leadership - Achiever Papers

Chap 15
Describe the sequential steps in staffing—why are these important to know?
Discuss the factors affecting staffing needs, particularly those around nursing shortages
What type of nursing staff should leaders plan to hire—why is this important to patient care?
Name factors that affect nurse recruitment
Define nurse retention and describe its importance to overall health of an organization
Turnover—describe the good, the bad and the ugly of this important factor in nurse staffing
Compare and contrast the structured vs unstructured interview process
Describe the advantages of using a team approach to interviewing candidates
What is unconscious bias and how does it affect the hiring process?
Name/define two aspects that define the hiring process
Name 5 common job interview mistakes that you are most worried about for yourself (or have done at some point)
Name 5 tips that help applicants during job interviews—which ones will serve you best as you anticipate job interviews?
What specific questions may not be asked on a job interview?
Describe one behavioral type interview that you can expect to see in an interview—how will YOU answer it?
Define the induction and orientation phases of employment
Chapter 16—Educating and Socializing Staff in a Learning Organization
Define a learning organization
According to Senge’s model, what are the key characteristics of the learning organization?
Compare and contrast the concepts of training vs education
In adult learning theory, define pedagogy an andragogy—what are the differences and similarities?
Define social learning theory and name three learning concepts that contribute to learning success
Describe barriers to adult learning
What characteristics support adult learning?
Describe the three most important reasons for staff development
Define the sequence for developing an educational program
How do you determine that learning has occurred in staff development?
Name and describe five strategies for promoting evidence-based practice in nursing
What are the principle tenets of socialization in nursing?
Who benefits from resocialization and why is it important to nurse managers?
What is the role of a preceptor?
Describe the mentoring characteristics
Why is it important to monitor for group norms? What are the risks when there are behaviors outside the norms?

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Chap 23—Quality Control in Creating a Culture of Safety

What is quality control and what is its importance to healthcare?
Describe the functions of management as it relates to quality improvement.
What criteria define Effective Quality Control programs?
Define the three steps associated with the Quality Control Process?
Define the steps in auditing Quality Control
What are the standards associated with Quality Control?
What role does the ANA play in quality control?
Define Benchmarking and its role in an organization’s approach to quality control/improvement
What is a Root Cause Analysis (RCA)?
Name three standardized nursing measures—what do they measure and how does this contribute to quality control?
What are the nursing-sensitive outcomes? Give 3 examples.
What are clinical practice guidelines and what does EBP have to do with them?
Define Quality Assurance and its evolution to Quality Improvement—what is the difference?
What are the main features of the Total Quality Management (TQM) system?
Why is the Toyota Production System (TPS) valuable as a tool for healthcare quality?
The Joint Commission (TJC) has much to say about quality improvement in healthcare. Define and name TJC Core Measures
TJC—National Patient Safety Goals—name 3 current NPSGs
Define and describe the role of TJC in accreditation of healthcare facilities
The Centers for Medicare and Medicaid Services (CMS)—how do their standards influence healthcare outcomes?
What is the mnemonic HEDIS? What is its mandate for healthcare quality?
What is the mnemonic HCHAPS? What does it measure that is important to patient care?
What is the “Just Culture” system and how does it work to decrease medical errors?
Define strategies to prevent medical errors—name examples of errors that have been addressed
What are Leapfrog Initiatives?
What is the Six Sigma Approach and its relationship to quality improvement?

Chapter 15
Employee Recruitment,
Selection, Placement, and Indoctrination

Learning Objectives
1. Identify variables that impact an organization’s ability to recruit candidates successfully for job openings (Text p 377 & 379)
2. Delineate the relationship between recruitment and retention (Text p 383)
3. Describe interview techniques that reduce subjectivity and increase reliability and validity during the interview process (Text p 384-86)
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Learning Objectives
4. Develop appropriate interview questions to determine whether an applicant is qualified and willing to meet the requirements of the position
5. Differentiate between legal and illegal interview questions
6. Select appropriate activities to be included in the recruitment, selection, placement and indoctrination of employees (Text 392-400)
*Orientation to the Institution, To the Unit (ATI p 10) (Text 400-402)
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Staffing—The Third Phase of the Management Process #1
In staffing, the leader-manager recruits, selects, orients, and promotes personnel development to accomplish the goals of the organization.
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Staffing—The Third Phase of the Management Process #2
Staffing is an especially important phase of the management process in health-care organizations because such organizations are usually labor intensive (i.e., many employees are required to accomplish organizational goals).

