Patient often has at least some anxietyFear of dia.docx

Patient often has at least some anxiety
Fear of diagnosis
Discomfort with lack of privacy
Fear of high costs/ time off work
Fear of pain or discomfortDifficult for MD’s and nurses
Administrative role to provide a supportive environment
Patient judge medical care based upon their entire experience,
not just physician quality
Parking
Registration
BillingDemeanor of manager may dispel complaints
Listen, empathize, change what you can, however….
Medical decisions are still the MD’s responsibility
Timeliness
Respect that their time is as important as yoursProvider attitude
Happy doctors and nurses, good “bedside manner”Complaints
may be a symptom of a larger problem
Patient anxiety
Financial concerns
Too little time with MDMD didn’t listenStaff was rude,
uncaringWait too longMD took calls during examPoor teaching,

no explanation for testsPoor explanation of billing,
insurancePoor communication between specialist and primary
care
Top complaints revolve around time, respect, and patient
instructionGather facts, information
Remember subjective patient information is only one side of the
story
Patients may be misunderstanding the purpose for tests or MD
decisionsEasier to resolve when organizational systems are in
place
Identification of the problem
Reactive: Complaints
Proactive: Data collection such as surveysAnalyze data to
identify trendsCommunicate information in an impartial way to
staff, leadersImplement actions to reverse trendsContinuous
evaluation to assure effectiveness
Inform patients of why the survey is being done
What the data will be used for
Confidentiality; that answers won’t affect future medical
careProvide a stamped envelope
Put no burden on the patient
If a patient puts their name and a personal note provide a
personal responseCommunicate results to staff
Complaint resolution/ patient relations is an area where an
administrator can make a tremendous impact
May reduce malpractice claimsNeed MD support
Establish peer review processes for MD’s
MD’s should be evaluated by other MD’s

Put in place a formal , objective complaint resolution
systemCommunicate continuously with staff
Hca 346 ambulatory care administration
Professor Haislip
Chapters 3 & 5
Basis of any quality program is to figure out what the customer
wants and needs while meeting or exceeding their expectations.
Driven from theme of customer-driven market
Customer service principles (ex: Six Sigma) and the common
methodologies, combined with the ten commonsense principles
(CSPs) and personal experiences, will deliver a customer-
focused culture.
Figure 3.1
Chapter 3: Engineering the customer connection
Quality Function Development (QFD)- an effective team
approach to designing products and services that involves key
stakeholders from the organizations that are responsible for
what the customer uses or purchases
notably called the voice of the customer
QFD and voice of the consumer refers to development of
prioritized set of customers wants and needs in support of new
program, service, or care delivery systems.
Also works to improve existing programs
Kaizen- improvement
Quality function deployment
Lean improvement methodologies capitalize on the elimination
of waste within work and personal space.
1. Muda- is an activity that is wasteful & doesn’t add value to

the customer or to the organization.
Exercises: profound & concentrate on reducing and eliminating
seven wastes: overproduction, unnecessary transportation,
inventory, motion, defects, overprocessing, and waiting.
Determine what adds value & what doesn’t to clean and
streamline processes.
Ex: eliminating med errors, reducing wait times
2. Mura- refers to inconsistency in process, people, or human
spirit. Just-in-time inventory and systems play a big part in
eliminating mura.
Kanban is an effective way of communicating inventory control.
Tells you what to produce, when, and how much to produce.
Table 3.1 & 3.2
3. Muri- based on unreasonableness or absurdity in work &
system processes. Concentrating on making processes logical is
necessary for success.
Reduces process steps to the simplest elements and knowing
how handoffs and next steps work produces systems that
patients, staff, and physicians can easily navigate
Three types of waste
1. Keep wait times to a minimum
2. Make a good impression
3. Be open and honest
4. Don’t blame the customer
5. Ask questions
6. It’s not a meat market
7. Follow through
8. No Medical Mumbo Jumbo
9. Work as a team
10. Relate to the person
10 commonsense principles
Make a point to know who the customers are for your outpatient

