BHA320 MGT Of Health Programs

• Module 4 – Case

  HEALTH CARE OPERATIONS AND QUALITY

  Assignment Overview

  According to the Agency for Healthcare Research and Quality (2002), “a central goal of healthcare quality improvement is to maintain what is good about the existing healthcare system while focusing on the areas that need improvement” (para. 2). This assignment will familiarize you with the quality improvement (QI) approaches and models that health care administrators can effectively apply.

  Case Assignment

  Use the library to access the following book: The healthcare quality book: vision, strategy, and tools.  Review Chapter 4, Quality Improvement: Foundation, Processes, Tools, And Knowledge Transfer Techniques. There are six approaches/models of quality improvement discussed in Chapter 4.

  Create an 8- to 10-slide PowerPoint (PPT) to discuss three of the six approaches/models of quality improvement discussed. Your presentation should address the following explicitly:

  1. Explanation and/or reasoning for the importance of using quality improvement as a health care administrator.  BHA320 MGT Of Health Programs

  2. The steps, stages, or processes of each selected approach/model.

  3. Example of health care administrator’s applicable use of each selected approach/model.

  ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

  Assignment Expectations

   

  1. Speaker notes, citations, and a reference slide are required.

  2. Conduct additional research to gather sufficient information to support the information presented in PPT.

  3. Support your case with peer-reviewed articles, with at least 2 references (you can use the book as one reference). Use the following source for additional information on how to recognize peer-reviewed journals:  http://www.angelo.edu/services/library/handouts/peerrev.php.

  4. You may use the following source to assist in formatting your assignment:  https://owl.english.purdue.edu/owl/resource/560/01/

•  

  Mod4readCh4.pdf
•  

  MOD4SLP.docx

  TRIDENT UNIVERSITY

  BHA 320- MGT OF HEALTH PROGRAMS

  Module 4 – SLP

  HEALTH CARE OPERATIONS AND QUALITY

  From the library access the following text: Healthcare Operations Management (Authors: Daniel B. McLaughlin & Julie M Hays). Review Chapter 1: The Challenge and the Opportunity (Introduction to Healthcare Operations).

  Then, review common hospital operations problems at  http://www.beckershospitalreview.com/hospital-management-administration/5-common-hospital-problems-and-suggestions-for-how-to-fix-them.html .

  Select two of the problems identified in the above article and develop a 2- to 3-page paper assessing the reasons for the problems and possible solutions (recommended solutions should include a brief plan of action). In your paper, identity which of the ten action steps recommended by Institute of Medicine (IOM) to close the quality chasm is applicable to each selected problem. The ten action steps can be found on pages 6 and 7 of  the text or at the following link:  http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

  SLP Assignment Expectations

  1. Conduct additional research to gather sufficient information to support your identification of problems and recommended solutions

  2. Limit your response to a maximum of 3 pages. BHA320 MGT Of Health Programs

  3. Support your SLP with peer-reviewed articles, with at least 2 references. Use the following source for additional information on how to recognize peer-reviewed journals:  http://www.angelo.edu/services/library/handouts/peerrev.php.

  4. You may use the following source to assist in your formatting your assignment:  https://owl.english.purdue.edu/owl/resource/560/01/ .

•  

  Mod4SLPReadCh1.pdf

  3

  KEY TERMS AND ACRONYMS

  Agency for Healthcare Research and Quality (AHRQ)

  consumer-directed healthcare evidence-based medicine (EBM) health savings account Institute of Medicine (IOM)

  knowledge-based management (KBM)

  patient care microsystem Vincent Valley Hospital and Health

  System (VVH)

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  Introduction

  The challenges and opportunities in today’s complex healthcare delivery sys- tems demand that leaders take charge of their operations. A strong opera- tions focus can reduce costs, increase safety, improve clinical outcomes, and allow an organization to compete effectively in an aggressive marketplace.

  In the recent past, the success of many organizations in the Ameri- can healthcare system has been achieved through executing a few key strategies: First, attract and retain talented clinicians; next, add new tech- nology and specialty care; and finally, find new methods to maximize the organization’s reimbursement for these services. In most organizations, new services—not ongoing operations—represented the key to success. BHA320 MGT of Health Programs

  However, that era is ending. Payer resistance to cost increases and a surge in public reporting on the quality of healthcare are strong forces driving a major change in strategy. To succeed in this new environment, a healthcare enterprise must focus on making significant improvements in its core operations.

  This book is about how to get things done. It provides an inte- grated system and set of contemporary operations improvement tools that can be used to make significant gains in any organization. These tools have been successfully deployed in much of the global business commu- nity for more than 30 years (Hammer 2005) and now are being used by leading healthcare delivery organizations.

  This chapter outlines the purpose of the book, identifies challenges that current healthcare systems are facing, presents a systems view of health- care, and provides a comprehensive framework for the use of operations tools and methods in healthcare. Finally, Vincent Valley Hospital and Health Sys- tem (VVH), which is used in examples throughout the book, is described.

