Train Yourself

1- A medication is ordered for a diabetic patient. Its capacity to improve health

status, as a Dimension of quality or performance, is it

a. effectiveness.
b. potential.
c. appropriateness.
d. efficacy.

2- If in the continuous improvement process, we increase our emphasis on

customer satisfaction and outcomes of care, which two dimensions of
quality/performance must be incorporated into all quality management activities?

A. Availability and respect/caring.

B. Respect/caring and competency.
C. Effectiveness and respect/caring.
D. Continuity and competency.

3- When JoEllen evaluates how many people in her facility's managed care plan
were able to receive the flu shot. She is evaluating, under Dimensions of
Performance

A. appropriateness.
B. availability.
C. effectiveness.
D. efficacy.

4- When JoEllen evaluates how many people in her facility's managed care plan
were happy with the service received while receiving the flu shot, she is
evaluating, under Dimensions of Performance,

A. effectiveness.
B. efficacy.
C. respect and caring.
D. safety.
5- JoEllen Smith is determining how many clients still became sick from influenza
after receiving flu shots at her facility. Under the Dimensions of Performance, she
is evaluating

A. appropriateness.
B. timeliness.
C. efficacy.
D. safety.

6- "Appropriateness" of care refers to:

a. The degree to which the care is accessible and obtainable

b. The degree to which needed care is provided to the patient at the most beneficial
time
c. The degree to which care provided is relevant to the patient's clinical needs
d. The coordination of needed healthcare services for a patient among all
practitioner and across various settings

7- That dimension of quality/ performance that is dependent upon evaluation by

the recipients and/or observers of care is:

a. Respect/caring.
b. Safety.
c. Continuity.
d. Availability.

8- Avoiding waste, in particular waste of equipment, supplies, ideas, and time

actualize which quality dimension:

A-effectiveness.
B-efficiency.
C-appropriateness.
D-efficacy.

9- Avoiding injuries to patient from care that's intended to help them is:

A-patient-centeredness.
B-equity.
C-safety.
D-timeliness.

10- The perception of quality by a patient receiving care in an ambulatory

healthcare center is influenced most by

a. The physical environment.

b. Caring staff and physician.
c. New technology.
d. The physician's technical competence.

11- When an employer contracts with a health plan or directly with a provider, this
employer should be concerned about which of the following perspectives:

a. The cost of the care provided

b. The quality of the care provided
c. The outcomes of the care provided
d. All of the above

12- The dimension of quality/performance that is addressed by introducing a rapid

response team in a hospital is
A. Continuity of care.
B. Efficiency.
C. Effectiveness.
D. Prevention and early detection.

13- Which of the following is an example of patient-centered care?

a- Bedside rounds
b- Using two patient identifications
c- Pre-printed discharge instructions
d- Age based dosing

14- What is the most important relationship between structure, process, and
outcome as types of indicators of quality?
a. Interdependent: Structure directly affects both process and outcome
b. Causal: Structure leads to process and process leads to outcome
c. Relational: Useful for comparisons, but not causal
d. There is no relationship; they are categories used to group indicators

15- Which of the following is the BEST definition of process?

A. The steps required to provide care.

B. A series of steps that achieve a desired outcome.
C. Patient care activities.
D. Technical aspects of providing care.

16- Which of the following does an outcome indicator measure?

A. What happens as result of a process.

B. The steps leading to process.
C. Individual performance of the process.
D. Priority area to improve the process.

17- Which of the following best describes the successful outcome of the quality
improvement process?

a. Customer satisfaction.
b. Enhanced communication.
c. Employee empowerment.
d. Improved statistical data.

18- If a hospital has a problem with multidisciplinary teams performance during

CPR , what is the best method to assess the problem?

a- Observe the process.

b- Review the hospitals code policy.
c- Survey the staff.
d- Review medical record documents.
19- In health care organization, the quality department developed an indicator to
measure the commitment of the staff to Myocardial infarction guidelines .This
indicator measure:

a. Process.
b. Structure.
c. Culture.
d. outcome.

20- Outcomes as used as indicators of quality are defined as any of the following
except:

a. Changes in health states.

b. Changes in knowledge or behavior pertinent to future health states.
c. Provide report of what is the organization is doing now.
d. Satisfaction with healthcare.

21- Nurse to patient ratio is an example of what type of measures?

A- Structure.
B- Process.
C- Outcome.
D- Monitoring.

22- The quality improvement team finds high needles sticks in emergency
department. Who should the team share this information with?

A- ED staff
B- medical staff.
C- medical executive committee.
D- Quality council.

23- Which of the following monitors provides patient outcome information?

a. Healthcare-acquired infection rate

b. Nursing care documentation compliance
c. Antibiotic therapy discontinuation compliance
d. Equipment malfunction rate

24- Effectiveness of performance improvement program best assessed by:

A- Patient satisfaction
B- Staff competencies
C- Guideline compliances
D- Organizational culture

25- Preliminary data shows increase medical errors in a unit. What should be
initially done?

A. Review technology and medication

B. Analyze the delivery process of care
C. Close the unit till change finishes
D. Ask for advice from other successful units

26- The primary goal of quality/performance improvement is to improve

a. Patient care processes.

b. Patient safety.
c. Patient outcomes.
d. Patient satisfaction.

27- In developing a program to evaluate the effectiveness of physician care, a

primary care clinic would select which one of the following indicators?

a. The patients will express overall satisfaction with clinic facilities.

b. The contract lab will provide results within 24 hours of sample delivery.
c. The staff complies with all infection control policies and procedures.
d. Newly diagnosed hypertensive patients are controlled within 6 months.

28- All of the following is positive patient outcome except:

A- Decreased complication.
B- Improved clinical & health status.
C- Reduced infection rate.
D- Decreased LOS

29- There were a large number of late visits for home care. The quality
professional wants to talk to the home care nurse at this problem. What is the best
approach?

A- Explain the cause of the problem and ask for solution

B- Describe the problem and ask for feedback
C- Share his home care experience
D- Blame her for this issue and require her justification

30- Which of the following is example of outcome measure:

A. Mortality rate.
B. Average LOS.
C. Medication dispensing rate.
D. Lab specimen

31- Customer survey gives score of 1-5 (1 dissatisfaction & 5 very satisfied) found
that customer satisfaction of pain management is 1.4, the benchmark score is 3.2,
what the healthcare quality professional should recommend:

A- Design full pain management program

B- Educate pain management all over the organization
C- Link with internal medicine department
D- Continue measuring for customer satisfaction

32- The medical record manager reports that authentication of verbal orders occurs
25% of the time , as compared to a reported 85% in situations ,which of the
following is the initial action for the manager to take ?

