leadership Exam #3

What is the origin of referent power

• personal traits such as likability, respect, and charisma

• people follow because they identify or admire the leader

Common sources of conflict in nursing

• poor communication

• role ambiguity

• staffing shortages/ workload

• limited resources

• interpersonal issues

Collaboration

• win-win

• both sides fully satisfied (best solution)

Compromise

each side gives up something (partial satisfaction)

Behavioral signs of integration

• flattery

• agreeing excessively

• favor-doing

What is the purpose of integration

gain favor, approval, or influence others

Nurses power-centrality

• being essential to workflow

• ex: nurses coordinate care—> high centrality= high influence

Indirect costs of organizational change

• decreased morale

• turnover

• reduced productivity

• resistance to change

What are the positive effects of conflict

• encourages innovation

• improves problem-solving

• clarifies issues

• strengthens team relationships

Conflict resolution (Quick Guide)

• avoiding —> low importance

• accommodating—> preserve relationship

• competing—> urgent decisions

• compromising—> middle ground

• collaborating—> best long-term solution

What is the continuum of care

ongoing care across settings

what is the importance of the continuum of care

• prevents gaps

• improves outcomes

• reduces readmissions

disease managment

• focuses on the specific disease

• population based

case management

• focuses on the individual patient

• coordinates total care

nurse directed care management

the nurse coordinates and plans care

self- management

patient manages their own condition

What are the functions of a case manager

• coordinates care

• resource management

• discharge planning

• cost control

• patient advocacy

What is MCR DRG

a fixed payment based on diagnosis. Instead of paying for every single service, medicare pays hospitals a fixed amount based on pts diagnosis and care category

how does MCR DRG relate to reimbursement to the hospital and length of stay

• hospital gets reimbursed

• hospitals expected to keep patients within an average length of stay for that DRG, if pt stays longer than expected, the costs increases and the hospital loses money

MCR part A

• inpatient hospital stays

• care in SNF

• hospice care

• some home health care

• no premium if paid medicare taxes

• only helps in facility or inpatient visit

MCR part B

• covers certain doctors’ services

• outpatient care

• medical supplies

• preventive services

• very expensive

• higher for higher income

• has to be paid 3 months ahead of time

MCR part C

• medicare advantage

• offered by private companies and include A, B, and D coverage at different rates, deductibles, and amount of coverage

• combination=good

MCR part D

helps cover prescription drugs (including recommended shots or vaccines only

Who is covered or eligible for medicare

• age 65+—> automatic in A+B as long as you are receiving SS benefits

• under 65 with disabilities

• specific conditions such as ALS and ESRD also qualify

Who is covered or eligible for medicaid

• low income children and adults below the federal poverty line

• pregnant women

• parents/caregivers of dependent children

• elderly 65+ with limited income

• disabled needing long-term care

ICD-10 codes

international classification of disease, tenth revision, clinical modification. its standardized system used to code diseases and medical conditions (morbidity) data

• diagnosis codes

• WHO owns and publishes

• usually 3-7 characters, starts with letter, followed by numbers, and can include more detail after a decimal

CPT codes

current procedural terminology. a set listing of terms and 5 digit codes that primarily describe medical services and procedure performed by physicians and other qualified healthcare professionals

Purpose of ICD and CPT codes

ICD codes describe why and CPT codes describe what; if they do not match payment may be denied

How does ICD-10 support DRG

• providing a diagnosis information used to assign a pt to the correct DRG for hospital payment

• secondary adjust severity and additional diagnosis may increase the DRG weight

• complications and comorbidity move the patient to a higher-paying DRG

most profitable services in health care reimbursement

• elective surgeries

• diagnostic imaging

• cardiac cath and interventional cardiology

• outpatient procedures

• specialty services with high volume (ophthalmology)

Least profitable services in health care reimbursement

• Ed care

• trauma services

• burn units

• intensive care for complex illnesses

• behavioral health and psych

• long hospital stays with complications

• care for uninsured and underinsurd

What is the staffing pattern or matrix based on

• staffing pattern- lists total number of direct care staff

• pt acuity

• pt census

• level of care

• skill mix

• unit workload

• regulatory/organizational guidelines

What staffing issues are associated with pt safety issues and/or poor-quality outcomes

• understaffing

• high pt to nurse ratios

• poor skill mix

• inadequate orientation or training

• high turnover

• excessive overtime/fatigue

• inadequate support staff

How is scheduling defined

process of determining a set number and type of staff for a future time period by assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time. staff are assigned shifts.

self-scheduling

when staff members choose their own shifts within guidelines then a manger reviews and finalizes the schedule

What is the purpose and makeup of a staffing pool

a group of nurses who supplement the core unit staffing. this includes PRN, agency, float pool, seasonal, travel and part-time nurses

What factors indicate that staffing effectiveness has been achieved

• better RN staffing—> reduced patient mortality, enhance outcomes and improve nurse satisfaction

Patient acuity

severity of the physical and psychological status of the pt, while the intensity attribute of acuity indicates the nursing care needs and the corresponding workload required

Patient classification systems

aimed at adjusting staffing for acuity have been plagued with the inability to accurately and reliably measure pt care variability. they lack organizational credibility and added documentation burden to the direct care nurses.