  Purpose of this Book

  Excellence in healthcare derives from three major areas of expertise: clinical care, leadership, and operations. Although clinical expertise and leadership are critical to an organization’s success, this book focuses on operations— how to deliver high-quality care in a consistent, efficient manner. BHA320 MGT of Health Programs. BHA320 MGT Of Health Programs

  Many books cover operational improvement tools, and some focus on using these tools in healthcare environments. So, why a book devoted to the broad topic of healthcare operations? Because there is a real need for an inte- grated approach to operations improvement that puts all the tools in a logi- cal context and provides a road map for their use. An integrated approach

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s

  4

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 5

  uses a clinical analogy—first find and diagnose an operations issue, then apply the appropriate treatment tool to solve the problem.

  The field of operations research and management science is too deep to cover in one book. In Healthcare Operations Management, only tools and techniques that are currently being deployed in leading healthcare organiza- tions are covered in enough detail to enable students and practitioners to “get things done” in their work. Each chapter provides many references for deeper study. The authors have also included additional resources, exercises, and tools on the website that accompanies this book.

  This book is organized so that each chapter builds on the next and is cross-referenced. However, each chapter also stands alone, so a reader inter- ested in Six Sigma could start in Chapter 8 and then move back and forth into the other chapters.

  This book does not specifically explore “quality” in healthcare as defined by the many agencies that have a mission to ensure healthcare qual- ity, such as the Joint Commission, National Committee for Quality Assur- ance, National Quality Forum, or federally funded Quality Improvement Organizations. The Healthcare Quality Book: Vision, Strategy and Tools (Ran- som, Maulik, and Nash 2005) explores this perspective in depth and provides a useful companion to this book. However, the systems, tools, and tech- niques discussed here are essential to make the operational improvements needed to meet the expectations of these quality-assurance organizations. BHA320 MGT of Health Programs

  The Challenge

  The United States spent more than $2 trillion on healthcare in 2007—the most per capita in the world. With health insurance premiums doubling every five years, the annual cost for a family for health insurance is expected to be $22,000 by 2010—all of a worker’s paycheck at ten dollars an hour. The Centers for Medicare & Medicaid Services predict that within the next decade, one of every five dollars of the U.S. economy will be devoted to healthcare (DoBias and Evans 2006). BHA320 MGT of Health Programs

  Despite its high cost, the value delivered by the system has been ques- tioned by many policymakers. Unexplained variations in healthcare have been estimated to result in 44,000 to 98,000 preventable deaths every year. Pre- ventable healthcare-related injuries cost the economy between $17 billion and $29 billion annually, half of which represents direct healthcare costs (IOM 1999). In 2004, more than half (55 percent) of the American public said that they were dissatisfied with the quality of healthcare in this country, compared to 44 percent in 2000 (Henry J. Kaiser Foundation, Agency for Healthcare Research and Quality, and Harvard School of Public Health 2004).Co

  py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s6

  These problems were studied in the landmark work of the Institute of Medicine (IOM 2001), Crossing the Quality Chasm—A New Health System for the 21st Century. The IOM panel concluded that the knowledge to improve patient care is available, but a gap—a chasm—separates that knowl- edge from everyday practice. The panel summarizes the goals of a new health system in six “aims.” (Box 1.1)

  BOX 1.1 Six Aims of a New Health

  System

  Patient care should be

  1. Safe, avoiding injuries to patients from the care that is intended to help them;

  2. Effective, providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively);

  3. Patient-centered, providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions;

  4. Timely, reducing wait times and harmful delays for both those who receive and those who give care;

  5. Efficient, avoiding waste of equipment, supplies, ideas, and energy; and 6. Equitable, providing care that does not vary in quality because of personal

  characteristics such as gender, ethnicity, geographic location, and socio- economic status.

  SOURCE: Reprinted with permission from Crossing the Quality Chasm—A New Health System for the 21st Cen- tury © 2001 by the National Academy of Sciences, Courtesy of the National Academies Press, Washington, D.C.

  The IOM panel recommended ten steps to close the gap between care with the above characteristics and current practice (Box 1.2).

  The ten steps to close the gap are:

  1. Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the healthcare system should be responsive at all times (24 hours a day, every day), and that access to care should be pro- vided over the Internet, by telephone, and by other means in addition to face-to-face visits. BHA320 MGT of Health Programs

  2. Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.

  BOX 1.2 Ten Steps to

  Close the Gap

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728. BHA320 MGT Of Health Programs

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 7

  3. The patient as the source of control. Patients should be given all relevant information and the opportunity to exercise whatever degree of control they choose over healthcare decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision making.

  4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.

  5. Evidence-based decision making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.

  6. Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.

  7. The need for transparency. The healthcare system should make available to patients and their families information that allows them to make informed decisions when selecting a health plan, hospital, or clinical prac- tice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence- based practice, and patient satisfaction.

  8. Anticipation of needs. The health system should anticipate patient needs rather than simply react to events.

  9. Continuous decrease in waste. The health system should not waste resources or patient time.

  10. Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of infor- mation and coordination of care.