A- Recommend continued measurement of the indicator.

B- Share the data with the medical staff
C- Organize a PI team
D- Recommend improvement strategies
33- A policy for time-out in the OR was initiated in the first quarter. In the second
quarter the data has 40% compliance with all elements of the process. The first step
the quality council should take is to:

A- Examine if the policy is clear and user friendly

B- Ask the nurses to identify the non-compliant surgeons
C- Continue to audit to confirm that problems exist
D- Create a letter for CEO to send to all surgeons

34- Review of the timeliness of high risk screening for diabetes addresses which
focus?

a. Outcome of care
b. Process of care
c. Structure of care
d. Administrative procedure

35- In implementing a care bundle for the management of acute myocardial

infarction, the recording of the extent to which smoking cessation counseling is
provided is a measure of

A. Structure.
B. Process.
C. Outcome.
D. Process and outcome

36- The performance indicator, “Total unscheduled inpatient admissions following

ambulatory procedure (within 48 hours)” is a measure of

a. Structure.
b. Process.
c. Outcome.
d. Process and outcome.

37- The number of designated women receiving breast cancer screening

(mammograms) in the reporting year measures
a. Structure.
b. Process.
c. Outcome.
d. Process and outcome.

38- Measuring the time it takes a nurse to perform a procedure addresses which of
the following aspects of care?

A. monitoring
B. process
C. outcome
D. structure

39- One of the aims in the treatment of severe community-acquired pneumonia is

to maintain an oxygen saturation of >94% (or 88 - 92% in patients with chronic
obstructive airway disease). Ensuring adequate oxygenation for this condition is a

A. process and outcome measure.

B. structure measure.
C. process measure.
D. outcome measure.

40- In health care organization, the quality department developed an indicator to

measure the commitment of the staff to myocardial infarction guidelines .This
indicator measure:
A. process
B. structure
C. culture
D. outcome

41- In an improvement project to reduce the wait times in an Emergency Room,

the time taken to be assessed by a physician is

A- a process measure.
B- an outcome measure.
C- a structure measure.
D- not a suitable measure.
42-Monitoring phlebitis associated with IV insertions by nurses in the Surgical
Intensive Care Unit addresses which focus?

a. Outcome of care
b. Process of care
c. Structure of care
d. Administrative procedure
43- Monitoring the specific organization and content requirements of a medical
record system is a review of which focus?

a. Outcome of care
b. Process of care
c. Structure of care
d. Administration of care

44- Complaint analysis is most useful identifying which of the following?

A. Adherence to standards
B. Quality of the services rendered
C. Competence of personnel
D. Customer expectations

45- After defining "internal" and "external" customers, your organization is

making a master-list of each type of customer before initiating a major change
process. Of the following, which is the best next question to ask of staff?

a. Who do you receive services from?

b. Who in your work day do you serve?
c. Which patients receive your services?
d. How do you know a customer from a supplier?

46- For which aspects of care are patient-reported measures most credible?

A Communication between providers

B Patient-provider interactions
C Adherence to clinical practice guidelines
D Appropriateness of therapy
47- Healthcare purchasers and payers are demanding that providers demonstrate
their ability to provide high quality patient care at fair prices. Specifically, they are
seeking:

A. Objective evidence that hospitals and other healthcare organizations manage

their costs well
B. Current performance
C. Baseline information
D. Objective evidence that hospitals and other healthcare organizations satisfy their
customers and have desirable outcomes

48- Information about customers can be obtained from all of the followings except:

A- Complaint logs
B- Managerial observations
C- Satisfaction survey
D- Employee's opinions about customer's attitude

49- The primary purpose of the survey is to measure

A. Patient expectations
B. Capacity of the process
C. Competence of the staff
D. Utilization appropriateness

50- An organization that is committed to a culture of team-work, collaboration, and

adaptability is referred to as having

A. A learning culture
B. An open culture
C. A just culture
D. A reporting culture.

51- The chief executive officer "CEO" of healthcare organization has requested a
recommendation for the most effective method of assessing the organization's
readiness to adopt CQI, which of the following methods should CPHQ
recommend:

A- Review aggregate results of employee performance appraisals

B- Hire a consultant to conduct personal interview of staff
C- Conduct leadership ‘‘walks through'' of the organization
D- Administer surveys to evaluate organization culture

52- To allow change to be maintained, you should ensure the change in:

A. The culture within the organization

B. The hierarchy of the organization
C. The values within the organization
D. The reward system

53- Evidence of strong organization culture:

a- Employees commitment to mission and vision
b- Employees participate in CQI activities
c- Leaders pass the organization values to staff
d- Invite physicians to participate in quality activities

54- The most effective role of a healthcare quality professional as a facilitator of

change to quality culture in the organization is:

a. Education of leaders
b. Education of staff.
c. Evaluation of performance.
d. Designing processes

55- Education and training of all employees in quality management principles must
be done continuously in order to:

A- Prepare the staff for management positions

B- Motivate the staff around central theme of improvement
C- Document staff training to improve reimbursement rates
D- Train the staff to become technical and competent in their jobs
56- When there's uncertainty about the outcome of the process with presence of
guidelines and experienced staff, the process is considered as:

A- Complicated
B- Complex
C- Simple
D- Flexible
57- Mortality reviews are a critical element of risk management and quality
improvement, conducted to determine

A. if the practitioner(s) involved was/were appropriately licensed and credentialed.

B. if treatments and patient care were adequate and appropriate.
C. who was responsible for the mortality and what disciplinary actions need to be
taken
D. what the unit staff was doing at the time

58- To achieve excellence of care under TQM philosophy, healthcare organizations

must ensure:

A. Cautious use of minimal standards of care.

B. Meeting minimal standards of care.
C. Ignore minimal standards of care.
D. Working with minimal standards of care.

59- Which of the following management approaches would be MOST likely to

harm-quality improvement initiatives?

A- A quick fix from quality improvement

B- CQI to save the organization money
C- Organization-wide involvement in QI
D- Role change throughout the organization

60- Total quality management philosophy assumes that

A. most problems with service delivery result from systems difficulties

B. frequent inspection is necessary to improve quality.
C. most problems with service delivery result from difficulties with individuals.
D. top management leadership in quality activities disenfranchises employees.
61- The major difference between traditional "quality assurance" activities and the
expanded quality improvement/performance improvement activities is the QI/PI
focus on

A. people and competency.

B. analysis of data.
C. performance measures.
D. systems and processes

62- Management using quality improvement principles should emphasize the

importance of

A. Staff orientation.
B. Customer expectations.
C. Quarterly statistical reports.
D. Team development.

63- Under the quality improvement paradigm, which statement is incorrect?

a. The focus is on the competency of individual practitioners.

b. The focus is on the efficacy and effectiveness of processes.
c. The focus is on the patient.
d. The focus is on organization performance.