program
Keep customer-mindedness on the agenda when speaking to
staff
Walk in your customer’s shoes. Know what its like to sit in
your waiting room. Are your front desk staff warm and open,
making strong, positive first impressions? Do you project a
healing environment? Is your service setting age appropriate?
Be critical and truly assess your organization from your
customer’s eyes and experience.
Key points
Human Resource Factor in outpatient settings promotes a
preventative and systematic people program that results in
successful outcomes for the patients we serve.
Covers employees, physicians, allied health professionals,
contract workers, vendors, and volunteers
Each group requires different levels of oversights and
management when it comes to meeting state, federal, &
regulatory requirements
Finding and retaining the right people in any organization is
vital
Take time to create well-thought-out policies, procedures, job
descriptions & other documents to adequately articulate what is
expected
Make sure HR links with your mission, vision, & values
Chapter 5:
the human resource factor
Recordkeeping is most important function of any human
resource department
File contains a record of every action that was taken for
employment or credentialing. Keep a file for everyone
associated with facility
Files that concern medical examinations & information,

disability, worker’s comp, and other related items are to be kept
separate
Employee’s HR files include personnel docs related to
employee’s job description & responsibilities, performance
evaluations, employment application, salary adjustments, and
other associated docs
Access should be limited to supervisors or those with regulatory
or legal need
Creating complete hr files
Health Care Quality Improvement Act of 1986
Vendor and contract services can contribute to a quality
program in an outpatient setting
Do due diligence when selecting providers
Contract with a vendor is a legal document. Read each contract
in detail to ensure proposal matches what the contract ends up
saying
Determine who signs contracts. All clinical contract services
need to go before medical staff and governing body for
approval, as they potentially impact patient care
Clinical Contract Employee Requirement & Files
Pg 70-71
Chapter 5: the human
resource factor
OSHA requires that employees & individuals affiliated with the
facility complete training before starting work and yearly
thereafter.
If done correctly, training and education can facilitate a safer
environment, leading to improved and sustained quality
outcomes
Training consists of following:
Infection prevention
Personal Protective Equipment (PPE)

Ergonomics
Workplace Violence
Harassment
Fire Safety
Portable Fire Extinguisher Use
Bloodborne Pathogens
Hazard Communication & Emergency Preparedness
Radiation Safety
OSHA requires businesses keep records showing compliance.
By keeping maintained, should be able to avoid heavy fines that
accompany noncompliance
Hr training to promote safety & quality
Next week: exam 1!
Discussion board due by 5:00pm on FRI. 2/21
study guide posted. Please contact me with questions.
Definitions of service or outputs:Value= providing the most
effective and appropriate care given the available
resourcesEfficacy=ability to produce the desired
effectAppropriate=applied to the right patient at the right
timeEffective=combination of efficacy and appropriateness
Definitions of organizational performance:Productive=ratio of
outputs to inputsEfficient=costs per unit of output

Brought in the patient experienceSafeTimely EffectiveEfficient
EquitablePatient centered
5 interrelated domains:Consumer satisfactionEmployee
satisfactionWorkforce stabilityClinical outcomesRegulatory
performanceRegulation is a legal mandate for minimum level of
qualityAccreditation aims for a higher standard
A difficult aspect of quality
managementStructureProcessOutcomeReliance on structure and
process due to difficulty in measuring outcomesAre outcomes
always related to structure and process?
Stakeholders may want emphasis on what they have most
control
of:Management=structureProviders=processClients=outcomesCh
allenge to account for factors outside of provider controlWhat is
the ‘baseline’ or starting pointWhat is influenced by factors
apart from the organization
Quality assurance focuses on eliminating poor providersHas
resulted in a documentation driven system; providers need to
“cover themselves”Little effectiveness, a minimum
standardLittle focus on changing processesQuality improvement
seeks to continuously move forwardDemands cultural change
and engaged leadership
Key concepts:Organizational work is process driven Quality is
obtained by altering processesThe customer is centralLack of