Sequential Steps in Staffing #1
Determine the number and types of personnel needed to fulfill the philosophy, meet fiscal planning responsibilities, and carry out the chosen patient care delivery system selected by the organization.
Recruit, interview, select, and assign personnel based on established job description performance standards.
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Sequential Steps in Staffing #2
Use organizational resources for induction and orientation.
Ascertain that each employee is adequately socialized to organization values and unit norms.
Use creative and flexible scheduling based on patient care needs to increase productivity and retention.

Factors Affecting Staffing Needs #1
Source of nursing pools
Number of students enrolled in local nursing schools
Usual length of employment of newly hired staff
Patient care delivery system in place
Knowledge level of
needed staff
Budget constraints
Times of high patient
census
Peak staff resignation
periods
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Factors Affecting Staffing Needs #2
Historically, when the economy improves, nursing shortages occur. When the economy declines, nursing vacancy rate decline as well.

Factors Affecting Staffing Needs #3
Numerous factors are contributing to significant future nursing shortages, including the aging of the nursing workforce, accelerating demand for professional nurses, inadequate enrollment in nursing programs of study, and the aging of nursing faculty.
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Factors Affecting Staffing Needs #4
Leaders should seek to proactively recruit and hire staff with age, gender, cultural, ethnic, and language diversity to better mirror the rapidly increasing diversity of the communities they serve.

Seeking Employee Diversity
Diversity also brings new perspectives to thinking and problem solving.
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Recruitment
The process of actively seeking out or attracting applicants for existing positions
Should be an ongoing process
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Factors That Affect Recruitment
Financial resources
Adequate nursing pool
Competitive salaries
The organization’s reputation
The location’s desirability
The status of the national and local economy

Recruitment Methods
Advertisements
Career days
Literature
Word of mouth by satisfied employees

Recruitment and Retention
Recruitment is not the key to adequate staffing in the long term. Retention is, and it occurs only when the organization is able to create a work environment that makes staff want to stay.
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Turnover
Some turnover is normal and in fact desirable.
It infuses the organization with fresh ideas and reduces the probability of groupthink.
However, excessive or unnecessary turnover reduces the ability of the organization to produce its end-product and is expensive.

Interviewing as a Selection Tool
The most common method for employee selection used by managers
Also the most time-consuming and thus one of the costliest selection tools
It generally requires an interviewer to use judgments, biases, and values to make decisions based on a short interaction with an applicant in an unnatural situation. Thus, reliability and validity are always suspect

Purposes of the Selection Interview #1
The interviewer seeks to obtain enough information to determine the applicant’s suitability for the available position.
The applicant seeks to obtain adequate information to make an intelligent decision about accepting the job, should it be offered.
The interviewer seeks to conduct the interview in such a manner that, regardless of the interview’s result, the applicant will continue to have respect for and good will toward the organization.

Purposes of the Selection Interview #2
The structured interview is a much better predictor of job performance and overall effectiveness than the unstructured interview.

Reliability and Validity Issues of the Selection Process
Validity increases with a team approach.
Negative information tends to be weighed more heavily than positive information.
The same standards should be used for all applicants.
Selection should be based on established criteria, not value judgments.
Personal bias should be minimized because negative feelings likely have no relation to the criteria necessary for success in the position.
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Limitations of the Interview Process as a Selection Tool #1
Subjectivity can never be totally eliminated.
High interview assessments
do not necessarily correlate
with high-level performance
on the job.
Mixed reliability and validity
Intrarater reliability high
Interrater reliability low in
unstructured interviews
Interrater reliability is better if interview is structured and same interview format is used by all interviewers.
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Limitations of the Interview Process as a Selection Tool #2
Negative information about the applicant
is weighed more heavily than positive information, and the earlier in the interview, the greater the negative effect.
Most decisions about the applicant are made in the first 30 to 60 seconds.

Limitations of the Interview Process as a Selection Tool #3
In unstructured interviews, the interviewer generally does most of the talking. In structured interviews, the interviewer talks less.
The environment is artificial, and it is difficult for many interviewees to relax and be natural.

