Transitions Exam II

Quality

Ensuring the best possible patient outcomes using the most efficient methods

To Err is Human (1999)

Landmark IOM report that was a catalyst for QI in US healthcare system

Total quality management

Systematic, multidisciplinary approach to designing, measuring, assessing, & improving performance; Emphasizes customer satisfaction, engages all members of organization in QI process

Pareto principle

80% of problems caused by 20% of sources/people/ideas

Zero defects

Standard for any process should be zero defects – no amount of error is acceptable

Quality indicator

An evidence-based measure of healthcare quality

Benchmark

A standard used to classify acceptable levels of performance

High reliability organizations

High risk environments with low incidences of serious or catastrophic failures (i.e. NASA)

Human error

Miscalculation due to inexperience, forgetting a crucial step; An unintentional outcome from an incorrect choice

At-risk behavior

Actions that fall outside of the norm, but are felt to be justified by the employee; Choosing to do something not knowing or ascertaining the risk

Reckless behavior

Substantial, non-justified, and conscious disregard for safety; A decision by the professional to purposefully deviate from the normal procedure

Sentinel event

Unexpected occurrence involving death or loss of limb or function; Warrants immediate investigation and response *Never event

Near-miss

Event/error that has potential to cause harm; Does not reach the patient due to preventative measures or chance

No harm

Event/error that reaches the patient; Does not cause harm because of early intervention or chance

Just culture

Environment where staff feel it is safe to report errors/near misses

Six sigma

Method using statistics to improve efficiency of business processes

Define

The issues, possible causes, goals

Measure

The existing system with metrics

Analyze

The gap between system and goal

Improve

Implement creative strategies

Control

Sustain the improvement

Root cause analysis

Process designed for use in investigating and categorizing the root causes of events

Rapid cycle changes

Tests an idea on a small sample

PDSA

Way to examine change; Used to plan, conduct, and improve RCC tests

National performance goals

Annual goals instituted by TJC; Focuses on significant problems in healthcare safety and specific actions to prevent them

The Joint Commission

Primary agency for hospital accreditation; Only evaluates healthcare institutions

Det Norske Veritas

Risk management company originating in Norway in 1864; Accredits maritime, automotive, aerospace, power, oil, gas, & food/beverage industries in addition to healthcare institutions

Centers for Medicaid & Medicare Services

Part of Department of Health & Human Services; Oversees compliance with health & safety standards for facilities serving Medicare and/or Medicaid beneficiaries *State performs surveys yearly or every 3 yrs

Medicare

65+ years old, >65 with certain disabilities, or anyone with ESRD

Medicaid

Low-income individuals and children ineligible for private insurance

Core measures

Standardized performance measurement system that focuses on a specific diagnosis or problem area; Hospitals must meet the performance measurement standards set by CMS to be accredited *TJC has their own

Hospital Consumer Assessment of Health Plans Survey

Measures patient satisfaction; Rates communication, responsiveness, pain management, discharge teaching, cleanliness, noise, if patients would recommend

Leapfrog survey

Focuses solely on hospital safety; Participating facilities given a grade of A, B, C, D, or F by safety officer

Nurse practice act

Set of state laws governing nursing practice; Includes scope of practice for each level of nursing practice

Criminal actions

Misdemeanor or felony; Considered harmful to society as a whole

Civil action

Tort or contract; Concern private interests and rights between individuals/entities

Negligence

Most common type of unintentional tort; Duty to care, breach of duty, foreseeable harm/proximal cause, and damage/injury occurs

Self-care

The practice of engaging in activities that promote a healthy lifestyle; Reduces stress, replenishes our capacity be compassionate and empathetic, and helps improve quality of care for our patients

Burnout

A gradual loss of enthusiasm for a job followed by continued deterioration, crisis, and devastation; This ultimately leads to an inability to work effectively

Compassion fatigue

A consequence of prolonged exposure to the traumatic experiences of patients; Essentially, it is caused by our empathy

Emotional intelligence

Consists of knowing one’s emotions, managing emotions, self-motivation, recognizing other’s emotions, and navigating relationships

Being emotionally healthy means…

Being able to distinguish what one is feeling, acknowledging that emotion, and then expressing it in a way that does not harm oneself or others

Spirituality

The way in which a person seeks meaning and purpose in their relationships with family, community, society, nature, work, and self

Mindfulness

A purposeful, nonjudgmental awareness of the current moment; It could also be considered being present

Cortisol

Hormone produced under stress and controls your flight or fight response; Too much in the body too often can have negative long term health effects

Right brain

Flexible/creative

Left brain

Structured/methodical

Resilience

The capability of achieving goals in a stressful situation with minimal psychological or physical cost; It can also be described as the ability to successfully cope in the setting of adversity, or the ability to “turn challenges into opportunities and learn from demanding situations”

Civility

Caring as the focal point of practice; emphasis on emotional intelligence & empathy

Incivility

One or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them

Bullying

Repeated, unwanted harmful actions intended to humiliate, offend & cause distress; Verbal, social (includes cyber) or physical

Lateral violence

Between co-workers of equal rank (ex: staff nurse to staff nurse); Usually limited to psychological harassment

Vertical violence

Between a superior & subordinate (either direction); Involves an inappropriate use of coercive power

Workplace culture

Encompasses the values & behaviors that contribute to the unique social & psychological environment of a particular organization

Leadership

Role models for positive practice

Shared values

Builds a feeling of camaraderie and a shared interest in success

Touch points

Rewards and recognition

Peer support

Coworkers are the most likely support people on your unit

Social climate

How people treat each other is tremendously important to our emotional and physical health

Norms

Define our expectations of appropriate behavior

Politics

The use of relationships and power to influence policies and the allocation of scarce resources

Power

Having the ability to effect change and influence others

Legitimate power

Connected to a position of authority

Reward power

Power to provide or withhold rewards

Coercive power

Derived from fear of consequences

Expert power

Specialized knowledge, skills, or abilities that are recognized and respected by others

Referent power

Others closely identify with that person’s personal characteristics

Information power

Knowledge a person possesses that is needed by others to function effectively

Leadership power

Ability to create stability and calmness out of conflict, problems, and disorder

Health advocacy

The process of promoting health and access to healthcare, particularly by seeking to influence government action

Political action committee

A mechanism whereby individuals can pool their resources and collectively support a candidate; Members make voluntary personal contributions to support candidates running for federal office

Coalition

A group of individuals or organizations that share a common interest in a particular issue

Lobbying

Influencing public official to take desired action

Self-empowerment

Feeling in control of your life, having the strength to do what you believe to be in your best interest, and having confidence in your skills and abilities