template" which consists of three horizontal lines called: central line (mean), upper control limit, and the lower control limit Interpreting a control chart
  • data that fall outside the control limits or display abnormal patterns indicate special cause variation
  • data that fall randomly between the upper and lower control limits represent common cause variation/stable process Control chart - attribute data
  • count or classification data (data is counted not measured)
  • can be counted and plotted as discrete events
  • discrete event: a whole number when collected (e.g. number of errors)
  • includes: counts or percentages, defective units, number of defects Defective unit A unit fails to meet a standard (acceptance criteria), irrespective of the number of defects defect a failure to meet one or more of a set of criteria