64- Incorporating TQM key concepts, compartmentalization of QM/QI activities

by organizational structure, i.e., by department or discipline, is

A. a weakness in implementing quality improvement.

B. the most efficient structure.
C. consistent with TQM philosophy.
D. important for preservation of medical staff autonomy.

65- The paradigm shift is:

A. change the reframe of thinking.

B. improve the monitoring measures.
C. increase the standards.
D. use the recent in medicine and technologies.

66- Organizational culture is best defined as:

A. assumptions about individuals and how work gets done

B. ethnic make-up of employees
C. provision of activities to employees such as National Nurses Week
D. professional development of employees

67- Health care organization is complex system. In complex system all of the
following are right except:

A- The interrelationships between agents are most important

B- The outcome is predictable
C- Dealing with complex system require understanding the big picture
D- Here's a high chance for variation that may be identified as error or innovation

68- All of the following leads to powerful culture for quality improvement except

A- Consider sharing of the staff to quality activities at the time of reappointment.

B- Align reward to behavior support activities.
C- Face the resistance to quality by strict action.
D- Integrate quality improvement into strategic planning.

69- The Pareto rule is which of the following?

A. 80% of QM activities are wasted.

B. 80% of the problems have 20% of the impact.
C. 20% of the problems have 80% of the impact.
D. 20% of the costs reap 80% of the benefit.

70- All of the following conditions contribute to system improvement except

Measuring
A- Performance of processes & their outcomes using valid statistics methods
B- Taking action to improve the way the processes are designed & carried out
C- Studying & understanding the complex process that contribute to care
D- Identifying & responding to individual performance issues

71- Which of the following is most important to the successful implementation of

quality improvement activities?

a. Financial commitment and written quality management plan

b. Leadership commitment and organizationwide collaboration
c. Leadership commitment and financial commitment
d. Information management and department collaboration

72- A hospital generally has a unique structure comprised of a "triangle." Which

three entities make up the triangle?

a. Governing body, administration, finance

b. Administration, department managers, medical staff
c. Governing body, administration/management, medical staff
d. Administration, medical staff, nursing

73- The leadership style that is said to motivate employees, and that optimizes the
introduction of change, is

A. autocratic
B. consultative
C. participatory
D. democratic

74- The authority and responsibility of each level of the organization with respect
to quality management mechanisms must be specified in the

A. administrative policies and procedures

B. medical/professional staff bylaws
C. corporate bylaws
D. organizational plan for the provision of patient care
75- In participative management the manager

A. relinquishes decision-making responsibility to the staff

B. retains the final decision-making responsibility
C. presents a final decision to the staff
D. permits staff participation only with noncritical issues

76- In a crisis situation, when a manager must make a rapid decision, the most
effective leadership style is

A. consultative
B. participatory
C. autocratic.
D. democratic

77- Which of the following is the major responsibility of senior management

regarding continuous quality improvement?

A. Communicate the organizational mission and values.

B. Develop organization-wide training sessions.
C. Participate in Quality Council activities.
D. Conduct periodic reviews of the program

78- The quality professional can best facilitate the development of a "quality
culture" in the organization by

A. assessing the organization's readiness to commit to change.

B. preparing a long-range plan for cultural transformation.
C. encouraging leaders to commit to a culture of excellence.
D. leading the cultural transformation redesign team.

79- The responsibility to promote organizational values and commitment among

the staff lies within:

A- Nurse executive and CEO

B- Nurse staff, senior management
C- Medical director, quality manager
D- Clinical, non-clinical leaders

80- After in-depth data analysis, there is evidence of over utilization of

computerized tomography to diagnose acute appendicitis. A team has been formed
to develop a performance improvement plan for emergency department physicians.
Which of the following leadership style is most effective to implement best
practice guidelines?

A. Laissez faire
B. Democratic
C. Participatory
D. Autocratic

81- Within the context of total quality management philosophy, communication of

quality is

A. the responsibility of top management leaders.

B. delegated to the Quality Management Department.
C. an internal organizational, not community, issue.
D. independent of process budgets or costs

82- Success of QI process depends on commitment of

a. Senior management
b. QM committee member
c. Middle management
d. Process owners

83- Commitment of the governing body to quality improvement is essential for the
success of quality improvement activities. Quality professional can enhance the
board's commitment to quality by:

A- Assess knowledge and provide easily understood information

B- Ask them to make search on quality concepts
C- Provide them with materials to be studied on their own
D- Use of external educator
84- Impressed by what he saw at a healthcare conference, the Chief Executive
Officer decided to adopt Lean Six Sigma as the hospital's new approach to process
improvement. If the desired results are not achieved, which of the following is the
most likely reason for this?
A. Lack of understanding of Lean Six Sigma
B. Lack of top management support
C. Projects not linked to organizational goals and objectives
D. Inadequate focus on behavioral change to support process change

85- Which of the following is the FIRST step in facilitating change in an

organization?

A. Review customer satisfaction surveys.

B. Take commitment from GB.
C. Identify key people in the organization that should be involved
D. Develop a performance improvement plan

86- A healthcare organization wants to adopt concurrent review process instead of

retrospective review. To facilitate this changes the first to be inspired are

A-Leaders
B-Managers
C-Physician
D-Nurses

87- The Quality Management Cycle, based on Juran's Quality Trilogy (quality
planning, quality control, quality improvement)

A. excludes the lab's activities to monitor equipment.

B. requires a departmentalized approach to quality management.
C. encompasses only the nonclinical aspects of QM.
D. incorporates information from strategic planning.

88- Quality improvement plan must be first

A. Focused on organizational improvement.
B. Consistent with business goals and objectives.
C. Evolve the training plan of hospital
D. Ensure regular maintenance program

89- In deciding to submit an application for an external quality award the first step
to determine if award criteria:

A. Are aligned with organization strategic plan

B. Are well written
C. Demonstrate excellence in quality
D. Are approved by the chief executive officer

90- A quality professional in a home health agency is charged to develop a quality

management/ quality improvement strategy. Of the following steps, which should
be done first?

a. Develop strategic quality initiatives

b. Determine the roles of leaders in implementation
c. Draft the QM/QI plan for review by leaders
d. Review the organization's scope of care and service

91- Patient safety officer developing safety plan and the following information was
provided:
- Incident report data,
- Performance indicator,
- Customer complain data
- Which of the following addition data need to write the safety plan:

A. Physician satisfaction and financial goals

B. Staff satisfaction and root cause analysis
C. Infection control data and accreditation result
D. The facility risk assessment and strategic goal

92- Hospital leader asked the CPHQ to develop patient safety program, what
should he do

A. check the other hospital (in the same area) plans

B. make patient survey
C. search for scientific data on internet
D. identify the scope of service

93- "Organization-wide functions" refer to

A. key governance, management, clinical, and support activities

B. functions of the governing body
C. cross-functional team activities
D. legal and fiduciary obligations to patients

94- Customer suggestions for new service are best used by the organization in
developing:

A- Staffing plan
B- Financial plan
C- Strategic plan
D- Performance improvement plan

95- The mission statement of the organization describes

A. where the organization is going.

B. the purpose of the organization.
C. the strategic direction of the organization.
D. the long-term goals of the organization.