Limitations of the Interview Process as a Selection Tool #4
The interviewer may have poor communication skills and be unable to generate a discussion.
Physical appearance often contributes substantially to an interviewer’s opinion about an applicant.
Interviewers frequently ask questions that demonstrate a self-fulfilling prophecy regarding their first impression of the applicant.

Limitations of the Interview Process as a Selection Tool #5
The major defect of the interview is subjectivity.

Overcoming Interview Limitations
Use a team approach.
Develop a structured interview format for each job classification.
Use scenarios to determine decision-making ability.
Conduct multiple interviews.
Provide training in effective interviewing techniques.

Suggested Interview Format
Introduce yourself and greet the applicant.
Make a brief statement about the organization and position and clarify the position for which the person is applying.
Discuss the information on the application and seek clarification or amplification as necessary.
Discuss employee qualifications and proceed with structured interview format.
If applicant is qualified, discuss the position further.
Explain hiring procedures
Terminate the interview.
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Two Aspects That Carry the Most Weight When Making Hiring Decisions
The requirements of the job
Qualified versus overqualified
Personal bias
Examine any
negative feelings occurring in the
interview for
personal bias.
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Common Job Interview Mistakes of Applicants #1
Arriving so early you appear overanxious
Saying too much
Wearing a coat/hat during the interview
Wearing psychologically intimidating colors or patterns
Sitting down before the interviewer does or addressing the interviewer by his or her first name
Asking about salary, vacation, or promotions too early in the interview
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Common Job Interview Mistakes of Applicants #2
Bad-mouthing or revealing confidential information about a former or current employer
Not having any questions
Overstating your accomplishments
Having a “what can you do for me?” attitude
Being vague, rambling, or evasive; all show poor communication skills
Lacking clear direction regarding what you want in your career
Showing apathy or lack of motivation

Tips for the Applicant During the Interview #1
Avoid a bad first impression!
Don’t be late.
Don’t avoid eye contact.
Avoid a cold, clammy handshake.
Don’t sit down until the interviewer does.
Don’t fidget with personal belongings.

Tips for the Applicant
Do your homework about the organization you are applying to.
Practice the interview and rehearse answers to foreseeable questions about your education and experience.
Be prompt on the day of the interview.
Look your best for the interview. Dress conservatively and make sure you are neatly groomed.
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Tips for the Applicant During the Interview #2
Do not slouch or fidget.
Do not chew gum or smoke cigarettes.
Bring a paper and pencil to take notes.
Answer the questions with confidence and watch the interviewer for nonverbal cues.

Practice Interview Questions
Why do you want this job?
What is your philosophy of nursing?
What strengths and weaknesses do you bring to this job?
Why should we hire you? Why us?
What is your 20-year career plan?
Can you define professionalism in nursing practice?
What do you know about our organization?
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Illegal Interview Inquiries
Age
Marital status
Children
Race
Sexual preference
Financial or credit status
National origin
Religion

After the Interview #1
Send a thank-you note to the interviewer.
If offered the job, send a formal letter accepting or rejecting the job.
Personally critique the interview experience. Review in your mind what you did well and what you would do differently the next time.
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After the Interview #2
Selection should be based on the requirements necessary for the job; these criteria should be developed before beginning the selection process.

Placement
The astute leader is able to assign a new employee to a position within his or her sphere of authority where the employee will have a reasonable chance for success.
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Phases of Employee Indoctrination
Induction: includes all activities that educate the new employee about the organization and employment and personnel policies and procedures
Orientation: teaches activities that are more specific to the position
Individual orientation to each department: Specific departments are responsible for developing their own orientation program.
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Chapter 16
Educating and Socializing
Staff in a Learning
Organization

Learning Objectives
1. Differentiate between education and training (Text p 413-14)
2. Select an appropriate sequence of events for educational planning (ATI p 11) (Text 418-20)
3. Identify problems that may occur when the responsibility for staff development is shared (Text p 420)
4. Select appropriate educational strategies that facilitate learning in a variety of situations (Text p 420)