quality is costlyInvolve every workerSet high standardsFocus
on priorites
Management that lacks focusLittle feedback or rewards for
progressDifficulties of culture change decrease moraleLack of
time for QI activitiesOnly involving upper
managementEvangelistic devotion to QI, irrationality
What is assessed and why based upon the purpose (mission) and
future goals (vision) of the organizationEx: a organization
designed to produce cars would rely heavily on measures of
efficiencyManagers balance between a business model and
meeting a larger social needAlso level of openness and
interconnectednessInternal and external measures of
improvement
Motivate Set criteria for evaluationLegitimize
activitiesRemember the balance between organizational goals
and legitimized means; are all activities working toward the
goal, or have some become ritualSend a message to those
outside the organization
What is measured should reflect organizational goalsShould be
easy to answer the “ why” questionsNeed to know which
stakeholders are getting the informationPhysicians want
different info than consumersHealth care organizations may
perform well in one domain, poorly in anotherNeed a
representative view
Remember complexity theory…Improving each subunit may not

improve the whole; based in interaction between the partsSmall
changes can have large effectsMeasurement should assess the
big picture, not is lab meeting it’s productivity goals but is the
patient experiencing a quality experience
Goals may be incompatibleEfficiency versus customer
satisfactionRestraints: safety or QOLSome change may be
ineffective currently but needed for future
adaptabilityPreventative carePresence of subunits that are
affected differently by QI
Multiple StakeholdersSome more powerful than othersNeeded
peer review among physiciansHx of MD’s evaluating MD’sCan
lead to dual lines of authorityNeed for both standardized
procedures and procedural flexibilityMost measures do not
address the complexity of the care giving situationFrustrating
for employees
Well trained professional staffHigh organizational
standardsExperienceCoordination of professional staffs,
including conflict resolution proceduresCulture of employee
participation, diverse inputTimely and accurate feedback Active
management of work environmentCompensation mechanisms
Assess for areas of needed improvementFacilitate team
approaches to change, diverse inputAllow professionals
flexibilityAssure adequate resources for data collection and
analysisReward performanceDon’t blame individuals, however,
for process failuresMaintain outside relationships to acquire
resources

Know:Why get accredited?What do you need to be eligible for
accreditation?
Understand:Standard=the goalRationale=why the goal is
importantElements=process to meet goalThe survey process4
steps to gather information
Hca 346 ambulatory care administration
Professor Haislip
Ambulatory services, for the “walking patient”, have the most
contact with patients
Part of the evolution of the health care system reflects changes
in the role of the physician. Used to be a supporter and
occasionally effective curative interventions. Today, role is to
treat symptoms and cure diseases
With the dramatic changes in diseases over time, doctors are no
longer able to carry their supplies in a little “black bag” and
move from home to home. Rather, they need advanced
institutional support to cure disease
Overview of Ambulatory care:
Ambulatory care encompasses all services used by the
noninstitutionalized patient
Central role is the initial and continuing point of contact with
the health care system
Continuing= follow-up, routine, ongoing care, and referral
source for specialized services
Especially important component= primary care
Serves to provide coordination, rationalization, and rationing of
healthcare (gatekeeper)
Important for managed care

Don’t want you to go directly to a specialist
Group Practice- affiliation of providers, usually physicians, who
share incomes, expenses, facilities, equipment, medical records,
and support through a formal, legally constituted organization
Group practice came about due to :
Increased specialization in medicine (one person couldn’t be
specialized in all areas)
Formal structure for sharing costs
Promote high-quality care, because group members able to
discuss patient problems
Physician advantages (more flexible hours, less financial risk)
Growth in HMOs since the 1980s also impacted
Managed care works with contracts. Easier to contract with
groups than individuals
Hospital moved throughout history to a provider of full range
health services, from primary to tertiary care (services have
expanded and multiplied)
This increased demands on hospital and lowered their ability
respond with the resources they possessed
Thus, most have responded by expanding outpatient services
and hiring full-time providers to staff redesigned hospital
ambulatory facilities
Also, ambulatory surgery centers developed for one-day
surgical care
Patients are screened by surgeons then assigned a date for
surgery
Patient is discharged 1-3hrs after surgery when anesthesia
recovery is complete

