CPHQ Quiz 4

According to the Institute of Medicine, which of the following is NOT one of the domains of
quality care?

Government regulation
Customization
Safety
Interventions consistent with the latest medical findings

In a successful lean healthcare facility, the largest costs related to quality will be incurred by…

Preventive efforts
Internal failures
Assessment programs
External failures

What is the best explanation for the relatively slow introduction of lean practices into medical
laboratories?
a. The variability and complexity of the samples in a laboratory is much higher than in

manufacturing environment
Scientists are less receptive to the core principles of lean
Medical laboratories function differently than factories
Medical research is mostly funded by the government

Which of the following is vastly different from the others?

SIPOC
DMAIC
PDCA
PDSA

In the perfect lean enterprise, delivery to the customer is…

Instantaneous
Rapid
Customizable
Optional

A hospital-wide set of professional standards is important because it…

Reduces the waste of time and resources
Eliminates bottlenecks
Encourages duplication
Minimizes the need for communication

The process chain in a laboratory is particularly subject to…

Variability
Delay
Disorganization
Conflict

Which of the following is NOT one of the typical questions in a force-field analysis?

“What do you hope to accomplish in the meeting?”
“What was bad about the meeting?”
“What was good about the meeting?”
“How can we improve meetings in the future?”

Hospitals that implement computerized provider order entry (CPOE) almost always see a
decline in…

Medication errors
Diagnostic errors
Adverse events
Latent errors

In a traditional meeting, the timekeeper and the minute-taker roles are…

Filled by different people every time
Filled by the same person
Filled by the same two people in each meeting
Filled by employees who are not required to participate in the meeting

When establishing a clinical-governance training program for the directorate, it is useful to…

Align the subject matter with the specific tasks of the audience
Eschew case studies
Emphasize the basic concepts of clinical governance
Customize instruction for each person

The protocol for ordering a medication should be…

The same every time
Customizable
Adaptable to verbal or written situations
Dependent on inventory

In a typical hospital, approximately what percentage of errors is reported?

Less than 5
Between 25 and 50
75
Between 80 and 90

During the periods with the highest incoming workload, a laboratory that has not implemented
lean practices is likely to have…

Substandard lead time performance
Diminished productivity
False positives
Selective engagement errors

During a meeting, the facilitator must intervene several times to stop disputes between
participants. Is this appropriate?

Yes, but the facilitator should stay in the background unless the progress of the meeting is threatened
Yes, the facilitator should rule in favour of one participant
No, the facilitator should never intrude upon a meeting
No, the facilitator should leave this duty to the chairperson

One consequence of the implementation of Lean Six Sigma practices in a hospital will be…

Reduction in inventory
The creation of systems for verifying orders
Reduction in staff
Reduction in manufacturing costs

The general intent of the PDSA cycle is to…

Optimize a process
Reduce bottlenecks
Incorporate new technology
Automate processes

One characteristic of the SOAP model for medical records is…

The inclusion of both subjective and objective data
The lack of a prognosis
The focus on therapeutic intervention
The absence of a differential diagnosis

After numerous staff meetings, a hospital administrator notices that one of his subordinates is
an excellent content leader. Which of the following would the subordinate be most likely to do?

Suggest amendments to the meeting agenda
Establish a tone of collegiality
Enforce rules of conduct during the meeting
Introduce new tools for examining data

As part of the implementation of lean practices, a laboratory categorizes activities as either
“value-add” or “non-value-add.” What should be done with “non-value-add” activities?

They should be minimized or, if possible, eliminated
They should be eliminated
They should be combined
They should be synchronized

A hospital uses infusion pumps to deliver intravenous medications. However, these pumps
occasionally malfunction, so a nurse is assigned to periodically monitor their operation. Is this a
good strategy?