Learning Objectives
5. Discuss criteria that should be used to evaluate staff development activities (ATI p 11—Staff Education)
6. Demonstrate knowledge of the needs of the adult learner and describe teaching strategies that best meet his or her needs (Text p 415)
7. Apply principles of social learning theory (Text 415-16)
8. Identify strategies that could be used to help staff deal successfully with role transitions (ATI p 11—Nursing Ability) (Text p 273/Chap 11—Benner) (Text 420-424)
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Learning Objective
9. Describe strategies that could be used to assist the new graduate nurse with socialization to the nursing unit (ATI p 11—Socialization) (Text p 421)
10. Contrast the roles of mentor, preceptor and role model (Text 424-26)
*Competence (ATI p 11) (Text 418)
* Staff Education (ATI p 10) (Text 418)
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Philosophy of Learning Organizations #1
The learning organization (LO) promotes a shared vision and collective learning in order to create positive and needed organizational change.
Collective learning goes beyond the boundaries of individual learning and releases gains for both the individual and the organization.
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Philosophy of Learning Organizations #2
A premise of the learning organization is that learning itself enhances the team.

Key Characteristics of Senge’s Model of LOs
Systems thinking
Personal mastery
Team learning
Mental models
Shared vision
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Training Versus Education #1
Training may be defined as an organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job.
Education is more formal and broader in scope than training. Whereas training has an immediate use, education is designed to develop individuals in a broader sense.
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Training Versus Education #2
Managers and education department staff have a shared responsibility for the education and training of staff.

Learning Theories
Adult learning theory (Knowles, 1970): Pedagogy versus andragogy
Social learning theory (Bandura, 1977): learning from interactions with others in a social context
Other learning concepts: readiness to learn; motivation to learn; reinforcement; task learning; transfer of learning; span of memory; chunking; knowledge of results
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Implications of Knowles’s Work for Trainers and Educators #1
A climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn.
Adults enjoy taking part in and planning their learning experiences.
Adults should be involved in the evaluation of their progress.
Experiential techniques work best with adults.
Mistakes are opportunities for adult learning.
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Implications of Knowles’s Work for Trainers and Educators #2
If the value of the adult’s experience is rejected, the adult will feel rejected.
Adults’ readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem).
Adults need the opportunity to apply what they have learned very quickly after the learning.
Assessment of need is imperative in adult learning.

Obstacles to Adult Learning
Institutional barriers
Time
Self-confidence
Situational obstacles
Family reaction
Special individual obstacles
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Assets for Adult Learning
High self-motivation
Self-directed
A proven learner
Knowledge experience reservoir
Special individual assets

Chunking as a Learning Strategy
Chunking refers to presenting two independent items of information and grouping them together into one unit.
Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses.
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Three Reasons for Staff Development
To establish competence
To meet new learning needs
To satisfy interests the staff may have in learning in specific areas
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Sequence for Developing an Educational Program
Identify the desired knowledge or skills that the staff should have.
Identify the present level of knowledge or skill.
Determine the deficit of desired knowledge and skills.
Identify the resources available to meet needs.
Make maximum use of available resources.
Evaluate and test outcomes after use of resources.
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Evaluation Criteria for Staff Development Activities
Learner’s reaction
Behavior change
Organizational impact
Cost-effectiveness

Evidence-Based Practice
Facilitating evidence-based practice is a shared responsibility of the professional nurse, the organization, leader-managers, and the education or staff development department.
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Strategies for Promoting Evidence-Based Practice #1
Develop and refine research-based policies and procedures.
Build consensus from the interdisciplinary team through development of protocols, decision trees, standards of care, institutional clinical practice guidelines, etc.
Make research findings accessible through libraries and computer resources.
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Strategies for Promoting Evidence-Based Practice #2
Provide organization support, such as time to do research and educational assistance to teach staff to interpret research statistics and use findings.
Encourage cooperation among professionals.
When possible, hire nurse researchers or consultants to assist staff.
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Socialization #1
Learning the behaviors that accompany each role by instruction, observation, and trial and error
Involves a sharing of the values and attitudes of the organization
Creates a fit between new staff members and the unit by introducing them to the norms of the group

Socialization #2
The first socialization to the nursing role occurs during nursing school and continues after graduation.

Resocialization
Occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes in the type of work they do, in the scope of responsibility they hold, or in the work setting itself

Role Change
Organizations often fail to address socialization problems that occur in job, position, or status changes.
Role overload occurs when the demands of the role are excessive.

Team Building via Role Models, Preceptors, and Mentors
These roles help to clarify role expectations through the use of social interaction and educational processes.
Each role has a different focus and uses different mechanisms.

