Chapter 2 Quality and Safety: Quality Improvement and Customer Satisfaction in Healthcare

Question 1 of 6

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Which factor differentiates the unique focus of risk management from other quality activities?

Prevents severe harm
Risk management focuses on protecting the organization from malpractice and other financial claims but does not directly prevent harm.

Incorrect

Correct

Prevents damage to the organization
Risk management identifies and attempts to mitigate situations that put the organization’s finances or public image at risk.

Removes unsafe clinicians
Risk management is focused mainly on the organization’s well-being. Removing unsafe clinicians is a function that is shared in risk and quality activities.

Fulfills requirements of The Joint Commission (TJC)
Risk and quality management programs both work to achieve TJC National Patient Safety Goals, but that is a similarity and not a difference.

Question 2 of 6

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Which manager’s recommendation would likely face resistance from the nursing staff?

Better staffing ratios are associated with decreased mortality.
Advocacy for better nurse-to-patient ratios will likely be met with support from nurses who are accustomed to the nursing shortage.

Correct

Twelve-hour shifts will increase errors due to fatigue.
Twelve-hour shifts and the associated 3-day workweek are popular among nurses, and proposals to eliminate the 12-hour option for safety will be met with some resistance.

Nurses must function at top of license and avoid work that can be delegated.
Advocating for nurses to do the work they were trained to do is a popular recommendation that nurses will support.

Nurses must use their vacation time to avoid burnout.
Vacation time is difficult to grant when staffing is low, but the decision to encourage the use of vacation time will be embraced by nurses.

Question 6 of 6

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To effectively promote diversity, which intervention would the manager take?

Mandating staff’s respect for cultural differences
Culture is deeply ingrained, so simply telling staff to respect other cultures is not likely to be effective.

Correct

Inviting a culturally different patient to speak at a staff meeting
Having a patient speak about their experience is effective because it helps nurses become aware of the feelings and difficulties the patient experienced during their care.

Providing staff lists of common cultural differences
Lists of differences may not be effective in promoting diversity because it is difficult to apply one list to any given culture.

Including cultures of admitted patients during the morning report
Culture may not be obvious, so nurses must be aware and integrate culture into their assessment. Simply reporting a patient’s culture is not likely to give enough information.

Question 3 of 6

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Which strategy is used by nurses to prevent events leading to permanent disability of a patient?

Instituting a zero-tolerance policy for errors
Zero-tolerance policies deal with behaviors that are not allowed. They cannot be applied to errors which are not avoidable.

Correct

Designing processes that anticipate adverse events and protect patients
Implementing measures to anticipate complications and reduce harm, such as requiring reversal agents at the bedside during sedation, is the best strategy for nurses to prevent disability.

Performing root cause analysis after events that result in severe patient harm
Root cause analysis occurs after harm has occurred, so it is not a good strategy for prevention.

Avoiding performing interventions that pose risk to the patient
Most nursing and medical interventions pose some risk to patients and cannot be avoided.

Question 4 of 6

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Which nurse’s action enhances quality improvement efforts?

Educating staff on handoff procedures for helicopter transport occurring two to three times per year
This is a high-risk procedure but occurs rarely, so there is little impact if the nurse focuses on it as an improvement opportunity.

Correct

Reinforcing education for emergency transport to ICU that occurs once or twice times per week
Transfers to the ICU are relatively frequent and potentially high-risk and thus would have a strong impact on nurses and patient safety. This is the most appropriate area on which to focus improvement efforts.

Providing education for post-mortem care that is performed once or twice times per month
Post-mortem care is a low-risk procedure and will not be an impactful area to focus improvement efforts.

Inservice organ donation procedure that occurs one to three times per year
Organ donation is important to do correctly but is an extremely low-volume procedure, which would not be best for improvement efforts since education will be forgotten between events.

Question 5 of 6

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To compensate for healthcare disparities, which group would need the most support?

Russian immigrants who speak limited English
Limited English proficiency is easily overcome with today’s technology, allowing almost any language to have a qualified translator on demand.

Correct

Non-English–speaking Guatemalan refugees with a 4th-grade education level
A combination of not speaking English and having a low education level, along with refugee status, means that this group would most need support since they may not know how to access healthcare and need resources to understand their condition and treatment.

Iranian immigrants reluctant to seek care due to discrimination
Reluctance to seek care may improve over time with positive interactions, so this group is not in the greatest need of support.

Haitian immigrants seeking care only after home remedies have failed
Using home remedies may cause this group to present with more advanced conditions, but the support they require is less than other groups with multiple barriers.