No, because it depends on the vigilance of one employee
No, because it will distract the nurse from her other duties
Yes, because it makes one person directly responsible
Yes, because it gives the nurse a clear directive

One way to create useful alignment in an organization is to…

Base the assessment of each department on the same set of performance dimensions
Have each employee report to a single manager
Eliminate adverse drug events
. Organize interdepartmental meetings

If an at-risk patient is left unattended and has an adverse response to medication, this is known
as a(n)…

Sentinel event
Initiator
Latent outcome
Slip

The minimum practical lead time for an analytical laboratory is…

The release constraint test time for the microbiology lab
Greater than the release constraint test time for the microbiology lab
Less than the release constraint test time for the microbiology lab
Unrelated to the release constraint test time for the microbiology lab

Team paralysis is NOT a common result of…

Rigid adherence to meeting protocol
Lack of familiarity with subject matter
The failure to build consensus
An overabundance of options

A hospital’s automated pharmacy program will not fill a prescription unless the patient’s allergy
information has been entered. This is an example of…

Constraint
Natural mapping
Affordance
Standardization

One disadvantage of using separate scorecards for financial and customer satisfaction data is
that…

Administrators are likely to overvalue the financial information
Employees will become confused
There is likely to be more resource waste
It requires special training

A hospital administrator wants to determine how changes in resource allocation would affect
total profit. By manipulating a variable, for instance the number of nurses assigned to a floor of the
hospital, the administrator can calculate the difference in profit. The administrator is performing
a…

Sensitivity analysis
Risk analysis
Force field analysis
Decision analysis

A quality improvement team wants to construct a simple chart that will depict how
institutional spending and time are applied to a set of basic tasks. This chart will take the form of
a…

T-shaped matrix
L-shaped matrix
X-shaped matrix
Y-shaped matrix

At present, the best way to improve the delivery of accurate and useful information about
medication would be to…

Create a universal database of patient records
Improve the time it takes pharmacies to deliver medicine
Give patients access to their lab reports
Encourage pharmacists to visit nursing stations regularly

Which component of decision-making typically receives much less time than it deserves?

Framing
Gathering information
Drawing conclusions
Voting

A health care facility has eleven wheelchairs. The likelihood that a wheelchair will be available
when needed can be calculated with a(n)…

Binomial distribution
Multinomial distribution
Factorial
Effects analysis

At the beginning of a planning meeting, the participants are asked to make a list of their
priorities. These lists are then compiled, and an overall list of priorities is created. This process is
known as…

Nominal group technique
Diversion and conversion
Force field analysis
Multi-voting

Employee incentive programs should emphasize…

Adherence to established protocols
Excellent results
Improved cost savings
Reduction in adverse events

Which of the following diagrams is appropriate for categorizing the needs of customers?

Kano model
Histogram
Flow chart
Matrix diagram

Root cause analyses most often reveal that mistakes are the result of…

A series of small errors
A single miscalculation
A culture of incompetence
Bad actors

Which of the following is the strongest basis for practice?

Systematic reviews of randomized clinical trials
Descriptive studies
Qualitative studies
Opinion leaders

Which of the following is NOT one of the types of quality problems identified by the Institute of
Medicine’s National Roundtable on Health Care Quality?

Misuse
Abuse
Overuse
Underuse

In behavioural health, the most important sentinel event for root cause analysis is…

Discharge
Death
Recovery
Medication error

When is the best time to discuss the results of a meeting exit survey?

Immediately upon receiving the responses
At the beginning of the next meeting
Via email in the interim before the next meeting
These results should not be discussed

A simple but effective way for managers to obtain the support of team members is to…

Threaten punishment
Ask for it
Mandate it
Ignore the team members

When is the best time for chairing during a meeting?

One hour beforehand
At the beginning
In the middle
At the end

A presentation on the basic structures and processes of clinical governance would be most
useful…

For small teams of employees
For the organization as a whole
For the directorate
For individual employees

The definitive proof of the success of a regulation program is…

Fewer complaints from customers
A decreased need for inspections
A boost in employee morale
An increase in throughput

A meeting of department managers is discussing the catering service and menu for a hospital wide
special occasion. This decision should be made by…

Building a consensus
Voting
Fiat
Brainstorming

Time available divided by time available and time required is the Six Sigma ratio for…

Productivity
Dependability
Customer satisfaction
Selectivity

When prescriptions are being prepared, the labelling process begins at the same time as the
medication is being packaged. However, the labelling does not take as long as the packaging. This
difference in time does not add to the overall duration of the prescription-filling process. This is an
example of…

Just-in-time manufacturing
Slack time
Mistake proofing
Inherent process variation