Role Models
Behavior you want to emulate
May be a passive or nonexistent relationship
A person can have many role models.
There is a cumulative effect.

Preceptor
An experienced nurse who provides knowledge and emotional support, as well as a clarification of role expectations, on a one-to-one basis
Effective preceptors role model and adjust teaching to each learner as needed.
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Mentoring
An in-depth supportive and nurturing relationship between an expert and a novice
Formal relationship typically lasts 2 to 5 years, with mentor being one generation older than mentee
Many nurses have limited opportunities to have a true mentoring relationship in their lives.

Phases of the Mentoring Process
Exploring whether to begin a mentoring relationship
Negotiating a mentoring agreement, with a goal(s) and deadline(s)
Implementing the agreement and periodically reviewing progress made
Summarizing and formally concluding the mentoring relationship
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Behavioral Sanctions
The bestowing of rewards and punishments
Used to show employees what behavior is rewarded or eschewed in an organization
Rarely carried out on a systematic and planned basis
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Group Norms
The manager should know what the group norms are and should be observant of the sanctions used by the group to make newcomers conform.
The manager should take appropriate intervention if group norms are not part of the organizational culture.
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Meeting the Educational Needs of a Culturally Diverse Staff
Respect cultural diversity—recognize its desirability.
Recognize different perceptions of classroom and instruction learning.

Unique Socialization Needs of International Nurses
Often experience cultural, professional, and psychological dissonance
Communication problems
Anxiety, homesickness, and isolation

Coaching
One person helping another to achieve an optimal level of performance
Tool for empowering subordinates, changing behavior, and developing a cohesive team
Emphasis on assisting the employee to recognize greater options, to clarify statements, and to grow

Chapter 23
Quality Control in Creating
a Culture of Patient Safety

Learning Objectives
1. Describe the complexity of defining and measuring quality health care (Text p 621-22)
2. Describe a systematic process (such as FOCUS PDCA) that could be used to initiate a quality improvement process (ATI p 12—Steps in the Quality Improvement Process) (ATI p 12—Quality Improvement) (Text 622-25)
3. Determine appropriate criteria or standards for measuring quality (Text p 625-26)
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Learning Objectives
4. Collect and analyze quality control data to determine whether established standards have been met (ATI p 13. Audits) )Text p 626-28)
5. Differentiate among outcome, structure, and process audits as well as concurrent, retrospective, and prospective audits (Text p 626-28)
6. Write nursing criteria for process, outcome, and structure audits (Text–Learning Exercise 23.2 p 628)
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Learning Objectives
7. Describe key components of total quality management (Continuous quality improvement) (Text p 630-31)
8. Debate the importance of articulating “nursing sensitive” outcome measured in measuring quality of health care (Text 638-39) (NDNQI website)
9. Describe the role of organizations such as The Joint Commission (TJC), the Centers for Medicare & Medicaid Services (CMS,) the American Nurses Association (ANA), and the Agency for Healthcare Research and Quality (AHRQ) in establishing standards of practice and clinical practice guidelines for healthcare organizations and healthcare professionals(Text p 633 & 633-638)
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Learning Objectives
10. Define and provide examples of sentinel events in healthcare as defined by TJC (Text p 633-34)
11. Describe the national efforts such as Health Plan Employer Data and Information Set, the National Database of Nursing Quality Indicators to standardize the collection of quality data and make that data more transparent to providers and consumers (Text 633-36)
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Learning Objectives
12. Identify the four evidence-based standards the Leapfrog Group believes will provide the greatest impact on reducing medical errors (Text p 640-42)
*ATI p 12—Nurse’s Role in Quality Improvement
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Quality Control: Fifth and Final Step of the Management Process
Activities that are used to evaluate, monitor, or regulate services rendered to consumers
Performance is measured against predetermined standards.
Action is taken to correct discrepancies between these standards and actual performance.

Management Controlling Functions
Periodic evaluation of unit philosophy, mission, goals, and objectives
Measurement of individual and group performance against preestablished standards
Auditing of patient goals and outcomes
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Hallmarks of Effective Quality Control Programs
Support from top-level administration
Commitment by the organization in terms of fiscal and human resources
Quality goals reflect search for excellence rather than minimums.
Process is ongoing (continuous).
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Three Steps of the Quality Control Process
The criterion or standard is determined.
Information is collected to determine whether the standard has been met.
Educational or corrective action is taken if the criterion has not been met.
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Standards #1
Predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced
Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care.

