Healthcare Management Concepts and Terminology, Exams of Nursing

Download Healthcare Management Concepts and Terminology and more Exams Nursing in PDF only on Docsity! CNML Test Question & Answers 204 DRGs - Correct Answers ✅Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - Correct Answers ✅Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - Correct Answers ✅Used by HMO's: insurance coverage for contracted providers or institutions HMOs - Correct Answers ✅Health maintenance organizations: comprehensive healthcare to people who pay a fee for a fixed period of time Capitation - Correct Answers ✅Fixed rate paid to provider per member per month for healthcare services; set fee paid by insurance company per month for all the patient needs PPOs - Correct Answers ✅Preferred provider organizations: special reduced rate for services when customers use certain providers approved by the insurance company; usually fee-for-service CNML Test Question & Answers 204 IPAs - Correct Answers ✅Individual provider arrangements: provide care in their offices for prepaid plans; coalition of physicians who serve HMO patients and third-party patients Fulltime FTE Hours - Correct Answers ✅2080 hours (1.0 @ 40 hours per week) Capital Expenses - Correct Answers ✅Long-term equipment or physical purchases: usually over $500-$1000 that will last years and depreciate over time and be used multiple times Zero-Based Budget - Correct Answers ✅With each new budget (i.e. fiscal year), it is determined which programs/areas get money; no historical context is used; may rank packages and then only fund top- ranked ones; can be time-consuming way to create a budget Variance Calculation & Reminders - Correct Answers ✅Variance $ /Budgeted $ X 100 = % difference; contract staff on separate line of budget; many staff sick costs more than a few staff on LOA Cost of Nursing Services Calculation - Correct Answers ✅Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total Nursing Cost per DRG CNML Test Question & Answers 204 RVU - Correct Answers ✅Relative value unit: what ancillary services might use to add up their UOS; # of hi-flows hooked up or vents started for RT., for example ALOS Calculation - Correct Answers ✅Average length of stay = # of pt. days / # of discharges (in same time period) CPUOS - Correct Answers ✅Cost per unit of service = salaries / UOS Productivity - Correct Answers ✅# of staff hours or $'s / # of UOS RN hours / patients in beds @ midnight (HOC) RN salaries / UOS Output / input Amount of work performed by a set # of staff Minimum Staffing - Correct Answers ✅Minimum staff needed to operate unit usually determined by law, hospital policy, and pt safety CNML Test Question & Answers 204 Breakeven - Correct Answers ✅Needed in order not to lose money; minimum patients needed to meet budget using minimum staffing; can't control admissions but some would work with staffing office to ensure minimum occupancy occurred Medicare - Correct Answers ✅Federal program that helps those over 65, those on dialysis/ESRD, and combines with state run Medicaid, younger people who are permanently disabled, and physician residency training EMTALA - Correct Answers ✅Emergency Medical Treatment and Active Labor Act: must treat people in ED regardless of ability to pay, citizenship, and legal status Case Mix Index - Correct Answers ✅A system that classifies patients by age, diagnosis, treatment, clinical, and financial categories to develop the reimbursement rate Productive Time - Correct Answers ✅2080 hours - Benefit hours Revenue - Correct Answers ✅Gross = $ charged Net = $ collected OE for Budgets - Correct Answers ✅Operating Expenses: salaries, supplies, rent, non-productive time, etc. CNML Test Question & Answers 204 Margin - Correct Answers ✅Difference between expenses and how much money is collected Margins down = less gross or net income Margins up = more gross or net income Workload Per Day - Correct Answers ✅Total workload hours / 365 days / 24 hours Costs in a Budget - Correct Answers ✅Fixed, variable & non- recurring (like installing new piece of equipment or 100th anniversary party for the hospital) Replacement Factor - Correct Answers ✅Adding up the benefit time because nurses don't actually work 2080 hours per year; add this to the total FTE's HCAHPS - Correct Answers ✅Hospital Consumer Assessment of Healthcare