Some physicians used to do surgery in their office, but stopped
after malpractice suits (oral, plastic, and ophthalmology
surgeons still do)
Furthers the need for group management practice
-What characteristics should a healthcare executive possess?
- How important is patient safety from a healthcare executive
perspective?
- Why should staff engagement start at the top?
Discuss last week’s article:
Measuring what matters is fundamental because success, failure,
and mediocrity are identified only when using a measurement
program
Necessary for formation & continuation of effective and high
performance quality & safety program
Scorecard measures need to be aligned with mission, vision, and
values of organization
What is learned from data helps leaders with their future
strategies
Some data is not numerical
Ex: customer murmurs (“It would make my life easier if you
were open on Saturdays.” “Why does it take so long to get an
appt?”)
Murmurs are an example of very valuable feedback
Chapter 6- measuring quality & safety
Induction and deduction are both needed for critical thinking
and logic
A scientific method consists of the collection of data through
observation and experimentation, and the formulation and

testing of hypotheses
Common method in healthcare:
PDCA cycle (plan, do, check, and act)
Figure 6.1 & Figure 6.2
Induction, deduction, & scientific method
8
Figure 6.3-6.8 show the results of a study initiated by staff
members to reduce patient cancellations.
Figure 6.8- shows significance because the p value is less than
.05
Figures 6.5 &6.7 lend important information regarding the days
of the week which cancellations occurred most frequently,
helping to point improvement efforts in the right direction
Case study
When creating a scorecard, think about what’s important from
financial, operations, salaries & benefits, clinical, customer
feedback, benchmarking, regulatory, licensing, and safety
perspectives
All are important, but keep it streamlined and consistent
Figure 6.9- sample scorecard
Once collect data, reuse but input a timeframe (months or
weeks) so you can compare results within an organization
Lists of example measures on pgs. 88-92
Sample: Financial measures:
Profitability
Revenue per patient
Rate per case by specialty and procedure type
Cost per case by physician

Payor mix
Supply cost
Collections as a percent of billings
Scorecards for outpatient services
Many times in healthcare, practices, leaders, employees,
physicians, and shareholders are rewarded based on results of
the measures put into place.
Thus, if scorecard results are used to financially reward, its
important to develop a nonbiased approach
Also needs to include some type of audit approach
Weave in checks and balances and do not leave in the hands of
one
Rewarding based on performance
Next week:
Chapters 3 & 5
HCA 346
Ambulatory Care administration
Keep structure simple.
No need for layers of committees or layer of employees
Ambulatory programs benefit from being small
Employees & physicians must play many roles
Pick the right people
Tie your quality strategy to your mission, vision, and values
Susan G. Komen for the Cure

If mission, vision, and values are nonexistent, engage a
committee to create your purpose, direction, and beliefs
Table 2.1
Chapter 2: Creating a structure for quality & safety
To meet MCR, licensing, and other guidelines, most ambulatory
clinics should have a governing body that takes on full legal &
fiduciary responsibility for policies that govern the program’s
operation and to ensure that policies are in implemented &
administered so that high quality & cost-effective care is
delivered in a safe environment
Table 2.2
Creating a structure for quality & safety
A physician or group of physicians may own the ambulatory
service program, but identification of someone to serve as an
administrator or manager is crucial for success
Governing body must clearly communicate expectations and
updates the expectations to match changing environments
Expectations should include: measurement results from
physicians, financial viability & profitability; clinical & quality
measures, and growth & business development
Figure 2.1 & Table 3.3
To keep the number of committees low, combine the Medical
Executive Committee and the quality committees.
Leader selection
When an outpatient program allows physicians and
nonphysicians practice within the services provided, the
guidelines for privileges and membership need clearly outlined.
Physician must agree to directly supervise these non-physician
providers & that all will work in the scope of their licenses