  SOURCE: Reprinted with permission from Crossing the Quality Chasm—A New Health System for the 21st Cen- tury © 2001 by the National Academy of Sciences, Courtesy of the National Academies Press, Washington, D.C.

  Many healthcare leaders have begun to address these issues and are cap- italizing on proven tools employed by other industries to ensure high per- formance and quality outcomes. For major change to occur in the U.S. health system, however, these strategies must be adopted by a broad spectrum of healthcare providers and implemented consistently throughout the contin- uum of care—ambulatory, inpatient/acute settings, and long-term care. BHA320 MGT of Health Programs

  The payers for healthcare must engage with the delivery system to find new ways to partner for improvement. In addition, patients have to assume a stronger financial and self-care role in this new system.

  Although not all of the IOM goals can be accomplished through oper- ational improvements, this book provides methods and tools to actively change the system to accomplish many aspects of them.

  BOX 1.2 Ten Steps to Close the Gap (continued)

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s8

  The Opportunity

  Although the current American health system presents numerous challenges, opportunities for improvement are emerging as well. Three major trends pro- vide hope that significant change is possible. BHA320 MGT of Health Programs

  Evidence-Based Medicine The use of evidence-based medicine (EBM) for the delivery of healthcare is the result of 30 years of work by some of the most progressive and thought- ful practitioners in the nation. The movement has produced an array of care guidelines, care patterns, and new shared decision-making tools for both caregivers and patients. The cost of healthcare could be reduced by nearly 29 percent and clinical outcomes improved significantly if EBM guidelines and the most efficient care procedures were used by all practitioners in the United States (Wennberg, Fisher, and Skinner 2004).

  Comprehensive resources are available to the healthcare organization that wishes to emphasize EBM. For example, the National Guideline Clear- inghouse (NGC 2006) is a comprehensive database of evidence-based clini- cal practice guidelines and related documents and contains more than 4,000 guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and American Association of Health Plans, now Amer- ica’s Health Insurance Plans (AHIP).

  Knowledge-Based Management Knowledge-based management (KBM) employs data and information, rather than feelings or intuition, to support management decisions. Practitioners of KBM use the tools contained in this book for cost reduction, increased safety, and improved clinical outcomes. The evidence for the efficacy of these tech- niques is contained in the operations research and management science liter- ature. Although these tools have been taught in healthcare graduate programs for many years, they have not migrated widely into practice. Recently, the IOM (Proctor et al. 2005) has recognized the opportunities that the use of KBM presents with its publication Building a Better Delivery System: A New Engineering/Healthcare Partnership. In addition, AHRQ and Denver Health provide practical operations improvement tools in A Toolkit for Redesign in Healthcare (Gabow et al. 2003). BHA320 MGT of Health Programs

  Healthcare delivery has been slow to adopt information technologies, but many organizations are now beginning to aggressively implement elec- tronic medical record systems and other automated tools. Hillestad et al. (2005) have suggested that broad deployment of these systems could save up to $371 billion annually in the United States.Co

  py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 9

  A More Active Role for the Consumer Consumers are beginning to assume new roles in their own care through the use of health education and information and more effective partnering with their healthcare providers. Personal maintenance of wellness though a healthy lifestyle is one essential component. Understanding one’s disease and treat- ment options and having an awareness of the cost of care are also important responsibilities of the consumer. BHA320 MGT of Health Programs

  Patients will become good consumers of healthcare by finding and using price information in selecting providers and treatments. Many employ- ers are now offering high-deductible health plans with accompanying health savings accounts (HSAs.) This type of consumer-directed healthcare is likely to grow and increase pressure on providers to deliver cost-effective, customer- sensitive, high-quality care.

  The healthcare delivery system of the future will support and empower active, informed consumers.

  A Systems Look at Healthcare

  The Clinical System To improve healthcare operations, it is important to understand the systems that influence the delivery of care. Clinical care delivery is embedded in a series of interconnected systems (Figure 1.1).

  The patient care microsystem is where the healthcare professional pro- vides hands-on care. Elements of the clinical microsystem include:

  FIGURE 1.1 A Systems View of Healthcare

  SOURCE: Ransom, Maulik, and Nash (2005). Based on Ferlie, E., and S. M. Shortell. 2001. “Improving the Quality of Healthcare in the United Kingdom and the United States: A Framework for Change.” The Milbank Quarterly 79(2): 281–316.

  Organization Level C

  Microsystem Level B

  Patient Level A

  Environment Level D

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s10

  • The team of health professionals who provide clinical care to the patient;

  • The tools the team has to diagnose and treat the patient (e.g., imaging capabilities, lab tests, drugs); and

  • The logic for determining the appropriate treatments and the processes to deliver this care.

  Because common conditions (e.g., hypertension) affect a large number of patients, clinical research has determined the most effective way to treat these patients. Therefore, in many cases, the organization and functioning of the microsystem can be optimized.

  Process improvements can be made at this level to ensure that the most effective, least costly care is delivered. In addition, the use of EBM guidelines can also help ensure that the patient receives the correct treatment at the correct time.