Providers and Systems: national survey asking patients how their stay was CNML Test Question & Answers 204 Landrum-Griffin Act 1959 - Correct Answers ✅Rights of union members in their unions; unions need by-laws, financials, and bill of rights; Secretary of Labor is watchdog of union contract National Labor Relations Board - Correct Answers ✅Independent board enforcing NLRC; conducts unionizing elections; investigate union/employer complaints; 5 members elected by President/Senate so politics determines how pro or anti union board is Conciliation and Mediation - Correct Answers ✅3rd party attempt to keep unions/management talking 3rd party to solve bargaining issues 7 Tests of Just Cause - Correct Answers ✅1. Notice: do employees know the rules and consequences for breaking them 2. Reasonable: necessary rule/punishment for safe, efficient operation of org 3. Investigation: looked into issue before punishment; get both sides 4. Fair and Objective Investigation: all parties and sides interviewed and considered 5. Proof: facts support the breaking of the rule 6. Equal Treatment: treat people and situations and rule-breaking in similar ways CNML Test Question & Answers 204 7. Reasonable Penalty: discipline should match the severity of the infraction; can be more lenient with employees in good and/or long standing Autocratic/Authoritarian Leadership - Correct Answers ✅Take charge; effective in short term but negatively impacts employee morale; directive, critical, and punitive; makes decisions, plans, fosters dependency Servant Leadership - Correct Answers ✅Serving put first; holistic approach with shared decision-making Leader - Correct Answers ✅Need to do the right things, challenged by change, focus on purpose, and think of the future; guide or show others Manager - Correct Answers ✅Do things right, challenged by continuity, focus on the present, consider schedules and evaluate performance Democratic Leadership - Correct Answers ✅Maintain less control; ask questions and make suggestions; group decision making and problem solving; creates independence; not as efficient as autocratic CNML Test Question & Answers 204 Laissez-Faire Leadership - Correct Answers ✅No control or plan; nondirective; uninvolved; chaos can occur; inefficient and unproductive Situational Leadership Theory - Correct Answers ✅Leadership approach should be based on staff level of development with the task Competing Values Framework - Correct Answers ✅Customize leadership style by putting Leader with that skill on that project; 4 quadrants of competing skills/focuses that leaders need to master; use different ones in different situations Transactional Leadership - Correct Answers ✅Leader sets goals for employees and then rewards; task oriented; like manager; based on hierarchy Transformational Leadership - Correct Answers ✅Promotes employee development; has vision; networks; cooperative; influence change and promote creativity; provide encouragement and support self-management; optimistic Gantt Chart - Correct Answers ✅The relationship of work planned/completed on axis and amount of time on the other; view of tasks over time; good way to track a project or work scheduled on a particular day CNML Test Question & Answers 204 Non-Directive Interview - Correct Answers ✅Winging it by asking questions based on last answer; meandering; applicant leads it; tell me about yourself Stress Interview - Correct Answers ✅Create anxiety and pressure on applicant; aggressive; needed for air traffic controller Interview Modalities - Correct Answers ✅Panel, individual, and video Keys to Effective Preceptor Programs - Correct Answers ✅Tracking system for productivity and progress Skill focused and culture/social focused Use adult learning principles Coaching and feedback Weekly check-ins Guidelines for assignments, role expectations, support Keys to Monitor & Manage Performance - Correct Answers ✅Plan: expectations communicated Track: ongoing attention to performance Review: formal eval CNML Test Question & Answers 204 SMART(S) Goals - Correct Answers ✅Specific, Measurable, Attainable, Realistic, Timely, (Strategically Linked) Corrective Action Steps - Correct Answers ✅Conference, verbal warning, written warning, suspension, termination Keys to Corrective Feedback - Correct Answers ✅Private, respectful, immediate, detailed, ends with a