Sanctions for practicing outside limits
Nurses must not complete tasks outside the scope of their
license
The defined scope and services of the program defines what can
and cant be done in each facility where the practitioner will
practice
Health professionals
Numerous ways to set up quality studies, reporting, and
outcome measures
In order to set up,
First, define scope
Then define what categories require ongoing measures,
preventative strategies, and innovation opportunities exist
Finally, implement strategies
Categories for quality programs include:
Preventative quality efforts
Medication safety and practices
Utilization management of resources
Infection prevention
Surgical and procedural case review
Clinical documentation
Medical staff processes and peer review
Competency, skills training, and knowledge based assessments
See complete list on pg. 31
Quality program topics
Staying true to your mission, vision, and values
Ex: Dolly Parton
Important to provide easily readable and comprehendible
documents for your staff and patients
Written documents should reflect the organization’s mission,
vision, and values. If written correctly, policies and procedures
will help improve, sustain, or revamp processes within an

organization.
Procedures represent a realization of policy & will vary over
time
Policies replicate the standards governing the execution of the
facility’s processes
Plans offer a series of steps. Attached to goals and define what
the organization is to accomplish
Chapter 4: policies, procedures & plans
Users of documents include clinical and nonclinical staff, and
customers of services
Make widely accessible
Don’t reinvent the wheel. Use other resources to create
documentation
Users of policies & plans
When outpatient service is accredited, licenses, or given status
by Medicare, document review is required
Evaluate policies, procedures, and plans yearly if possible
If documents are kept electronically, allowing easy access for
staff and physicians, make sure you have at least one hard copy
available
Assess any written document against a set base of criteria such
as:
Application to your mission, vision, & values
Necessary to meet state, federal, or regulatory requirements
Need to enhance competency
Requirement to define quality and safety for the organization
Ability to guide employees and physicians on how to care for
patients
Documents to create and have on hand

Read chapters 2 & 4 with this lesson and complete the
Discussion Board homework assignment
HCA 346
Ambulatory Care administration
Professor Haislip
What is the difference in Acute care & ambulatory care?
2
Two myths about Outpatient care (in comparison to Acute Care)
Easy & Safe
Any provider can do it
Instead, rich with quality offerings, accrediting agencies, &
leadership credentialing to promote excellence.
Overall, still needs more investment in mandatory licensing,
standards across states, & outpatient service lines
But the hope is that consumers will use the information they
receive to only choose the best, thus ridding the industry of
subpar care
Preface
Apprehension, uncertainty, waiting, expectation, fear of
surprise, do a patient more harm than any exertion. -Florence
Nightingale

Easier to take the “Bad Apple” Approach- reacting only to
errors & bad outcomes
Crisis Management
Poor Communication
Ostrich quality- burying head to avoid tough issues
Groupthink behavior
Apple Pie Strategy is using “Good Apples” (good qualities) to
make the most desirable pie.
Prevention is practiced
Process oriented
Innovated, passionate, realistic
Huddles daily with staff
Benchmarks against the best of the best
Don’t waste time putting bad apples in your apple pie
Bad apples & apple pie
Outpatient Care
Growing rapidly
Movement of care from inpatient to outpatient
More than 1billion outpatient encounters every year (National
Quality Forum)
Quality
Wide variation in quality practices
Inconsistent oversight by regulatory, licensing, accreditation &
benchmarking agencies
Mostly rely on honor system
Economic prosperity depends on reducing variations, improving
efficiencies, & implementing predictive models
Chapter 1:
Defining outpatient healthcare

What are some outpatient services?
Consists of treatment performed without requiring an inpatient
stay
Also known as ambulatory care
Settings:
Ambulatory Surgery Centers (ASCs)
Minute clinics
Urgent Care Facilities
Physician practices
Imaging centers
Oncology centers
Dialysis centers
Homecare
Freestanding emergency centers
Endoscopy centers
Chiropractors
Aesthetician and health spas
Emergency departments
outpatient services
Centers for Disease Control and Prevention (CDC) & National
Center for Health Statistics (NCHS) conducts surveys of
healthcare providers and facilities, including hospitals,
ambulatory surgery centers, and physicians.
The results have shown the following:
Steady increase in ambulatory visits
Need for medication therapy (need for continuum of care)
Individuals can obtain in several sources. Can lead to drug
interactions and overdoses
Increase by 300% in freestanding Ambulatory Surgery Centers
since 1996
Due to demonstrated efficiencies, ease of access, and
attractiveness to consumers