Standards #2
The American Nurses Association (ANA) has played a key role in developing standards for the nursing profession.

Quality Gap
The difference in performance between top-performing health-care organizations and the national average is called the quality gap. Although the quality gap is typically small in industries such as manufacturing, aviation, and banking, variation is more common in health care.
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Benchmarking #1
The process of measuring products, practices, or services against best-performing organizations
Organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement.

Benchmarking #2
Critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur.
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Audits Frequently Used in Quality Control
Structure—monitor the structure or setting in which patient care occurs
Process—measure the process of care or how the care was carried out
Outcome—determine what results, if any, followed from specific nursing interventions for patients
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Sample Standardized Nursing
Languages and Measures #1
NANDA International (NANDA-I)
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
Clinical Care Classification
System (CCC)
The Omaha System
Perioperative Nursing Data
Set (PNDS)
International Classification
for Nursing Practice (ICNP)
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Sample Standardized Nursing
Languages and Measures #2
Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)
Logical Observation Identifiers Names and Codes (LOINC)
Nursing Minimum Data
Sets (NMDS)
Nursing Management
Minimum Data Sets
(NMMDS)
ABC Codes
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Nursing Sensitive Outcomes
There is growing recognition that it is possible to separate out the contribution of nursing to the patient’s outcome; this recognition of outcomes that are nursing sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession.

Clinical Practice Guidelines
Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care
Also called standardized clinical guidelines
Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices
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Quality Assurance and Quality Improvement #1
Over the past three decades, the American health-care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI).
The difference between the two concepts is that QA models target currently existing quality; QI models target ongoing and continually improving quality.

Quality Assurance and Quality Improvement #2
Two models that emphasize the ongoing nature of QI include total quality management (TQM) and the Toyota Production System (TPS).

Total Quality Management (TQM)
Also referred to as continuous quality improvement (CQI)
Based on the premise
that the individual is
the focal element on
which production and
service depend
Focus is on doing the
right things, the right
way, the first time, and problem-prevention
planning, not inspective
and reactive problem solving.
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Toyota Production System (TPS) #1
Customer-focused quality improvement model
Production system built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible
Adopting TPS in an organization requires a substantial commitment of leadership time and resources
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Toyota Production System (TPS) #2
Quality control in health-care organizations has evolved primarily from external forces and not as a voluntary effort to monitor the quality of services provided.

Quality Measurement as an Organizational Mandate #1
The Joint Commission
ORYX
Core measures
National Patient Safety Goals

Quality Measurement as an Organizational Mandate #2
The Joint Commission is the major accrediting body for healthcare organizations and programs in the United States. It also administers the ORYX initiative and collects data on core measures to better standardize data collection across acute care hospitals.

Centers for Medicare & Medicaid Services (CMS) #1
CMS plays an active role in setting standards for and measuring quality in health care including pay for performance.
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Centers for Medicare & Medicaid Services (CMS) #2
The National Committee for Quality Assurance (NCQA), a private nonprofit organization that accredits managed care organizations, also developed the Health Plan Employer Data and Information Set (HEDIS) to compare quality of care in managed care organizations.

Centers for Medicare & Medicaid Services (CMS) #3
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. It measures recently discharged patients’ perceptions of their hospital experience.

Medical Errors #1
A plethora of studies across the past two decades suggests that medical errors are rampant in the health-care system.
Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems.
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Medical Errors #2
A “just culture” deemphasizes blame for errors and focuses instead on addressing factors that lead to and cause near misses, medical errors, and adverse events.

Strategies to Prevent Medical Errors
Better reporting of the errors that do occur
The Leapfrog initiatives
Reform of the medical liability system
Other point-of-care strategies
Bar coding
Smart IV pumps
Medication reconciliation
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Leapfrog Group Initiatives
Computerized physician–provider order entry
Evidence-based hospital referral
ICU physician staffing
The use of Leapfrog safe practices scores

Six Sigma Approach
Sigma is a statistical measurement that reflects how well a product or process is performing.
Higher sigma values indicate better performance.
Historically, the health-care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six.
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