question to clarify understanding/expectations Hot Stove Rule - Correct Answers ✅Good discipline provides a warning, is consistent, is immediate, is impersonal (like touching a hot stove) Keys to Shared Decision-Making - Correct Answers ✅Equity, ownership, partnership, and accountability Constructive Conflict - Correct Answers ✅Change/growth occurs, problem is solved, increases involvement of those involved, builds cohesion on the team Thomas-Kidman Conflict Modes From Crucial Conversations - Correct Answers ✅Avoiding, Accommodating, Compromising, Collaborating, and Competing CNML Test Question & Answers 204 Performance Management - Correct Answers ✅Use performance improvement to focus and improve patient safety, monitor/promote workplace safety, communication with intra and inter departments LEAN - Correct Answers ✅Focus on cutting wastes flow of organization, push/pull system, and what customer really wants; process focused CQI - Correct Answers ✅continuous quality improvement with lots of ideas on the table and using data that test/refine process; incremental improvement PDC(S)A - Correct Answers ✅Plan, do, check (study), act; control and continuous improvement DMAIC - Correct Answers ✅Data-driven improvement cycle; 5 phases for problem solving; define, measure, analyze, improv, control Six-Sigma - Correct Answers ✅Minimizes variation and reduces error rates by getting rid of defects Histogram - Correct Answers ✅Bell curve graph showing where/when most issues occur CNML Test Question & Answers 204 because they care about quality/mission/QI; commitment to quality, empowering employees, using facts to make decisions, continuous improvement, and focusing on customers - multi-disciplinary; lots of perspectives Systems Theory - Correct Answers ✅Idea that behavior and actions are related to the system so errors are related to the system too; must understand how the parts of a system relate to each other Learning Organization - Correct Answers ✅Change, adaptation, and learning are foundations of a workplace culture Kuhn Theory on Change - Correct Answers ✅People resist change who are more closely tied to the history; people want to do things the way they are used to doing them Words Absorbed with Communication - Correct Answers ✅Only 7% of communication is the words! Running Effective Meetings - Correct Answers ✅Determine what should be face-to-face; have a value-added agenda; keep it short if not a lot on the agenda; get employee input on agenda items; specific items; stick to time CNML Test Question & Answers 204 Optimists and Change - Correct Answers ✅They reframe change events as opportunities to try something new, rebuild, or understand that they have succeeded in the past so will again Bridges' Ending Phase of Change - Correct Answers ✅Something new is coming so staff mourn what they will leave behind; managers should spend time listening and give info to staff as they adjust Bridges' Beginning Phase of Change - Correct Answers ✅Just go out and start! Bridges' Neutral Zone of Change - Correct Answers ✅Staff anxieties rise, motivation falls, old weaknesses emerge; communication suffers Effective Teams - Correct Answers ✅Based on trust, embrace conflict, committed, accountable, and pay attention to results Disruptive Innovators - Correct Answers ✅Staff who introduce new ideas, products, or processes for improvement but disrupt current flow/equilibrium Keys to Rapid Change - Correct Answers ✅Can you put some changes off? Create a transition team CNML Test Question & Answers 204 Keys to Morale Issues - Correct Answers ✅Get Shared Governance; ask employees; walking rounds with staff (walking rounds or rounding for outcomes) Stages of Team Conflict - Correct Answers ✅Forming, storming, norming, and performing Disaster Training - Correct Answers ✅Staff at front-line need to know how to deal with crisis in the moment Stages of Situational Leadership - Correct Answers ✅Directing, Coaching, Supporting, and Delegating Occupational Safety & Health Administration (OSHA) - Correct Answers ✅Develops standards, creates regulations, inspects for compliance, and cite noncompliance of work healthy & safety; federal agency; work places must keep records of illnesses/accidents & report them Workarounds - Correct Answers ✅Going off policy to deliver care by problem solving o help enable work to get done in