A behavioural health specialist notices a particularly high number of restraint deaths at a facility.
An analysis of the root causes of these events is most likely to indicate problems with…

Equipment
Staff orientation and training
Staffing levels
Alarm systems

A good meeting facilitator will…

Not need to ask very many questions
Focus on process rather than content
Refrain from offering suggestions
Focus on content rather than process

Individual instruction on clinical governance is most effective when…

It is delivered to a group
It is delivered before a performance review
It is combined with targeted training
It is targeted at new employees

When establishing an incentive program for employees, the critical-to-quality parameters
should be…

Agreed upon by all participants
Attainable and significant
Determined while the program is underway
Established by the senior administrator

The discharge department of a hospital is at optimal efficiency when it completes the discharge
process…

More often than customer requests occur
At about the same rate as customer requests occur
Less often than customer requests occur
Twice as fast as customer requests occur

The first and most important step in a disclosure conversation is…

Assessing the patient’s mood
Admitting error and apologizing
Discussing the root cause analysis
Compensating the patient

What are the three dimensions of quality in the most common framework for quality
assessment?

Service, process, and mortality
Structure, process, and outcomes
Population, structure, and satisfaction
Function, outcomes, and clinical status

A top-level administrator is asked by a lower-level manager to lead a meeting of new
employees. What should the administrator do first?

Review the notes from previous meetings
Discuss the meeting participants with the manager
Organize preliminary notes
Compose an introductory statement

Which of the following contracts would be most appropriate when remodelling an old wing of a
hospital?

Formal contract
Time and materials contract
Cost reimbursement contract
Fixed price contract

A set of key measures that is used to judge progress is known as a(n)…

Performance factor
Dashboard
Independent variable
Benchmark

The most common source of the goal statement for a tree diagram is…

An affinity diagram
The root cause identified by an interrelationship digraph
An assignment
A histogram

Over the past three decades, medical knowledge and technology have…

Expanded at a slow rate
Expanded at an exponential rate
Both expanded and declined at different times
Declined at a slow rate

In healthcare, the most common adjustment to the traditional balanced scorecard is the…

Focus on financial performance
Extra emphasis on patient results and customer satisfaction
Elimination of business operations
Use of advanced metrics

One difference between evidence-based practice and research utilization is that…

Research utilization takes into account the preferences of the patient
Research utilization relies on only one study
Evidence-based practice is based on tradition
Evidence-based practice incorporates the ideas of opinion leaders

In general, how many steps should a failure modes and effects analysis take in each direction?

One
Two
Five
Ten

Which of the following is NOT a goal of quality circles?

To improve customer relations
To develop new services
To improve job satisfaction
To maximize employee potential

Which of the following is NOT a primary goal of lean enterprise?

Improve quality
Stabilize total costs
Eliminate waste
Reduce lead time

A hospital experiences very infrequent problems with infusion equipment. The best statistical
distribution model for examining these errors would be the…

Binomial distribution
Poisson distribution
Normal distribution
Multinomial distribution

When assessing an emergency room, the best strategy for data collection is…

Cluster sampling
Continuous sampling
Matched random sampling
Accidental sampling

The most important characteristic of the controls in a case-control study is that they are…

Drawn from a random pool of patients
Identical to the cases in every respect except for the presence of the targeted condition
Available for frequent observation
Literate

One common problem in labs with low turnover is…

Excessive slack time
Narrow specialization by technicians
Failure to adapt
Confrontations between management and technicians

Frequent benchmarking is important in lean service because…

It boosts employee morale
It prevents an organization from failing to react to external changes
It eliminates employee waste
It reduces adverse drug events

Which of the following groups is least likely to report errors?

Primary care physicians
Support staff
Independent contractors
Nurses

Whenever possible, medication orders should be by…

Weight
Volume
Dose
Strength

A doctor fails to administer an indicated test, and the patient’s condition deteriorates to the
point that he must be admitted to an inpatient facility. This is an example of…

Preventive error
Treatment error
Diagnostic error
Communication error

Which of the following does NOT contribute to evidence-based practice in healthcare?

Clinical expertise
Evidence collected by expert panels
Tradition
Patient preferences

What is one disadvantage of the visioning strategy for setting goals?