96- Ask staff recall of the appropriate use of safety behavior in which level

A. Learning
B. Behavior
C. Reaction
D. Result

97- To enhance coping of the desired behavior by the employee, you should

A- punish the undesired behavior maker

B- Make rewards on the desired behavior
C- make the desired behavior appear as normal requirement and needs no
recognition
D- blame and train the undesired behavior maker
98- In order to introduce performance improvement concepts throughout the
organization, a healthcare quality professional should consider implementing all of
the following steps except

a- Distributing a newsletter containing applicable quality topics

b- Providing lectures regarding quality topics
c- Meeting with each department head on a regular basis
d- Mandating staff participation in self-study activities on quality

99- Measurement of effectiveness of a seminar delivered to the staff on new

methods for training asthmatic patients to use metered dose inhaler is best done by:

A. Satisfaction survey for the trainees

B. Tracking number of attendees
C. Incidence and severity of acute exacerbation
D. Satisfaction survey for the patients

100- An organization hires a quality professional to pass quality improvement

concepts to the staff. The first thing the quality professional should do

A- Deliver lectures to the staff

B- Assess the present knowledge of the staff
C- Review the previous performance of the staff
D- Make interview with the staff

101- Developing educational training program in quality improvement, what

component should be included

A- Quality definition & principles

B- Performance appraisal results
C- Discussion of incidents
D- Individual focus of activities
102- After education of continuous quality improvement program to evaluate
effectiveness of the program:

A- Do pre & post education exam

B- Evidence that the staff begin continuous quality improvement activities
C- Monitoring the previous performance of the staff
D- Review the attendance rate of the staff

103- Barriers to effective communication include

A. direct meaning and clear messages.

B. two-way, free flowing ideas.
C. judgments and assumptions
D. repetition and feedback .

104- A nurse receives a verbal order for medication from physician, the nurse
should

A. Ask the medication from pharmacists

B. Neglect the order
C. Read the order back
D. Write and tell the order

105- The senior leaders of a hospital have decided to adopt Lean methodology, to
which there is a large degree of resistance among the staff. Each of the following is
an effective strategy for change management except

A. explaining the benefits of the new methodology to individuals and groups.

B. conducting a large, multi-departmental project from the outset to create
participation and buy-in.
C. focusing on the system and processes instead of individuals.
D. rewarding efforts to implement the new methodology.

106- A poster contain information will most effectively convey outcome

information to internal customers?

A- 2 Bar graphs showing the 2 unites with fewest number of falls over past year
B- (Patient fall decreased over 4 years) printed above a line graph showing
percentage of falls to patient days
C- Patient fall indicate downward trend. Keep moving team!
D- (Patient fall last year were 0.5% of patient days) printed to photograph of the
organization staff

107- Strategic planning is best described as

A. a long-term focus, projecting the present into the future

B. a set of top-level performance measures
C. a statement of mission, vision, and values
D. an ongoing look into the future.

108- The mission statement of the organization describes

A. where the organization is going.

B. the purpose of the organization
C. the strategic direction of the organization.
D. the long-term goals of the organization.

109- The member or group responsible for continuous improvement of

organization

A- CEO
B- Quality council
C- Share holders
D- Governance board

110- The ultimate responsibility of implementation of quality relays on

A- CEO
B- Quality council
C- Share holders
D- Governance board

111- Who is responsible for developing vision for change:

A. CEO
B. Quality Council
C. Quality Leader
D. Quality Manager

112- The person/group legally responsible for maintaining quality patient care is
the

A. governing body
B. quality improvement council
C. chief executive officer
D. medical/professional staff

113- The first step in the design process of a QI plan is:

A. determine the scope of the organization

B. make a cost-benefit analysis
C. establish performance objectives
D. establish the project goals

114- Performance improvement plan (Order or Arrange):

1-Gathering baseline data
2-Evaluate effectiveness & improvement
3-Make commitment
4-Implementation

A- 2- 1- 3 -4
B- 3-1- 4- 2
C- 1 – 2- 3 -4
D- 3 -4 -1 -2

115- After the team action the plan and implement it, and analyze data shows not
reaching the target, what is the next step on PDCA cycle is now should follow;

A- plan
B- do
C- Check
D- Act

116- A continuous quality improvement team has proposed a major change in the
billing process for home health service. Staff acceptance of the change is best
facilitated by:

A. Immediate implementation
B. Medical staff education
C. Long-range planning
D. A pilot project

117- Lean strategy that means continuous incremental improvement:

A- kaizen
B- kanban
C- pokayoka
D- six sigma

118- When incorporating lean thinking into process improvement, the quality
professional teaches the team to

A. identify suppliers and their inputs.

B. focus on special cause variation.
C. consider the system's structure.
D. identify and eliminate wasteful steps.

119- The following criteria should be considered when selecting a measurement

except

A- Reliability & validity.

B- Approval by accreditation body.
C- Scientific acceptability.
D- Usability.

120- CPHQ try to improve care through accurate definition of indicators .which of
the following indicators reflect performance of surgeons:
a) No of patients’ referrals to ICU after surgery / no of all surgeons
b) No of patients admitted to ICU /total no of surgeries
c) No of patients’ referral to ICU after minor surgery / no of minor surgery
d) No of patient admitted to ICU / no of major surgery

121- The ability of a data measurement tool to produce the same results over a
period of time is known as

a. sensitivity.
b. specificity.
c. validity.
d. reliability.

122- Sometimes, when developing indicators to measure performance, specific

criteria must be written to fully define the measure. This type of criteria facilitates
which step?

a. Intensive analysis.
b. Initial analysis.
c. Data aggregation.
d. Data collection.

123- Which of the following is considered (0 % acceptance, 100 % analysis):

A. Occupancy report
B. Sentinel event
C. Cause and effect analysis
D. Cost benefit analysis

124- Assuming the measurement instrument is reliable, which of the following

ensures that measurements are almost identical no matter who does the measuring?