National health Statistics reports
Ambulatory Medical Care UtilizationResultsRate of Visits
(annually in 2006)1.1 billion visits to physician offices, EDs,
hospital outpatient deptsVisit rates to medical specialty
offices29% increase from 1996-2006Hospital outpatient
department visitsFrom 25.4 per 100 persons in 1996 to 34.7 in
2006Emergency Dept. VisitsIncreased from 34.1 per 100
persons in 1996 to 40.4 in 2006Ambulatory Care Visits18.3% of
all visits in 2006 were for conditions such as routine checkups
& pregnancy examsMedications7 of 10 ambulatory visits had at
least one medication provided, prescribed, or continued in 2006.
Amounted to 2.6billion overall
National health Statistics reports
National health Statistics reportsAmbulatory Surgery
UtilizationResultsRate of visits to freestanding ASCsIncreased
300% from 1996-2006Rate of visits to hospital-based surgery
centersRemained unchanged from 1996-200634.7million ASC
visits w/53.3 million surgical & nonsurgical procedures
performed in 2006Of those, 19.9million occurred in hospitals
and 14.9 in freestanding ASCsGenderFemales had significantly
more ASC visits at 20million versus 14.7 million for
malesDischarge disposition93.1% routine discharge w/.8%
admitted as inpatients for 2006PayorsMore than half of
outpatient surgery visits were paid by private insurance
54%ProceduresProcedures performed most often in an ASC:
endoscopies of the large & small intestine
Payors are pressuring for reduction of costs
Consumers are demanding more outlets
Technology & medications will continue to evolve
Hard to handle the above without improved quality measures!

Why?
Need for stronger quality programs
Outpatient programs are attractive to physicians and
administrators because of:
Advanced technology, speed, improved medication options,
shorter medical procedure duration, and cost effectiveness
But it’s not highly supported by payor sources
The goal is to demonstrate superb quality & financial outcomes.
Then, it would be appealing to a wider provider and payor base.
Think about any situation where quality matters. You buy
something at the store. Would you buy that item again if it was
junk? If you had heard negative feedback or had a negative
experience with a service provider would you go back?
Insurers are the same way. They don’t want to pay for
outpatient services, if the person is just going to end up in the
hospital for a medical error or “bad” job.
Quality begins at the facility level!
Outpatient quality initiatives
The Hospital Outpatient Quality Data Reporting Program ( HOP
QDRP) includes 7 clinical performance and 4-MCR fee-for-
service claims-based measures.
So that facilities can increase their payment rate from
Outpatient Prospective Payment System (OPPS), hospitals must
publically report this data using standardized measures to CMS.
Intent of CMS is to provide consumers with data so that better
decisions can be made about healthcare choices and care at the
hospital level
Doesn’t apply to freestanding clinics
Examples: Pg. 7
Cardiovascular disease

Aspirin at arrival
Median time to electrocardiogram (ECG)
Cms outpatient initiatives
Healthcare reform initiatives are looking at improving
efficiency & effective care models for outpatient services
What is an ACO?
If successful, ACOs will push inpatient & outpatient entities
together to share MCR reimbursement
Savings for MCR
Quality & safety is necessary to make outpatient programs
affordable & accessible
Why????
Ambulatory care & health reform
Accountable Care organization- part of health reform 2010. A
local network of providers that can manage the full continuum
of care of patients, with the goal of improving health quality
outcomes & reducing healthcare costs. It is believed by some
that an ACO could change the healthcare system because ACO
healthcare provider participants would receive payment for
improving the quality of healthcare & reducing costs
14
National Quality Forum endorsed 34-medical safe practices
Errors that create & contribute harm are due to:
Organizational system failures
Leadership failures
Predictable human behavioral failures
Must stop & think before doing!
Ex: foot in mouth when speaking
How can we cut down on errors?
Safe practices for better healthcare