  The organizational infrastructure also influences the effective delivery of care to the patient. Ensuring that providers have the correct tools and skills is an important element of infrastructure. The use of KBM provides a mech- anism to optimize the use of clinical tools. BHA320 MGT of Health Programs

  The electronic health record is one of the most important advances in the clinical microsystem for both process improvement and the wider use of EBM. Another key component of infrastructure is the leadership displayed by senior staff. Without leadership, effective progress or change will not occur.

  Finally, the environment strongly influences the delivery of care. Key environmental factors include competition, government regulation, demo- graphics, and payer policies. An organization’s strategy is frequently influ- enced by such factors (e.g., a new regulation from Medicare, a new competitor).

  Many of the systems concepts regarding healthcare delivery were ini- tially developed by Avedis Donabedian. These fundamental contributions are discussed in depth in Chapter 2.

  System Stability and Change Elements in each layer of this system interact. Peter Senge (1990) provides a useful theory to understand the interaction of elements in a complex system such as healthcare. In his model, the structure of a system is the primary mechanism for producing an outcome. For example, an organized structure of facilities, trained professionals, supplies, equipment, and EBM care guide- lines has a high probability of producing an expected clinical outcome. BHA320 MGT Of Health Programs

  No system is ever completely stable. Each system’s performance is modified and controlled by feedback (Figure 1.2). Senge (1990, 75) defines feedback as “any reciprocal flow of influence. In systems thinking it is an axiom that every influence is both cause and effect.” As shown in Figure 1.2,

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 11

  higher salaries provide an incentive for higher performance levels by employ- ees. This, in turn, leads to better financial performance and profitability; increased profits provide additional funds for higher salaries, and the cycle continues. Another frequent example in healthcare delivery is patient lab results that directly influence the medication ordered by a physician. A third example is a financial report that shows an overexpenditure in one category that will prompt a manager to reduce spending to meet budget goals.

  A more formal systems definition with feedback includes a process, a sensor that monitors process output, a feedback loop, and a control that modifies how the process operates.

  Feedback can be either reinforcing or balancing. Reinforcing feedback prompts change that builds on itself and amplifies the outcome of a process, taking the process further and further from its starting point. The effect of reinforcing feedback can be either positive or negative. For example, a rein- forcing change of positive financial results for an organization could lead to higher salaries, which would then lead to even better financial performance because the employees were highly motivated. In contrast, a poor supervisor could lead to employee turnover, short staffing, and even more turnover. BHA320 MGT of Health Programs

  FIGURE 1.2 Systems with Reinforcing and Balancing Feedback+

  +

  +

  –

  –

  Employee motivation

  Salaries

  Financial performance, profit

  Add or reduce staff

  Actual staffing level

  Compare actual to needed staff based on patient demand

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s12

  Balancing feedback prompts change that seeks stability. A balancing feedback loop attempts to return the system to its starting point. The human body provides a good example of a complex system that has many balancing feedback mechanisms. For example, an overheated body prompts perspira- tion until the body is cooled through evaporation. The clinical term for this type of balance is homeostasis. A clinical treatment process that controls drug dosing via real-time monitoring of the patient’s physiological responses is an example of balancing feedback. Inpatient unit staffing levels that drive where in a hospital patients are admitted is another. All of these feedback mecha- nisms are designed to maintain balance in the system. BHA320 MGT of Health Programs

  A confounding problem with feedback is delay. Delays occur when there are interruptions between actions and consequences. When this hap- pens, systems tend to overshoot and perform poorly. For example, an emer- gency department might experience a surge in patients and call in additional staff. If the surge subsides, the added staff may not be needed and unneces- sary expense will have been incurred.

  As healthcare leaders focus on improving their operations, it is impor- tant to understand the systems in which change resides. Every change will be resisted and reinforced by feedback mechanisms, many of which are not clearly visible. Taking a broad systems view can improve the effectiveness of change.

  Many subsystems in the total healthcare system are interconnected. These connections have feedback mechanisms that either reinforce or balance the subsystem’s performance. Figure 1.3 shows a simple connection that originates in the environmental segment of the total health system. Each process has both reinforcing and balancing feedback. BHA320 MGT of Health Programs

  An Integrating Framework for Operations Management in Healthcare

  This book is divided into five major sections:

  • Introduction to healthcare operations; • Setting goals and executing strategy;

  FIGURE 1.3 Linkages

  Within the Healthcare

  System: Chemotherapy

  Payers want to reduce costs for chemotherapy

  New payment method for chemotherapy is created

  Chemotherapy treatment needs to be more efficient to meet payment levels

  Changes are made in care processes and support systems to maintain quality while reducing costs

  Environment Organization Clinical microsystem Patient

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 13

  • Performance improvement tools, techniques, and programs; • Applications to contemporary healthcare operations issues; and • Putting it all together for operational excellence.

  This schema reflects the authors’ view that effective operations man- agement in healthcare consists of highly focused strategy execution and orga- nizational change accompanied by the disciplined use of analytical tools, techniques, and programs. The book includes examples of applications of this approach to common healthcare challenges.