A. One person taking all the measurements

B. An operational definition
C. Close supervision
D. Repeating the measurement for each observation
125- In any quality management approach, how can you best evaluate the
effectiveness of action taken?

a. Use the same performance measures to remonitor the process.

b. Formulate a new special study to monitor the action.
c. Interview the staff involved in implementing the action plan.
d. Do nothing. Effectiveness is expected with well-planned action

126- Validity of measures is defined as:

A-Repeated measuring leads to the same results

B-Low in cost
C-Well understood
D-Measure what's intended to measure

127- When facility make development of clinical indicator criteria, Healthcare

quality professional should:

A- Selecting indicators that are approved by accrediting organization

B- Selecting indicators that are approved by Payers
C- Develop criteria that reflect processes & outcomes
D- Prioritize indicators for selection by process owners

128- The basic philosophy of benchmarking is

a. Eliminating the competition.

b. Finding best practice and incorporating it
c. Getting all processes under statistical control.
d. Eliminating process deficiencies.

129- To effectively communicate performance indicator results, information

should be disseminated to the

A. Medical executive committee

B. Quality council
C. Entire staff
D. Department heads
130- A performance improvement team aims to reduce the rate of post-surgical
infection rates in a small rural acute care facility. Which of the following should
the team use as a reference?

A. The post-surgical infection rates among individual surgeons.

B. Postoperative antibiotic use among the surgeons.
C. National benchmark post-surgical infection rates based on the most recent
research.
D. Post-surgical infection rates in similar facilities

131- Healthcare quality program had prepared a balanced score card that displayed
patient satisfaction was 98%, financial target has been met , medication error had
been increased by 30% and heart surgery rate decreased 3% , what additional
information the governing body may ask for?

a) Type of medication error

b) Heart surgery case.
c) Patient satisfaction data.
d) Review patient compliant

132- As a performance measurement system, the key value of the "balanced

scorecard" concept is its ability to

a. Serve as a comparative "report card" with like organizations.

b. Focus the organization on financial measures of survival and success.
c. Encompass all the organization's clinical and non-clinical measures.
d. Align measurement with the vision and strategy of the organization.

133- Negligence means a lack of proper care. In medical malpractice "proper care"
is determined by:

a. Joint Commission standards.

b. Jury of civilian peers.
c. Tort law.
d. Medical peers.
134- To establish evidence based practice guideline, it is best to
A. reply on subjective, expert opinion
B. review every possible intervention or treatment
C. include those who resist process
D. allow individual practitioner to make any exception to guideline

135- In development of the practice guidelines, the following is involved except:

A. Physician
B. Quality manger
C. Evidence based research
D. Nurses

136- The following is important in development of practice guidelines except

A. Evidence based researches

B. Experience of peers
C. Patient expectation
D. Clinical knowledge of peer physician

137- Practice guidelines cannot help the physicians in:

A. Identifying the best practice

B. Saving money to the facility
C. Meeting patients’ expectations
D. Identifying errors in patient care

138- Practice guidelines should be based on:

A- Scientific evidence.
B- Computer generated Data.
C- Utilization review characteristics.
D- Senior consultant review

139- The key advantage of case management in managed care is

a. Control of clinical risk.
b. Control of hospital use.
c. Coordination of care.
d. Prevention of illness.

140- Failure to schedule a surgical date for the patient is considered

a- Overuse
b- Under use
c- Misuse
d- Appropriate use

141- A patient not given enough instruction on the care plan this problem
concerned with:

A. Transition care.
B. Case Management
C. medical coverage
D .reconciliation

142- The patient discharged without any counseling of his care, this problem
concerned with

A. Transition care.
B. Case Management
C. medical coverage
D .reconciliation

143- Discharge planning should begin:

A. at the time of admission to the hospital.

B. after the patient's medical condition stabilizes and he is transferred from the
Intensive Care Unit to a medical ward.
C. after the physician writes the discharge planning order.
D. two days before the expected date of discharge.
144- In evaluating length of stay &outcome data on cardiac cathertization.
HealthCare quality professional identified direct relationship between adverse
outcomes & physician practice pattern. This integrated approach involves
correlating:

A- Case/care management & finance

B- UM & QM
C- Finance & UM
D- Discharge planning & QI

145- Attempts to align financial incentives of purchasers, payers &providers with

provider performance on clinical process &outcome measures encourages

A. under-utilization
B. community backlash
C. over-utilization
D. reengineering

146- The goal of an integrated service approach is to:

a. Reduce the cost of services

b. Increase the organization financial return.
c. Involve top management, leaders, and department managers in the process
d. Involve all working personnel in the process

147- A radiology department regularly monitors x-ray repeat/reject, timeliness of

report dictation, and patient waiting times. What component is missing in this
department's ongoing evaluation program?

a. Appropriateness review.
b. Process evaluation.
c. Quality control.
d. Documentation analysis

148- Hospital Utilization Management Plan generally includes provision for

a. Disaster planning.
b. Transition planning.
c. Quality planning.
d. Financial planning

149- An effective risk management plan includes all of the following except:
A) Description of educational programs
B) Statement of purpose
C) Description of reporting mechanisms
D) Scope of the program

150- On discharge, the patient refuses billing because 2 out of 3 days of his stay in
the hospital is due to medication anaphylaxis. This occurrence is:

A. Billing error
B. Potentially compensable event
C. Nurse Incompetence
D. Admission error

151- If your department has contract with another facility to provide a risky service
this is considered as

A- Risk shift
B- Risk adjustment
C- Claim against you from 3rd party
D- Negligence

152- "Occurrence reporting" is a type of

a. Risk reduction
b. Risk evaluation
c. Risk identification
d. Risk prevention

153- An effective risk-management program for a health care organization

emphasizes:
A. Harm prevention for patients, visitors, and staff
B. Reduction of financial losses
C. Staff training and education
D. Compliance with accrediting agency standards

154- Being immediately responsive and attentive to a family's concerns following a

patient's fall in the subacute care facility is:

a. Risk avoidance activity.

b. Loss prevention activity.
c. Risk shifting activity.
d. Loss reduction activity

155- A patient using a large exercise ball in outpatient rehabilitation fractures three
ribs when the ball bursts and she falls onto the floor. The risk manager tells the
patient that all costs of care will be covered. Of the following, this action best
represents risk

a. Avoidance or prevention
b. Assessment or analysis
c. Transfer or shifting
d. Handling or intervention

156- In a culture of patient safety, the most appropriate surveillance to assess the
infection rate within the hospital is:

A. Total house surveillance

B. Targeted surveillance
C. Community surveillance
D. Prioritized surveillance

157- Most important in review physician profile:

A- Surgery case mix

B- Medical record completion
C- Blood utilization review
D- Fall rate review
158- Who is responsible for the FPPE and OPPE in a healthcare organization?

