ANM Performance Improvement and Quality 4 — Questions and Answers
Question 1: An ANM is implementing a new hand hygiene protocol. Which change management model emphasizes creating urgency, building a guiding coalition, and consolidating gains?
- Lewin's Change Theory
- Kotter's 8-Step Change Model (Correct answer)
- Rogers' Diffusion of Innovation
- ADKAR Model
Correct answer: Kotter's 8-Step Change Model
Kotter's 8-Step Model explicitly includes creating urgency, forming a guiding coalition, and consolidating gains as sequential steps for leading change.
Question 2: A hospital tracks its medication error rate using DPMO (Defects Per Million Opportunities). A Six Sigma process has a DPMO of approximately:
- 66,807
- 6,210
- 233
- 3.4 (Correct answer)
Correct answer: 3.4
Six Sigma quality level corresponds to no more than 3.4 defects per million opportunities, representing 99.99966% accuracy.
Question 3: Which CMS Hospital Value-Based Purchasing (VBP) domain directly measures clinical outcomes such as mortality and complications?
- Person and Community Engagement
- Safety
- Clinical Care – Outcomes (Correct answer)
- Efficiency and Cost Reduction
Correct answer: Clinical Care – Outcomes
The Clinical Care – Outcomes domain of CMS VBP specifically measures mortality rates, complications, and other clinical outcome measures.
Question 4: A root cause analysis (RCA) team identifies that inadequate nurse-to-patient ratios contributed to a fall with injury. This is an example of a:
- Direct cause
- Latent contributing factor (Correct answer)
- Proximate cause
- Sentinel trigger
Correct answer: Latent contributing factor
Inadequate staffing ratios are a latent (system-level) contributing factor that creates conditions for errors rather than directly causing them.
Question 5: The HCAHPS survey is BEST described as:
- A clinical quality measure for infection rates
- A standardized patient experience survey publicly reported by CMS (Correct answer)
- A staff satisfaction assessment tool
- A peer-review accreditation instrument
Correct answer: A standardized patient experience survey publicly reported by CMS
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a standardized, publicly reported patient satisfaction survey mandated by CMS.
Question 6: An ANM observes that staff skip a required time-out step before procedures when the unit is busy. Using the Swiss Cheese Model, this represents:
- A latent error aligning holes across defensive layers (Correct answer)
- An active error with immediate consequence
- A special cause variation
- A sentinel event trigger
Correct answer: A latent error aligning holes across defensive layers
The Swiss Cheese Model shows how latent holes (like skipped time-outs) across multiple safety layers can align to allow harm to occur.
Question 7: Which PI approach focuses on eliminating waste through the categories of Transportation, Inventory, Motion, Waiting, Overproduction, Overprocessing, and Defects?
- Six Sigma DMAIC
- Lean's 7 Wastes (TIM WOOD) (Correct answer)
- TQM Continuous Improvement
- FMEA Analysis
Correct answer: Lean's 7 Wastes (TIM WOOD)
Lean methodology categorizes waste into 7 types remembered by the acronym TIM WOOD, targeting each to maximize value in care delivery.
ANM Performance Improvement and Quality 4
An ANM is implementing a new hand hygiene protocol.
Which change management model emphasizes creating urgency, building a guiding coalition, and consolidating gains?