HCA 333 1st Edition Exam # 1 Study GuideLecture 1 (1-28)Chapter 1 What does the industry want?Industry wants safer patients and less errors.What are examples of different opinions on how to attain the goal?Different opinions include stronger laws, more data collection, more mandated reporting, complete redesign of the delivery system and others.What are Key Indicators of success?Indicators of success include – buy in from leadership, buy in from staffWhat are some obstacles to strengthening patient care through more reporting and data collection?Obstacles = litigation, disciplinary action etc.The Institutes of Medicine recommendations:Why create a “Center for Patient Safety” within the Agency for health Care Policy & Research?Set national goals, track progress, and issue annual report to the President and Congress. Develop knowledge and understanding of errors and evaluate methods of identifying and improving patient safety.What are the benefits of a national mandatory reporting system?Identify and designate an entity that is held responsible for promulgating and maintaininga core set of standards to be used by states. Health care organizations would be required to report standardized information. Provide funding & technical support/expertise.How should Congress use the reported information?Congress should only use it for improving safety and quality.What should health care providers do to demonstrate a greater focus on safety and quality?Providers should be mandated to implement meaningful patient safety programs with defined executive responsibility.What should public and private purchasers do to improve safety and quality?Purchasers should provide incentives What should professional societies and licensing bodies do to improve safety and quality?Societies and licensing bodies should incorporate safety and quality into credentialing processes. Also, develop curriculum and classes promoting safety etc.What should the FDA do?FDA should focus on drugs: labeling & packaging, naming, & post marketing surveillance to protect safety of patients.How can health care organizations/professionals demonstrate their commitment to patient safety?HC orgs should have established formal programs; clear vision and attention, Non-punative systems for reporting, incorporate well-understood principles, & establish interdisciplinary team trainings that incorporate the previous.What else could orgs do?Implement proven medication safety programs.Chapter 2What is “Crossing the Chasm”A report b the IOM where a committee created on the behalf of Health Care quality describes problems in healthcare and changes needed.What are the 15 priority conditions? 1. Cancer2. Diabetes3. Emphysema4. High Cholesterol5. HIV/AIDS6. Hypertension7. Ischemic heart disease8. Stroke9. Arthritis10. Asthma11. Gallbladder disease12. Stomach ulcers13. Back problems14. Alzheimer’s and other dementia15. Depression & AnxietyWhat are the priority conditions based on?1. Volume2. Cost3. RiskChapter 6 – Why are we interested in Patient Safety Now?Errors causing harm to patient safety go back almost 100,00 years.Why is accurate counting extremely difficult?Costs. There are legal, cultural and administrative barriers to reporting.How should these errors be addressed?Systemic Inclusion based on self collected data.Finding the Root Cause of the ErrorWhen punitive measures don’t appear to workLecture 2 (2-4)Chapter 14Cancer Patient Story  Goeltz took it upon herself ot be creative and informed regardingthe treatment optionsChapter 15Functional Illiteracy definition:Illiterate but able to survive in societyWhat is the connection between low health literacy & utilization of health care services?Lover the Literacy the higher the utilizationHow does one assess literacy?TOFHLA (Test of functional health literacy)How is literacy addressed by legislation?Title VI (Civil rights act & then accreditation)Chapter 27What contributes to suboptimal performance?– Lack of knowledge– Lack of skill– Results of health related issues (mental & physical)Why is it difficult for organizations/people to respond to poor performance?– Difficulty of detection– Organizational barriers– Supervisory barriersEconomic barriersLecture 3 (2-11)Chapter 4What is “Organizational Development”?– Planned Approach to implementing organizational change that emphasizes the need to integrate individual needs with organizational goals.What is The Burke-Litwin model of Organizational Development (OD):– A coordinated application of top-down & bottom-up interventions which allows participants to see changes quicklyWhat are the attributes of the Burke-Litwin Model?– External environment – examples?– Organizational Culture of communication– Managerial Practices – to reduce complexity– Individual and organizational performances – align incentivesAttributes of Leadership?– Scanning environment– Creating a culture– Aligning staff around safety– Accept accountabilityChapter 11Attributes of High reliability Organizations?– Flexibly structured– Reliability over efficiency– Rewards – Acknowledgement of risk– Valid and reliable sense making– Heedfulness of individual players– Migrating decision making– “Big Picture” sense of what is going on– Redundancy – multiple parties can catch mistakes– Formal rules and procedures– Lots of trainingChapter 18Skills required to be effective?– Leadership & Management of multi-disciplinary groups– Knowledge:• Regulation• Financing• Information systems• Organizational culture• Process knowledge – purpose – root cause analysisWhat is success?– Every member is of an organization is involved in CQIChapter 20• What is driving the changes in measuring quality in medicine? – Complexity• Treatments• Drugs• Organizations• # of patients• What was the historical role of the physician and what is it today?– Was = Absolute leader– Today = Less direct control and part of a complex team• What are the systemic changes?– Credentialing & Privileging processes– Assessment of clinical performance• Peer review• Electronics– “Catching” impaired physicians– Ways to deal with “disasters”• Keys to systemic redesign:– Early involvement of stakeholders– Clear and compelling incentives for stakeholders– Mitigating the negative effects of electronic systems– Clear understanding of how information collection/use