It isolates team members
It tends to bring internal conflicts to the surface
The group must have at least six members for it to be feasible
It tends to reinforce group norms

Before conducting a safety audit in an emergency department, an administrator must first
obtain…

A list of the employees in that department.
A map of the department
A written set of safety standards
Statistics on adverse events

During a meeting, the facilitator notices that one of the participants is getting agitated. After the
meeting, what would be the best question for the facilitator to ask the participant?

“Why are you so angry?”
“What didn’t you like about the meeting?”
“Were you feeling irritated during the meeting?”
“Don’t you hate it when your co-workers act that way?”

A hospital manager notices that a significant proportion of medication errors in the facility
involve the same two drugs. What is the most likely cause of this?

The drugs are widely available
The drugs are made by the same company
The drugs come in similar packaging
The drugs are habit-forming

A whole systems approach to clinical governance is important because…

It isolates particular areas of concern
It can be administered within one week
Changes must be applied at all levels of the organization
Delays in service provision are rare

Because of a doctor’s poor handwriting, a prescription must be reworked before it leaves the
pharmacy. Which of the following is true?

The doctor should be reprimanded
The pharmacy should incorporate bar coding
The prescription should not count towards the pharmacy’s yield
The error should be reported to the FDA

A hospital manager finds that she is unable to effectively supervise all of the employees who
report directly to her. A reorganization of the hospital hierarchy should…

Eliminate some of the subordinate employees
Reallocate material resources
Minimize the manager’s span of control
Call for the hiring of another manager

An adverse drug reaction…

Decreases the efficacy of therapy
Increases the toxicity of other medication
Both A and B
A and/or B

In the lean enterprise model, what is the first step toward improving quality?

Establishing performance metrics
Reviewing product design
Understanding the expectations of the customer
Identifying potential defects

A hospital manager operates on the assumption that his employees will thrive when they are
given responsibility and the opportunity to perform well. The manager’s beliefs are aligned with…

The theory of constraints
Theory X
Theory Y
Theory Z

When a hospital official notes that most errors are occurring at the “sharp end,” she means
that…

They involve surgical tools or knives
They occur in clusters
They occur during the interactions between caregivers and patients
They are more likely to occur during busy periods

Which of the following procedures is NOT a good way to mitigate injury?

Maintaining a ready supply of antidotes to high-risk medications
Simulation training
Programming equipment to shut off in the event of a crisis
Requiring employees to practice crisis response

A root cause analysis of inpatient suicides would be most likely to discover problems with…

Staffing levels
Staff orientation
The physical environment
The availability of information

A hospital’s medication system is vast, and various elements of it fall within the purview of
several different departments. One important step towards reducing errors in this system is to…

Make each department responsible for the system as a whole
Have each department use the same self-assessment tools
Give a single person responsibility for overseeing the entire system
Simplify it

According to JCAHO, the primary cause of wrong-site surgery errors is…

Unusual patient characteristics
The necessity of multiple surgeries
Communication failure
The presence of multiple surgeons

Which of the following is NOT mandatory in a generic dispensing program?

Active ingredient must be the same
Chemical composition must be the same
Salt form must be the same
Dosage form must be the same

If administrators are given a list of the variables that predict mortality for patients with a given
condition, they should be able to…

Reduce the number of deaths
Eliminate wasteful therapies
Create a formula for the risk of death for each patient
Reduce bottlenecks in the emergency room

Volatility in nursing workload is less likely to be reported than other sources of waste because…

Nurses are unlikely to complain
It can only be perceived through the use of advanced metrics
It is less observable
It takes place infrequently

One of the consequences of successful application of the theory of constraints is…

Major system changes
Fewer employees
The creation of new constraints
Capital improvements

Most quality problems in healthcare are the result of…

Lack of compassion
Lack of resources
Disorganization
Ignorance

The system limits of a process typically are based on the average and standard deviation of the…

Yield and error rate
Duration and validity
Yield and duration
Validity and yield

It has been determined that a hospital’s blood transfusions are 99.7 percent error-free. Which
function can be used to determine the number of blood transfusions that are likely to be performed
before an error is made?