  Figure 1.4 illustrates this framework. An organization needs to under- stand the environment, develop a strategy, and implement a system to effec- tively deploy this strategy. At the same time, the organization must become adept at using all the tools of operations improvement contained in this book. These improvement tools can then be combined to attack the funda- mental challenges of operating a complex healthcare delivery organization. BHA320 MGT of Health Programs

  Introduction to Healthcare Operations The introductory chapters provide an overview of the significant environ- mental trends healthcare delivery organizations face. Annual updates to industry-wide trends can be found in Futurescan: Healthcare Trends and Implications 2008–2013 (Society for Healthcare Strategy and Market Devel- opment and American College of Healthcare Executives 2008). Progressive organizations will review these publications carefully. Then, using this infor- mation, they can respond to external forces by identifying either new strate- gies or current operating problems that must be addressed.

  Business has been aggressively using operations improvement tools for the past 30 years, but the field of operations science actually began many cen- turies in the past. Chapter 2 provides a brief history.

  Healthcare operations are being strongly driven by the effects of EBM and pay-for-performance. Chapter 3 provides an overview of these trends and how organizations can effect change to meet current challenges and opportunities.

  FIGURE 1.4 Framework for Effective Operations Management in Healthcare

  Setting goals and executing strategy

  Performance improvement tools, techniques, and programs

  Fundamental healthcare operations issues

  High performance

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s14

  Setting Goals and Executing Strategy A key component of effective operations is the ability to move strategy to action. Chapter 4 shows how the use of the balanced scorecard can accom- plish this aim. Change in all organizations is challenging, and formal meth- ods of project management (Chapter 5) can be used to make effective, lasting improvements in an organization’s operations. BHA320 MGT of Health Programs

  Performance Improvement Tools, Techniques, and Programs Once an organization has in place strategy implementation and change management processes, it needs to select the correct tools, techniques, and programs to analyze current operations and implement effective changes.

  Chapter 6—Tools for Problem Solving and Decision Making—outlines the basic steps of problem solving, beginning with framing the question or problem and continuing through data collection and analyses to enable effective decision making. Chapter 7—Using Data and Statistical Tools for Operations Improvement—provides a review of the building blocks for many of the more advanced tools used later in the book. (This chapter may serve as a review or reference for readers who already have good sta- tistical skills.)

  Some projects will require a focus on process improvement. Six Sigma tools (Chapter 8) can be used to reduce the variability in the outcome of a process. Lean tools (Chapter 9) can be used to eliminate waste and increase speed. Many healthcare processes, such as patient flow, can be modeled and improved by using computer simulation (Chapter 10), which may also be used to evaluate project risks. BHA320 MGT of Health Programs

  Applications to Contemporary Healthcare Operations Issues This part of the book demonstrates how these concepts can be applied to some of today’s fundamental healthcare challenges. Process improvement techniques are widely deployed in many organizations to significantly improve performance; Chapter 11 reviews the tools of process improvement and demonstrates their use in improving patient flow.

  Scheduling and capacity management continue to be major concerns for many healthcare delivery organizations, particularly with the advent of advanced access. Chapter 12 demonstrates how simulation can be used to optimize sched- uling. Chapter 13—Supply Chain Management—explores the optimal methods of acquiring supplies and maintaining appropriate inventory levels. BHA320 MGT of Health Programs

  In the end, any operations improvement will fail unless steps are taken to maintain the gains; Chapter 14—Putting it All Together for Operational Excellence—contains the necessary tools. The chapter also provides a more detailed algorithm that can help practitioners select the appropriate tools,

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 15

  methods, and techniques to make significant operational improvements. It includes an example of how Vincent Valley Hospital and Health System (VVH) uses all the tools in the book to achieve operational excellence.

  Vincent Valley Hospital and Health System Woven throughout the sections described below are examples designed to consistently illustrate the tools discussed. A fictitious but realistic health sys- tem, VVH, is featured in these examples. (The companion website, ache.org/books/OpsManagement, contains a more expansive description of VVH.)

  VVH is located in a Midwestern city of 1.5 million. It has 3,000 employees, operates 350 inpatient beds, and has a medical staff of 450 physi- cians. In addition, VVH operates nine clinics staffed by physicians who are employees of the system. VVH has two major competitor hospitals, and a number of surgeons from all three hospitals recently joined together to set up an independent ambulatory surgery center.

  Three major health plans provide most of the private payment to VVH and, along with the state Medicaid system, have recently begun a pay-for- performance initiative. VVH has a strong balance sheet and a profit margin of approximately 2 percent, but feels financially challenged.