What are the three pt classification/acuity measurement methodologies

• prototype tools- system does not accomodate the rapidly changing needs of pts throughout thee day

• summative task tools- nurses multitask a lot and this is difficult to quantify

• care interaction tools- accepts that the pt care is greater than thee um of its parts

Variable staffing

units are staffed below maximum workload conditions and staff is then supplemented when needed

Fixed staffing

staffing is built around aa fixed projected maximum workload requirement, and the staffing pattern is based on maximum workload conditions

FTE for budgeting

• full time equivalent- represents the number of paid staff positions based on a full time horse

• used to calculate salary costs and staffing budgets, focuses on how many positions the unit can afford

TFE for quality improvement

• threshold for evaluation

• predetermined performance limit used to monitor quality, safety, or risk. it acts as a trigger to initiate an investigation or corrective action when performance falls below or exceeds set standard

Revenue

income or amounts owed for purchased services or goods. total operating expenses are the result of summing the costs of all resources used to produce services (before expenses are deducted)

Expenses

the costs or prices of activities

Income

aka profit, the excess revenues over expenses, or revenues minus expenses

Reasons staff nurses should be involved in budget planning and financial performance review

• budget variances should be shared at unit meetings to enhance the nursing staff’s awareness of the unit’s financial performance

• provides opportunity to suggest cost saving strategies

What is the typical timeframe for many hospitals’ operating budgets and what is this year called

• operating budget- annual plan for the units daily functioning revenue and expenses for a single year.

• fiscal year

What factors influence margin

• income expressed as a percentage

• staffing and labor costs

• pt acuity and case mix

• reimbursement and payer mix

• quality outcomes and pt safety

• length of stay

• resource utilization

• operational efficiency

• external market

Ways that nurses can show fiscal responsibility in the care of patients

• ability for the nurse manager to plan, manage, and use financial resources wisely

• staff time

• staff assignments

• discharge planning

• costs of human resources

• professional growth and development

Purpose of capital budget

financial plan used to allocate money for long-term investments ( things that will last more than one year and support operations over time)

What is a variance report and when is this required

• provides factual accounting of pt safety incident or adverse event to ensure that all facts surrounding the incident are recorded.

• protection of privacy of staff who reports occurrences

• reports should be received from a broad range of staff

• reports must be completed in a timely manner

• structured mechanisms must be in place for reviewing reports and developing action plans

required when?

• pt harm or potential harm

• near misses

• equipment or system failures

• safety or environmental hazards

Steps in Healthcare FMEA

• mitigation of potential hazards

• developing a plan of what to do should the event occur- planning

• reposing to the actual event- implementation

• assisting the hospital and community in the short and long term recovery that will follow- evaluation

How does CMS value-based purchasing affect hospitals?

• adjust hospital payments based on performance in key quality measures. aims to improve patient care outcomes, enhance hospital transparency, and link medicare payments more directly to the value rather than the volume of services provided

• hospitals awarded or penalized based on how well they perform of specific quality measures

• encourages higher quality safer care and promotes pt centered care

Steps in the NM developing a culture of safety

• establish a just culture: promote accountability without blame

• encourage open communication: create a speak-up environment

• promote incident reporting

• analyze errors and improve systems

• educate and train staff

• use data to drive improvement

• foster teamwork and collaboration

• standardize practices

• lead by example

• provide feedback and continuous improvement

Purpose of Sentinel Event Alerts from The Joint Commission

• identifying high risk areas

• perpetrators of violence to patients

• prevention strategies

Purpose for using a Root Cause Analysis

find the true cause and prevent the event from happening again, focus on system failure not individual blame, and improve overall pt safety and quality of care

What is benchmarking?

includes routinely comparing indicators against best performance and seeking ways to make improvements with the greatest impact on outcomes, ideally, the reference point is a demonstrated practice

What happens when data reaches the TFE

• when a performance indicator meet or exceeds a pre-set threshold, it triggers further review and action

• the data point and flagged for review and investigated by leadership.

Principles of Just Cause environment

• balance accountability and learning

• no blame system for errors

• accountability for reckless behavior

What is risk adjustment and why is it used

• accounts for pt factors, such as the intrinsic risks that a pt brings to the health care encounter in the form of clinical or demographic factors, before drawing conclusions about the meaning of different values of indicators

• ensures providers are paid more for higher-risk, sicker patients and less for healthier ones. mitigates incentives for insurers to cherry pick healthy enrollees

3 aspects of quality according to Donabedian, and which is the most common place for quality analysis

• structure- what do we have?

• process- what do we do?

• outcomes- what happened to the pt?

• process is the most frequent focus

Difference between outcomes research and quality management

• outcome research- studies result of care and effectiveness of patient outcomes

• quality management- improves care processes and standards of care

Definition of an indicator

measurable element of performance

Which agency requires collection of data to measure performance

the joint commission

Difference between evidence-based practice and practice-based evidence

• EBP- method of care that uses the best available research to guide clinical decisions, combined with clinical expertise and pt references

• PBE- a method of care that collects and uses data from real-world practice to guide improvements and generate evidence

Be able to select when a TFE has been met and further evaluation is needed

• know the threshold

• observe is the data is at or above threshold

• investigate cause

• develop and implement interventions

• monitor for improvement