A. Governing Body
B. Medical Staff
C. Chief Medical Officer
D. Team Leader

159- A facility has medical staff consists of 5 internists, 3 neurologists, 2

pediatricians, and 1 dermatologist, who should make the peer review for the
dermatologist?

a. The internist
b. Chair of medical staff
c. Peer from outside
d. The neurologist

160- Physician is asked to review the appropriateness of care provided by another

physician. This process is called:

A. Initial review
B. Clinical peer review
C. Appeals considerations
D. Reappointment rules

161- A healthcare system has decided to centralize its credentialing departments.

What is the main purpose for doing so?

A- Streamline jobs
B- Reduce costs
C- Meet NCQA requirements
D- Eliminate duplication of credentialing

162- When review clinical competency of surgeon at the time of reappointment:

A- group interview with practitioners

B- interview with the practitioner
C- quality professional review credential file
D- chief of surgery department review practitioner profile

163- Which of the following can demonstrate multiple aspects of a practitioners

practice as required for renewal of clinical privileges?

a- Credentialing
b- Peer review
c- Privilege delineation
d- Practitioner profile

164- A credentialing committee has determined that a practitioner has significantly

higher rate of complications after surgeries than the practitioners peer. Which of
the following the committees do next?

A- Initiate a focused professional evaluation (FPPE).

B- Limit the practitioner’s current surgical privileges
C- Require the practitioner to attend continuing education
D- Continue ongoing professional practice evaluation

165- A hospital has found that the performance of one of its department is
consistently below the expected standard. The hospital administration wants to
locate the source of the problems and see improvement in the department within
six months what is the health care Quality management professional role in this

A. Research the problems and develop a program that applies current standards to
the department
B. Recommend that the hospital replace the current administration of the
individual department
C. Advise that performance improvement team be assembled to review and address
the failings
D. Review the expected standards and submit these to the department for
immediate applications

166- Significant Deficiencies in the Provision of Care require:

A. Documentation.
B. Aggregation.
C. Intensive Analysis.
D. Initial Analysis.

167- The chart below shows the rate of Cesarean Sections in a hospital.
The healthcare quality professional should

A. continue monitoring the monthly rates of Cesarean Sections.

B. recommend a Cesarean Section audit by peer review.
C. review the policies and procedures for Cesarean Section.
D. review the antenatal care of women who had Cesarean Sections.

168- A recent review of the risk management process within a medical facility has
revealed a number of serious failings. What is the healthcare quality management
professional’s role in preventing future risk management errors from occurring?

a. Identify employees and staff members who contributed to the risk management
failures
b. Create a new risk management program that utilizes improvements in
technology and identifies failures earlier
c. Notify all employees about the risk management failures and disseminate
information to prevent future failures
d. Assist in revising the current risk management plan to take findings from the
review into account
169- It's noticed that there is a significant increase in aggressive behavior among
psychiatric patients, what is the appropriate action:

A- Focus group with psychiatric department staff

B- Trend data over time
C- Review restrains policy
D- Use sedation for those patients

170- In compiling and writing performance improvements reports, which of the

following would not be included?

a- Project objective
b- Methodology
c- Meeting minutes
d- Improvement achieved

171- On presentation of the annual review to the governing body, the following is
important to include the presentation:

A- Graphs & tables

B- Minutes
C- Team achievement
D- Complaints

172- What to report to GB:

a- Details for all QI activities

b- Summary about results and outcomes for patients
c- Findings from peer review
d- Errors in staff documentation

173- In a high quality community hospital, a group of quality professionals

conducted a patient safety survey. As a hospital leader, you can guarantee that the
survey report may not contain data about:

A. The organization readiness

B. The impact of the patient safety intervention
C. The cost and the time spent in the survey
D. Benchmarking data about how well the organization is doing in establishing a
culture of safety

174- A quality director is evaluating effectiveness of training for a healthcare

quality professional who recently attended a course on data analysis. Effective
learning can be best demonstrated when the learner

a. Develops a run chart showing falls data over time

b. Interprets a pie chart that displays falls by department
c. Builds a color-coded spreadsheet to report falls data
d. Discuss the implications of falls within the context of patient safety

175- For CQI to be successful who must be included in team

A. administrator.
B. person performing process
C. quality management representative.
D. department supervisor.

176- At one of its meetings, the team has digressed from its original discussion.
Who is responsible for bringing the conversation back to the meeting agenda?

a) Team sponsor
b) Team leader
c) Team facilitator
d) Team members

177- The responsibility for providing organizational direction for a facility

continuous quality improvement program frequently rests with the quality

a- Council
b- Teams
c- Leader
d- Facilitator
178- Team charted in mental & psychiatry health to improve level of care, the
facilitator should be knowledgeable about

A. Mental& psychiatry health

B. Level of care
C. Moderate group teamwork
D. Assign tasks to team members

179- The healthcare quality professional's role in a quality improvement team

should least likely be

A. Team leader
B. Coordinator of the team process.
C. Team member.
D. Facilitator.

180- A facilitator`s best start with a team is to:

A- agree on meetings underground.

B- forming homogeneous team members
C- support team leader decisions.
D- set meeting agenda and priorities

181- The Board and Chief Executive Officer have renewed their commitment to
improving quality in Hospital X. Your primary role as the Director of Quality &
Patient Safety should be

A. Data Consultant.
B. Team Leader.
C. Facilitator.
D. Quality Champion.

182- For continuous quality improvement team to be successful, who must be

included in the team?

A. Administrator.
B. Department supervisor.
C. Process Owners
D. Facilitator.

183- Facilitating a team in improvement of care level of health/ cognitive statue

quality facilitator should:

a. Have knowledge in care levels

b. Have knowledge in health and cognitive status
c. Moderate group
d. Not a member

184- Quality teams can be an important component in an organization quality

improvement as avenue (a way) for:
A. Credentialing and reappointment
B. Administrative support
C. Staff involvement
D. Reporting to the governing body.

185- The best way to evaluate any team is by:

A. Learning and innovation

B. Quantifiable objectives
C. Members Satisfaction
D. Aligning the vision of the organization

186- Team members are divided about the next course of action in an important
project. It appears that the conflict is severe enough to warrant intervention. Who is
responsible for managing the conflict?