  The board of VVH includes many local industry leaders, who have asked the chief executive officer to focus on using the operational techniques that have led them to succeed in their businesses. BHA320 MGT of Health Programs

  Conclusion

  This book is an overview of operations management approaches and tools. It is expected that the successful reader will understand all the concepts in the book (and in current use in the field) and should be able to apply at the basic level some of the tools, techniques, and programs presented. It is not expected that the reader will be able to execute at the more advanced level (e.g., Six Sigma black belt, Project Management Professional). However, this book will prepare readers to work effectively with knowledgeable profession- als and, most important, enable them to direct their work. BHA320 MGT of Health Programs

  Discussion Questions

  1. Review the ten action steps recommended by IOM to close the quality chasm. Rank them from easiest to most difficult to achieve, and give a rationale for your rankings.

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  I n t r o d u c t i o n t o H e a l t h c a r e O p e r a t i o n s16

  2. Give three examples of possibilities for system improvement at the boundaries of the healthcare subsystems (patient, microsystem, organi- zation, and environment).

  3. Identify three systems in a healthcare organization (at any level) that have reinforcing feedback.

  4. Identify three systems in a healthcare organization (at any level) that have balancing feedback.

  5. Identify three systems in a healthcare organization (at any level) where feedback delays affect the performance of the system.

  ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

  References

  DoBias, M., and M. Evans. 2006. “Mixed Signals—The CMS 10-Year Spending Pro- jections Inspire Both Hope and Skepticism, and Leave Plenty of Room for Lobbyists.” Modern Healthcare 36 (9): 6–8.

  Gabow, P., S. Eisert, A. Karkhanis, A. Knight, and P. Dickson. 2003. A Toolkit for Redesign in Healthcare. Washington, D.C.: Agency for Healthcare Research and Quality.

  Hammer, M. 2005. “Making Operational Innovation Work.” Harvard Management Update 10 (4): 3–4.

  Henry J. Kaiser Foundation, Agency for Healthcare Research and Quality, and Harvard School of Public Health. 2004. National Survey on Consumers’ Experiences with Patient Safety and Quality Information. Menlo Park, CA: Kaiser Family Founda- tion. [Online information; retrieved 8/28/06.] www.kff.org/kaiserpolls/ upload/National-Survey-on-Consumers-Experiences-With-Patient-Safety-and- Quality-Information-Survey-Summary-and-Chartpack.pdf.

  Hillestad, R., J. Bigelow, A. Bower, F. Girosi, R. Meili, R. Scoville, and R. Taylor. 2005. “Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs.” Health Affairs 24 (5): 1103–17.

  Institute of Medicine. 2001. Crossing the Quality Chasm—A New Health System for the 21st Century. Washington, D.C.: National Academies Press.

  ———. 1999. To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academies Press.

  National Guideline Clearinghouse (NGC). 2006. [Online information; retrieved 8/28/06.] www.guideline.gov/.

  Proctor, P., W. Reid, D. Compton, J. H. Grossman, and G. Fanjiang. 2005. Build- ing a Better Delivery System: A New Engineering/Health Care Partnership. Washington, D.C.: Institute of Medicine.

  Ransom, S. B., J. S. Maulik, and D. B. Nash, (eds.), 2005. The Healthcare Quality Book: Vision, Strategy, and Tools. Chicago: Health Administration Press.

  Senge, P. M. 1990. The Fifth Discipline—The Art and Practice of the Learning Orga- nization. New York: Doubleday.

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  C h a p t e r 1 : T h e C h a l l e n g e a n d t h e O p p o r t u n i t y 17

  Society for Healthcare Strategy and Market Development and American College of Healthcare Executives. 2008. Futurescan: Healthcare Trends and Implications 2008–2013. Chicago: Health Administration Press.

  Wennberg, J. E., E. S. Fisher, and J. S. Skinner. 2004. “Geography and the Debate over Medicare Reform.” Health Affairs 23 (Sept. 2004 Variations Supple- ment): W96–W114.

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  18

  2 CHAPTER

  HISTORY OF PERFORMANCE IMPROVEMENT

  CHAPTER OUTLINE

  Operations Management in Action

  Overview Background Knowledge-Based Management History of Scientific Management Mass Production Frederick Taylor Frank and Lillian Gilbreth Scientific Management Today Project Management Quality Walter Shewhart W. Edwards Deming

  Joseph M. Juran Avedis Donabedian TQM and CQI, Leading to Six

  Sigma ISO 9000 Baldrige Award JIT, Leading to Lean and Agile Baldrige, Six Sigma, Lean, and ISO

  9000 Service Typologies Supply Chain Management Conclusion Discussion Questions References

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728

   

   

  19

  KEY TERMS AND ACRONYMS

  agile Agency for Healthcare Research and

  Quality (AHRQ) Centers for Medicare & Medicaid

  Services (CMS) continuous quality improvement

  (CQI) critical path method (CPM) Deming’s 14 points for healthcare enterprise resource planning (ERP) Institute for Healthcare Improve-

  ment (IHI) ISO 9000 Juran’s quality trilogy just-in-time (JIT) knowledge-based management

  (KBM) knowledge hierarchy Lean

  Malcolm Baldrige National Quality Award

  materials requirements planning (MRP)

  plan-do-check-act (PDCA) plan-do-study-act, a variation of

  plan-do-check-act program evaluation and review tech-

  nique (PERT) service process matrix service typologies single-minute exchange of die