Binomial distribution
Poisson distribution
Negative binomial distribution
Multinomial distribution

Which of the following is a reactive system?

Questionnaires
Market research
Information obtained from customer complaints
Interviews with customers

If the load and the mix of a testing laboratory are levelled, the result will be…

An increase in capacity
A reduction in cost
An increase in capacity and/or a reduction in cost
An increase in capacity or a reduction in cost

Team members begin to reach consensus on the rules for operation during the stage known
as…

Storming
Forming
Norming
Recognition

In the most efficient labs, each technician…

Can only complete a single task
. Performs every task
Can perform every task, but usually performs only one
Rotates between tasks on a daily basis

Why is it important to use customized benchmarks?

Administrators may not release comprehensive data
Customer satisfaction is the most important measure of success
External factors may differentiate otherwise similar organizations
Customization eliminates resource waste

Which of the following is NOT one of the four elements of a health service microsystem?

A clear and identifiable population of patients
An environment in which self-assessment information can be obtained
A broad collection of health-care providers, support personnel, and private contractors
Well though-out work processes

What is one advantage of a voluntary error reporting system over a mandatory error reporting
system?

Mandatory systems are only targeted at very narrow areas of practice
Voluntary systems eliminate the need for communication between healthcare organizations
Voluntary systems elicit more reports from front-line practitioners
Mandatory systems discourage the reporting of non-fatal errors

The main difference between the Taguchi model of service provision and the traditional model
is that…

The Taguchi model identifies waste any time a process varies from its target
The traditional model is less forgiving of error
The Taguchi model is only applicable to manufacturing processes
The traditional model requires an organization with at least fifty employees

When a hospital administration decides on strategy, this information should be shared with…

Employees, patients, and the community
Employees only
Employees and patients only
No one

When conducting an audit of a large department, an administrator will likely apply the central
limit theorem. What does this mean?

She will average all of the data from the department
She will focus her efforts on the departmental leadership
She will assume that a sample is representative of the department as a whole
She will compare the department’s performance to ISO 9001 standards

A brief analysis of interventions for stroke is likely to be relatively unhelpful because…

Most stroke victims die
Stroke victims tend to be very old
Research has yet to discover an effective standard treatment
Strokes are likely to be accompanied by other conditions

It is easy to conduct a survey of medication-related errors because…

There are very few of them relative to other types of error
Deaths caused by such errors are rarely discovered
Such errors have small but noticeable effects on health care costs
Prescription-drug use is common and well documented

A delay in discharging patients is likely to cause recurrent bottlenecks in…

Admissions from the emergency room
The filling of prescriptions
Admissions from surgical wards
All of the above

Which of the following conditions should a quality assessment program NOT examine?

A condition that is thought to be treatable
A condition for which the treatment is susceptible to significant influence by health care providers
A condition that has cost-effective treatments
A rare condition that has a small effect on mortality or morbidity

Research suggests that the largest proportion of adverse events attributable to negligence occur
in the…

Post-trauma unit
Surgery unit
Maternity ward
Emergency room

Which of the following is the source of the most medication errors?

Orders that require lab results
High-risk orders
Automatic orders
Verbal orders

One advantage of the kaizen approach to DMAIC implementation is that…

It replicates the project-team approach
All of the team members are involved in all phases of the process
It can be performed while employees complete their normal tasks
It is accomplished in about a week

The practice of waiting for a certain number of samples before commencing a test run results
in…

Fewer bottlenecks
More bottlenecks
Shorter lead times
Longer lead times

Confronted by excessive WIP levels, many laboratories take the unhelpful step of…

Decreasing the number of test runs
Acquiring a larger laboratory
Hiring more employees
Installing new technology

Which of the following steps should be taken before QA activities begin?

Responsibility should be shared
The principals should be informed
Resources should be pooled
The scope of involvement should be identified

Because the hospital is busy, an anaesthesiologist is given less time than usual to examine the
infusion device that will be delivering medication to a patient during surgery. The machine
malfunctions and the doctors on hand must work feverishly to save the patient’s life. This is an
example of…

Active error
Equipment error
System error
Latent error

As much as possible, medications should be standardized. However, when this is impossible, it
is important to…

Assume that side-effects will occur
Warn clinicians about the potential for overdose
Only use them as a last resort
Differentiate them clearly

A hospital uses the same labels for all of its prescriptions, but these labels do not fit on the
smallest container, so employees must cut and paste the labels in a special way in order to fill the
prescription. This is an example of…

Overproduction
Queuing
Work-in-progress
Extra processing

Which of the following factors is NOT included in a calculation of risk priority number?