A Sponsor or Team Leader

B Team Leader or Coach
C Coach or Sponsor
D Team Leader only

187- A meeting facilitator notices that the team has a tendency towards groupthink.
What is one structural way to correct this problem?
a. Meet late in the day
b. Meet more often
c. Break the group down into smaller subgroups
d. Have comments submitted in writing

188- In an organizationwide QI model, the person or group usually accountable for

continuously assessing and improving performance at the department level is the

a. Cross-functional QI team.
b. Quality council.
c. Department director.
d. Department team.
189- In order to perform a task for which one is held accountable, there must be an
equal balance between responsibility and

A. Authority
B. Education
C. Delegation
D. Specialization

190- Responsibility of quality improvement teams include all of the following

except:

a- Defining the roles and duties of the members.

b- Communicating results.
c- Setting goals and timetable for the steps of the process.
d- Establishing the need for the team

191- You lead one of the organization's strategic quality initiative teams. One of
your key members consistently arrives at least 15 minutes late. Your best approach
is to

a. Delay the start of the meeting to avoid going back over the material.
b. Confront the group with the possibility of changing the meeting time to
accommodate the late arriver.
c. Start the meeting on time and do not draw any attention to the late arriver.
d. Interrupt the meeting to acknowledge the late arrival to the group.
192- The role of a team facilitator is to focus on

A. Analyzing problems during meetings

B. The process
C. Generating and selecting solutions
D. The content

193- In preparing for a meeting, what should be sent to the team members in
advance?

a. Agenda with all attachments

b. Agenda with key information requiring a decision at the meeting
c. Just the agenda, because members will lose the other information
d. Agenda and the confidential information, because guests will attend the meeting

194- Which of the following actions is the most appropriate for the team leader to
take during the norming stage of team development:

A-fully utilize team member's skills, knowledge, and experience

B-represent, advocate for the team with other group and individuals
C-develop and implement agreements about how decisions are made and who
makes them
D-provide clear direction and purpose.

195- When the team members start to interest in hearing each other and being on
focus on goals and to respect each other, this is the stage of:

A. Performing
B. Storming
C. Norming
D. Forming

196- During patient focus group, the facilitator should do first:

A. Choose homogenous group.

B. Make ground rules.
C. Make rapport to the group.
D. Instruct orders.

197- When choosing an outside consultant to lead employee focus groups, what
priority areas of expertise should CPHQ look for?

A- Team development & management

B- Organizational assessment & change management
C- Improve Group dynamics & facilitation
D- Organizational design & re-engineering

198- By forming a team After 1 month team attendance is declined , which stage of
team development:

A- Storming
B- Norming
C- Performing
D- Forming

199- Which stage cause the team to dissolve prematurely?

A- Norming
B- Performing
C- Storming
D- Conforming

200- Which of the following make a successful focus group?

A. Small group
B. Include patient
C. Short duration
D. Good moderator

201- Cohesion will be which stage of team building

A- Forming
B- Storming
C- Norming
D- Performing

202- After PI team finish the program who will submit results to the GB

A. team leader
B. facilitator
C. recorder
D. any member

203- It is generally understood that the patient owns the information in his or her
medical record. The physical record is the property of the

a. Patient.
b. Physician.
c. Healthcare organization.
d. Third party payer.

204- The most important time to collect and use data is

a. Before the QI project begins, to prove a problem exists.

b. During the QI project, to answer questions about cause.
c. During the QI project, to help prioritize the implementation of improvements.
d. After the implementation of the improvement, to maintain the gain.

205- If planning data collection for antibiotic use in urinary tract infection (UTI),
what should you do first?

a. Define UTI.
b. Define the population.
c. Determine which antibiotics to include.
d. Determine which sampling method to use.

206- Focus groups provide patient/customer input or feedback. What type of

information do they offer?

a. Qualitative.
b. Quantitative.
c. Measured.
d. Opinionated.

207- A focused review of every other case seen in the Emergency Department on
June 2, is an example of which type of sampling?

a. Nonprobability quota.
b. Stratified random.
c. Systematic random.
d. Nonprobability purposive.

208- Your medical center QM department is asked to prepare quarterly summaries

comparing cause of death as listed in the medical record with final autopsy
findings. How could you set up the initial screening process to minimize effort?

a. Use the master patient index.

b. Use the death register.
c. Contact the pathologist on a regularly scheduled basis.
d. Review all death charts after 90 days.

209- Which of the following may be considered examples of discrete variables?

a. Height and weight.

b. Community-acquired and nosocomial infection rates.
c. Surgical or emergency department response time.
d. Patient visits in the months of May and June.

210- One way to measure a clinical outcome is through

A. Aggregate data review

B. Pareto charts
C. Pre-admission review
D. The number of healthcare contracts

211- Prospective review may be beneficial unless

a. The patient is having elective total knee replacement.
b. The patient is being readmitted for bypass surgery following heart
catheterization
c. The patient was admitted through the Emergency Department for a fractured hip.
d. The patient is a member of a managed care organization

212- Data gathering method includes all of the following except:

A- Measurement
B- Observation
C- Correlation
D- Interviewing

213- The first step in collecting meaningful data is:

A. Establishing the goals of data collection.

B. Developing operational definitions.
C. Planning for data consistency.
D. Evaluating the resources available

214- A primary purpose of an information management system is to allow an

organization to:

A. Save time
B. Centralize demographics
C. Reduce cost
D. Evaluate data

215- A valid data collection should incorporate

A. a reliable graphic presentation

B. the definition of data elements
C. a minimum of 20 data elements
D. allowance of variance of interpretation
216- An organization leader has directed a Healthcare Quality Professional to
measure the success of a corrective action plan on patient care planning. The
organization leader wants to be at least 95 % confident of the accuracy of results.
The average daily census at the organization is 1000 patients. The most accurate &
efficient sampling technique for this study would be:

A- Review 100% of all active records on one day of past month

B- Review 10% of all discharge records for the past quarter
C- Estimate the percentage of records to be reviewed using an accepted statistical
formula appropriate for the population
D- Identify 30% of all records that failed preliminary care plan compliance review
217- The stratified random sample is

A. Random sampling after dividing the population into groups

B. Portions of the population
C. Choosing subjects fulfill the criteria
D. sampling randomly

218- The sample include all available data in the area is:

A. Quota
B. Convenience
C. Stratified random
D. Purposive

219- T-test used in:

A- Difference between sample size variance

B- Difference between occurrence of variables
C- Difference between effect of two treatments
D- Significance of treatment

220- The method of ordering data by listing all possible values, and all individuals
receiving each value, is called

a. The range.
b. The standard deviation.
c. A simple frequency distribution.
d. A grouped frequency distribution.

221- When data has a range of values between the lowest and highest that is wide,
but you want to rank-order them, it is best to use a

a. Line graph.
b. Simple frequency distribution.
c. Grouped frequency distribution.
d. Cumulative frequency distribution.