  (SMED) Six Sigma statistical process control (SPC) supply chain management (SCM) systems thinking total quality management (TQM) Toyota Production System (TPS)

  Co py ri gh t © 2 00 8. H ea lt h Ad mi ni st ra ti on P re ss . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er

  U. S. o r ap pl ic ab le c op yr ig ht l aw .

  EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 2/28/2018 3:07 PM via TRIDENT UNIVERSITY AN: 237622 ; McLaughlin, Daniel B., Hays, Julie M..; Healthcare Operations Management Account: s3642728. BHA320 MGT Of Health Programs

NR507 Wk4 Midterm Review

NR507 Wk4 Midterm Review

WEEK 1

1. Cells in _____ may act as a reservoir in which HIV can be relatively protected from antiviral drugs.

2. Which statement is true about fungal infections?

3. What of the following remains a significant cause of morbidity and mortality worldwide?

ORDER ORIGINAL, PLAGIARISM-FREE ESSAY PAPERS HERE

4. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction?

5. Which statement about vaccines is true?

6. What is the role if reverse transcriptase in HIV infection?

7. After sexual transmission of HIV, a person can be infected yer seronegative for _____ months. NR507 Wk4 Midterm Review

8. The class if antibody involved in type I hypersensitivity reactions is

9. What disease involves the deposition of circulating immune complexes containing an antibody against host DNA, resulting in tissue damage? NR507 Wk4 Midterm Review

10. Hypersensitivity is best defined as a(n)

11. What is the mechanism in type III hypersensitivity reactions?

12. Stress-induced norepinephrine results in

13. Which hormone increases the formation of glucose from amino acids and free fatty acids?

14. Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of

15. Which of the following represents the correct nomenclature for benign and malignant tumors of adipose tissues, respectively?

16. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-@) in cell metastasis.

17. Many cancers create a mutation of ras. What is ras?

18. Which if the following cancers originate from connective tissue?

19. Inherited mutations that predispose to cancer are almost invariably what kind if gene?

20. Which characteristic among women correlates with a high morbidity of cancer of the colon, , uterus, liver, gallbladder, pancreas, breast, uterus, and kidney?

21. What congenital malformation is commonly linked to acute leukemia in children?

WEEK 2

1. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the

2. Which enzyme is secreted by the juxtaglomerular cells of the kidney when circulating blood is reduced?

3. Water movement between the intravascular fluid compartment and the extracellular compartment is primarily a function of

4. Physiologic ph is maintained around 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of

5. Which are indications of dehydration?

6. In hyperkalemia, cardiac rhythm changes are a direct result of

7. What is a major determinant of the resting membrane potential necessary for transmission of nerve impulses?

8. Which inflammatory mediators are produced in asthma?

9. ___ is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.

10. Dyspnea is not a result of

11. Which of the following is a true statement?

12. Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of accessory muscles, and tachypnea with prolonged expiration are indicative of

13. The most successful treatment of chronic asthma begins with

14. Clinical manifestations of pulmonary hypertension include

15. Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of ___mmHg.

16. In tuberculosis, the body walls off the bacilli in a tubercle by stimulating

17. Kussmaul respirations may be characterized as a respiratory pattern

18. Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration? NR507 Wk4 Midterm Review

19. Cystic fibrosis (CF) is caused by a(n)

20. An accurate description of childhood asthma is that it is a(n)

21. What is the primary cause of Respiratory Distress Syndrome (RDS) of the newborn?

22. The release of fibroblast growth factor affects ARDS by causing

23. Chest wall compliance in infants is ___ in adults.

24. Which immunoglobulin is present in childhood asthma?

25. Which of the following statements about the advances in the tx of RDS of the newborn is incorrect?

WEEK 3

1. Symptoms of polycythemia vera are mainly the results of

2. Pernicious anemia generally requires continued therapy lasting

3. Clinical manifestations of mild to moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia?

4. In hemolytic anemia, jaundice occur only when

5. A woman c/o chronic gastritis, fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit levels, and a high mean corpuscular volume. These findings are consistent with ____anemia.

6. The underlying disorder of ___ anemia is defective secretion of intrinsic factor, which is essential for the absorption of Vit B12.

7. Which of the following is a description if consistent with chronic lymphocytic leukemia (CLL)?

8. Heparin-induced thrombocytopenia (HIT) is described as a(n)

9. What change is seen in the leukocytes during an allergic disorder (type I) often caused by asthma, hay fever, and drug reactions?

10. What is the most common cause of vit K deficiency?

11. The sickle cell trait differs from sickle cell dx in that the child with sickle cell trait

12. Polycythemia occurs in a fetus because

13. G6PD and sickle cell dx are

14. What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain?

15. In full term infant, the normal erythrocyte life span is __ days, whereas the adult is ___days.

16. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune process involving antibodies against

17. The risk of developing coronary artery dx is increased up to threefold by

18. What is the primary mechanism of atherogenesis?

19. An individual who is demonstrating elevated levels of troponin, creatine kinase (CK), and lactic dehydrogenase (LDH) is exhibiting indicators associated with:

20. Which disorder causes transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?

21. When does most cardiovascular development occur?

22. The foremen ovale is covered by a flap that creates a check valve allowing blood to flow unidirectionally from ___ to the ___ .