response to complex systems or time constraints; can compromise patient safety CNML Test Question & Answers 204 Facilitating Change - Correct Answers ✅Assess readiness, gather info, involve staff/stakeholders to design change process, communicate changes, support staff during change, and evaluate outcomes Lewin Change Theory - Correct Answers ✅Considered the father of social psychology; 3-stage model of change = unfreeze-change- refreeze * Unfreeze: create the "burning platform" (let go of the old/counterproductive) * Change: articulate a vision that engages (change in thoughts, feelings, behavior) * (Re)Freeze: reinforce learning & desired behaviors (change becomes new habit or standard operating procedure) Bridges' Change Theory - Correct Answers ✅Focuses on internal transition not the outward change occurring to people 1. Ending, Losing & Letting Go (lots of fear, uncertainty, and resistance as people accept that something is ending) 2. The Neutral Zone (resentment, low morale, low productivity, and anxiety but also more creativity and innovation) 3. The New Beginning (acceptance & energy, high commitment, openness to learning) CNML Test Question & Answers 204 Issues with Lewin's Change Theory - Correct Answers ✅Can't really freeze again because change is so continuous and there is not time; one criticism of the simplicity of the theory; also staff may return to old habits with changes during this phase SWOT Analysis - Correct Answers ✅Strengths, weaknesses, opportunities, and threats; used to project plan Qualitative Research - Correct Answers ✅non-numerical data; open ended questions; depth & detail of a small sample/example Jean Watson Science of Caring Theory - Correct Answers ✅Makes 7 assumptions about caring influencing patients for the better as practiced by nurses; 4 concepts of human being, health, environment/society, and nursing Ethical Principles - Correct Answers ✅Autonomy, Beneficence, Fidelity, Justice, Nonmaleficence, paternalism, respect for others, utility, & veracity Ethical Autonomy - Correct Answers ✅Freedom of choice; consent Ethical Beneficence - Correct Answers ✅Actions should promote good CNML Test Question & Answers 204 Ethical Fidelity - Correct Answers ✅Keeping commitments and promises Ethical Justice - Correct Answers ✅Treating people equally & fairly Ethical Nonmaleficence - Correct Answers ✅If you cannot do good, at least do no harm Ethical Paternalism - Correct Answers ✅Someone else makes decisions; only seen as good if it prevents harm to another Ethical Utility - Correct Answers ✅What is best for the common good outweighs what is best for the individual Ethical Veracity - Correct Answers ✅Telling the truth; informing patients and families of healthcare truth to make well-informed decisions Keys to Creativity - Correct Answers ✅Environment of trust, acceptance, and good humor; allow risks; positivity Keys to Powerpoint Presentations - Correct Answers ✅Keep is simple, put up pictures, use color well, use fonts well, and be consistent in style; avoid text heavy; add graphs and visuals CNML Test Question & Answers 204 Purposeful/Hourly Rounding - Correct Answers ✅Try to improve patient experience by rounding every hour to accomplish tasks, ask for needs, answer questions, be present, 4 p's, and assess environment Taxonomy of Learning Domains - Correct Answers ✅1. Cognitive Domain - mental skills and knowledge 2. Affective Domain - feelings, emotions, and attitudes 3. Psychomotor Domain - motor skills and coordination AACN Synergy Model - Correct Answers ✅Applying nurse competencies to patient needs: when they meet there is synergy which creates good patient outcomes and good nurse well-being Decile - Correct Answers ✅Splitting ranking into 10 points that each represent 10%; 2 would be 20% and 9 would be 90% Rogers' Stages of Innovation - Correct Answers ✅Agenda, matching, redefining/restructuring, clarifying, routinizing People react as innovators, early adopters, early majority, late majority, and laggards Thompson Change Theory - Correct Answers ✅Forming, storming, norming, performing CNML Test Question & Answers 204 Design & Implementation of Planned Changes - Correct Answers ✅1. Ample time for planning/implementing 2. Staff have necessary skills/knowledge 3. Resources needed are in place ROI Calculation - Correct Answers ✅(Cost$ - Benefit$)/ Cost$