Severity of possible adverse effects
Effectiveness of controls
Likelihood of an adverse effect
Cost of controls

A program for assessing the validity of rolled throughput yield calculation is called…

Composite clinical indication
Performance measure selection
Continuous quality management
Measurement systems analysis

One common model for administrative meetings is for small groups to discuss specific problems
and then join together in a…

Process intervention
Confab
Colloquium
Plenary

Why would a hospital include an APACHE III score on an analysis of the infection rate?

To indicate trends related to age
To link infection with socioeconomic status
To find areas of resource waste
To establish the general likelihood of infection for patients with various conditions

One important driver of customer dissatisfaction in health care over the past decade has been…

The introduction of online services
The lack of communication between physicians and patients
The rise in income inequality
The improvement of customer care in other service industries

Which of the following is most important?

. Patient satisfaction
Clinical satisfaction
Employee satisfaction
Patient, clinical, and employee satisfaction are equally important

In the optimal decision-making process, the most time will be devoted to…

Framing the question
Learning from feedback
Drawing conclusions
Gathering information

In lean enterprise, which is the worst type of waste?

Extra processing
Queuing
Transport
Overproduction

The frequency of errors in a particular process would best be displayed in a(n)…

Matrix diagram
Pareto chart
Affinity diagram
Histogram

An increase in chronic conditions is one consequence of…

More complicated intervention strategies
Advances in medical technology
Greater population density
Longer life expectancy

The “four bads” associated with drug-related morbidity are…

Bad drugs, bad doctors, bad pharmacists, and bad patients
Bad drugs, bad patients, bad luck, and bad doctors
Bad drugs, bad pharmacists, bad nurses, and bad luck
Bad drugs, bad patients, bad prescribing, and bad luck

Which of the following is NOT one of the basic components of an optimization model?

Constraints
Objective function
Variable inputs
Price information

Which of the following is a characteristic of a high-performing group?

More advocacy than inquiry
More internal than external focus
More scepticism than optimism
A blend of internal focus and external review

When developing quality standards, the best source of information is…

Trade publications
The facility scorecard
Prior performance measures
External benchmarking data

Which of the following is NOT one of the operational measurements emphasized by the theory
of constraints?

Throughput
Operating expense
Inventory
Net profit

The most common and effective style of checklist for hospital employees is…

Standardized and rarely updated
Requires detailed responses
Only required for new employees
Designed to prompt a response of “yes” to almost every question

A meeting facilitator notices that the team has a tendency towards groupthink. What is one
structural way to correct this problem?

Meet late in the day
Meet more often
Break the group down into smaller subgroups
Have comments submitted in writing

An administrative team is using an interrelationship digraph to examine the problem of
nursing workload volatility. What will the team do after making a list of the factors that influence
this issue?

Confer with an expert
Tabulate the data
Identify root causes
Draw relationship arrows between the factors

To deal with volatile workloads, a laboratory creates a fast track for samples that need to be
processed immediately. One common result of this strategy is that…

Average lead times will be reduced
The laboratory will stop having bottlenecks
Technicians will become confused
The portion of samples placed in the fast track will steadily increase

Research suggests that people make fewer errors when they…

Perform several tasks at once
Work creatively
Work individually
Work in a team

Hospitals pay special attention to blood transfusions because…

They are easy to monitor and verify
They are rare
They are responsible for the largest percentage of malpractice suits
They are complicated and dangerous

The main difference between a dashboard and a scorecard is that…

A dashboard is only to be viewed by senior administrators
A scorecard includes performance measures from multiple departments
A dashboard only includes one measure of performance
A scorecard describes past performance, while a dashboard depicts performance in real time

No. of Questions	Mark Of Each Question	Duration	Min Passing Percentage
140	1	120 min	60%

CPHQ Quiz 4

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