23. When does systemic vascular resistance in infants begin to rise?

24. Which congenital heart defects occur in trisomy 13, 18, and down syndrome?

25. What is the most important manifestation of aortic coarctation in the neonate?

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

WEEK 4

1. What primary problem resulting from respiratory distress syndrome (RDS) of the newborn?

2. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganism?

3. How high does the plasma glucose have to be before the threshold for glucose is achieved?

4. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describes the pathophysiologic characteristics of which type of anemia?

5. Which statement is true concerning the IgM?

6. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? NR507 Wk4 Midterm Review

7. The coronary ostia are located in the:

8. Which hepatitis virus is known to be sexually transmitted?

9. The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks or gestation?

10. What is the ratio of coronary capillaries to cardiac muscle cells?

11. What is the most common cause of insufficient erythropoiesis in children?

12. Which term is used to identify the movement of gas and air into and out of the lungs?

13. Perceived stress elicits an emotional, anticipatory response that begins where?

14. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations?

15. Causes of hyperkalemia include:

16. Which criterion is used to confirm a dx of asthma in an 8-year-old child?

17. What is the role of caretaker genes?

18. What is the action of urodilatin?

19. The Papanicolaou (Pap) test is used to screen for which cancer?

20. What is the life span of an erythrocyte (in days)?

21. Hypersensitivity is best defined as a(n):

22. What is the final stage of the infectious process?

23. What is the life span of platelets (in days)?

24. What process allows the kidney to an increase response in workload?

25. Which substance has been shown to increase the risk of cancer when used in combination with tobacco smoking?

26. Hemolytic disease of the newborn (HDN) can occur if the mother:

27. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve spells?

28. How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?

29. The function of the foramen ovale in a fetus allows what to occur?

30. Low plasma albumin causes edema as a result of a reduction in which pressure?

31. In a normal, nonmutant stage, an oncogene is referred to as a:

32. Causes of hyperkalemia include:

33. Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?

34. What is the functional unit of the kidney called?

35. What is the first stage in the infectious process?

36. Which statement concerning exotoxins is true?

37. An infant’s hemoglobin must fall below ___g/dl before signs of pallor, tachycardia, and systolic murmurs occur.

38. What is the role of collagen in the clotting process?

39. Where are antibodies produced?

40. What is the purpose to the spirometry measurement?

41. What is the most abundant class of plasma protein?

42. What is the most important negative inotropic agent?

43. Decrease lung compliance means that the lungs are demonstrating which characteristic?

44. Blood vessels of the kidneys are innervated by the:

45. What are the abnormalities in cytokines found in children which cystic fibrosis (CF)?

46. The generation of clonal diversity occurs primarily during which phase of life?

47. How is most of the oxygen in the blood transported? NR507 Wk4 Midterm Review

48. Fetal hematopoiesis occurs in which structure?

49. What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn?

50. Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever? NR507 Wk4 Midterm Review

SOME MIXED QUESTIONS

1. Raynaud phenomenon is classified as a type III hypersensitivity reaction and is due to:

2. Deficiencies in which element can produce depression of both B and T cell functions

3. During a stress response, increase anxiety, vigilance, and arousal is prompted by

4. Stress-age syndrome results in decreased

5. Which of the viruses below are oncogenic DNA viruses?

6. Which cytokine is involved in producing cachexia syndrome?

7. Childhood exposure to all of the following risk factors increase susceptibility to cancer, except

8. What id the mechanism in type II hypersensitivity reactions?

9. What effect does estrogen have on lymphocytes?

10. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?

11. Intestinal polyps are benign neoplasms and the first stage in development of colon cancer. These findings support the notion that:

12. In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes

13. Tobacco smoking is associated with cancers of all of the following, except

14. In which primary immune deficiency is there a partial to complete absence of T-cell immunity?

15. The effect that low serum albumin has on the central stress response is to

16. How does the loss of chloride during vomiting cause metabolic alkalosis?

17. When thirst is experienced, how are osmoreceptors activated?

18. Why are infants susceptible to significant losses in total body water?

19. In ARDS alveoli and respiratory bronchioles fill with fluid as a result of the:

20. A(n) __ is a circumscribed area of suppuration and destruction of lung parenchyma.

21. Which of the following types of croup is most common?

22. Kussmaul respirations as a respiratory pattern may be associated with which characteristics?

23. What is the fundamental physiologic manifestation of anemia?

24. Which of the following describes how the body compensates for anemia?

25. Local signs and symptoms of hodgkin’s disease-related lymphadenopathy is a result of:

26. __ is the virus associated with Burkitt lymphoma in African children:

27. Which defect produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border with an occasional ejection click? NR507 Wk4 Midterm Review