Answers:
Creating & sustaining a culture of safety
Informed consent, life-sustaining treatment, disclosure, and care
of caregiver
Facilitating information transfer & clear communication
Medication management
Prevention of healthcare-associated infections
Condition and site-specific practices
15
Check out the website for the Kentucky Ambulatory Care
licensing
Website located in Appendix I
Find and Read the Kentucky Regulation on Ambulatory Surgery
Centers
101 Facility specifications; ambulatory surgical center
Assignment for next class:
This is 1 exam
Patients judge medical care based upon their entire experience,
not just physician quality

· Question 2
4 out of 4 points
Ambulatory Care involves several different settings. Name four
types of outpatient/ambulatory care facilities.
· Question 3
2 out of 2 points
Which of the following is not included in the PDCA cycle?
· Question 4
2 out of 2 points

Users of documents in a facility include:
· Question 5
5 out of 5 points
Why is important to have a governing body?
· Question 6
2 out of 2 points
Why is there a need for stronger quality programs?

· Question 7
2 out of 2 points
Nurses may complete tasks outside the scope of their license as
long as the physician requests it.
· Question 8
2 out of 2 points
Written documents should reflect the organization’s mission,
vision, and values.

· Question 9
2 out of 2 points
Ambulatory care encompasses all services used by the non-
institutionalized patient.
· Question 10
5 out of 7 points
What characteristics should a healthcare executive possess?
How important is patient safety from a healthcare executive
perspective?
· Question 11
2 out of 2 points

______________ simply means improvement.
· Question 12
2 out of 2 points
Lean improvement methodologies capitalize on the elimination
of waste within work.
· Question 13
18 out of 25 points
–Three part question! You must answer all three for full credit.
As a healthcare manager, it is likely that you will be in contact

with an unhappy patient at one time. 1). Name 5 of the Top 8
customer complaints. 2). How would you go about handling
these complaints as the manager of an ambulatory care facility?
3).What procedures and characteristics would you include in
your facility’s complaint management system?
· Question 14
2 out of 2 points
Which does not make clients happy?
· Question 15
2 out of 2 points
_______________ replicate the standards governing the
execution of the facility’s processes.

· Question 16
2 out of 2 points
Apple Pie Strategy is using “bad apples” to react only to errors
and bad outcomes.
· Question 17
2 out of 2 points
A contract with a vendor is a legal document.

· Question 18
2 out of 2 points
Employee HR files should include all of these items, except:
· Question 19
2 out of 2 points
Which of these does not make measuring quality difficult?
· Question 20
2 out of 2 points

It is not necessary to identify a leader to serve as the manager
of a group practice of physicians.
· Question 21
5 out of 5 points
What does OSHA do in healthcare facilities?
· Question 22
2 out of 2 points
Which of following acts as the gatekeeper to care?

· Question 23
2 out of 2 points
Group practice came about due to:
· Question 24
2 out of 2 points
The central role of ambulatory care is the initial and continuing
point of contact with the health care system.

· Question 25
2 out of 2 points
What needs to be in place for rewarding based on performance
to work?
· Question 26
2 out of 2 points
Outpatient services are attractive to physicians because
· Question 27
2 out of 2 points

Quality Improvement includes all of these concepts, except:
· Question 28
2 out of 2 points
Why did physicians stop performing surgery in their offices?
· Question 29
2 out of 2 points
The role of today’s physician is to be a supporter and
occasionally effective curative interventions.

· Question 30
3 out of 4 points
Some data is not numerical. What are Customer murmurs and
why are they so important?
· Question 31
2 out of 2 points
In lean improvement concepts, which is not a type of waste?

Friday, November 18, 2016 7:33:16 PM CST
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