222- The average between the highest and lowest measures is the

a. Median.
b. Mean.
c. Mode.
d. Dispersion.

223- The most accurate measure describing the amount of variability in a

distribution is the

a. Variance.
b. Range.
c. Standard deviation.
d. Dispersion.

224- When comparing averaged immunization data from two pediatric medical
groups, it is appropriate to use

a. Standard deviation.
b. A T-test.
c. A chi-square test.
d. Variance.

225- The distance from the lowest to the highest value in a frequency distribution
of wait times in the Emergency Department is the

a. Standard deviation.
b. Range minus 1.
c. Range.
d. Variance.

226- Inpatient length of stay (LOS) is the number of days, including the day of
admission and excluding the day of discharge. What data elements are essential in
order to calculate the average length of stay for simple pneumonia patients for 1st
quarter, this year?

a. Number of discharges and number of patient days.

b. Each pneumonia patient's LOS.
c. Number of pneumonia patients and number of discharges.
d. Total LOS for pneumonia patients.

227- Measures of central tendency include:

A. Median & mode & mean

B. Standard deviation and range.
C. Proportion and ratio.
D. Quartiles and Deciles.

228- In a normal probability distribution, the relationship among the median, mean
and mode is that:

A- They are all equal to the same value.

B- The median and mode have the same value but the mean is different.
C- The median always has the highest value.
D- The mean equals the sum of both the median and the mode.

229- The Body Mass Index (a measure of body fat) was measured in a group of
women attending a primary care clinic. The graph below summarizes the results.
Which of the following measures best summarizes the data?
A- Mean
B- Mode
C- Median
D- Range

230- As a result of the customer survey the mean score was calculated with each
item. Weight was applied to range each item in order to importance to the customer
which of the following the highest weighted mean score:

a.Mean3 and weight0.9

b.Mean4 and weight0.8
c.Mean5 and weight0.7
d.Mean6 and weight0.3

231- What is the highest weighted mean

A. mean 3 weighted mean 3.4
B. mean 9 weighted mean 6.5
C. mean 6 weighted mean 9.2
D. mean 2 weighted mean 2.3

232- Which of the following tools is most appropriate for investigating the
relationship between two characteristics?

A. Scatter plot
B. Cause-and-effect diagram
C. Failure modes and effects analysis
D. Pareto chart

233- Positive correlation appears as:

A- Points in a circular shape in the graph

B- Points in triangular shape
C- Increase in X-axis with an increasing in Y-axis
D- Increase in X-axis with a decreasing in Y-axis

234- Circular shape of data on scatter diagram indicate:

A- Positive linear relationship

B- Negative linear relationship
C- No relationship between the two variables
D- Special cause variation

235- Of the following, the best way for the Sunset Nursing Home to determine if a
nursing staff shortage might be related to an increase in the number of patient falls
is to perform a

a. Root cause analysis.

b. Staffing effectiveness survey.
c. Regression analysis
d. Events and causal factors analysis.

236- The rate of increase or decrease in total medication errors over a six-month
period could best be displayed by the use of a

a. Frequency polygon.
b. Line graph.
c. Bar graph.
d. Cumulative frequency curve.

237- Measurement and assessment activities by the local Ambulatory Surgery

Center indicate that monthly surgical site postoperative infection rates have
increased over the past year. A comparison of the local Center's aggregated rate to
the other surgery centers in the same region, for like procedures, is best displayed
by the use of a

a. Bar graph.
b. Pie graph.
c. Grouped frequency distribution.
d. Line graph.

238- The use of regression analysis to help determine relationships between groups
of numbers is most closely associated with which graphic display technique?

a. Frequency distribution.
b. Scatter diagram.
c. Line graph.
d. Histogram.

239- You are the quality professional for a large provider organization. You have
two sets of monthly utilization data—total costs and total reimbursements from
payers—for the last two years. Use this information to answer question:

To best display the data for the full two years, which of the following types of
graphic displays should you use?

a. Pie charts.
b. Bar charts.
c. Run charts.
d. Pareto charts.
240- Which is the best graphic display to show proportion?

a. Pie chart.
b. Bar chart.
c. Run chart.
d. Pareto chart.

241- Which display is best to help the ambulatory clinic team decide which of 10
reasons for patient dissatisfaction to address this year?
a. Pie chart.
b. Bar chart.
c. Run chart.
d. Pareto chart.

242- The primary care clinic tracks callers’ telephone wait times as a recurring
performance measure twice a year. In the last two months, wait times have been
increasing. On the latest run chart, 8 consecutive data points all in ascending order,
with 21 total data points, represents a/an

a. Common cause variation.

b. Special cause variation.
c. Cyclical variation.
d. Astronomical value.

243- "Common causes" of problems in processes refer to

a. One-time situations.
b. Temporary situations.
c. Acute situations.
d. Chronic situations

244- Special cause variation is to the process:

A. random, extrinsic, outlier

B. assignable, intrinsic, noise
C. random, inlier, identifiable
D. assignable, extrinsic, outlier.

245- In the community health clinic, at least four complaints have been received
per month for the past four months, compared to an average of one per month for
the six prior months. The average number of patients seen per month is 2000. The
trigger is >0.2%. What is the appropriate response?

a. Select a more useful indicator.

b. Perform intensive analysis now.
c. Trend for at least three more months.
d. Reward the entire staff.

246- Which of the following charts is used to institute quality improvement &
monitor cost reduction on ongoing basis?

A- Pie chart
B- Control chart.
C- Pareto chart
D- Fishbone diagram

247- Teaching the use of QI tools is more effective when

A. All possible tool options are covered

B. Statistical process control is covered first
C. The team needing the tool is meeting together
D. Watching a videotape

248- In analyzing data, the healthcare quality professional can minimize the risk of
interpreting noise as if it were a signal and minimize the risk of failing to detect a
signal when it is present by using a

A. run chart.
B. control chart.
C. specifying a target.
D. comparing data to average values.

249- A sentinel event is regarded as a:

a. Common cause variation.

b. Assignable variation.
c. Noise.
d. Random variation

250- In statistical process control, it is important first to

a. Eliminate assignable causes of variation.

b. Eliminate random causes of variation.
c. Prioritize causes of variation.
d. Eliminate all causes of variation.

251- Special cause variation is to the process:

A. random, extrinsic, outlier

B. assignable, intrinsic, noise
C. random, inlier, identifiable
D. assignable, extrinsic, outlier

252- "Common causes" of problems in processes refer to

a. One-time situations.
b. Temporary situations.
c. Acute situations.
d. Chronic situations

253- For variance interpretation the most suitable tool;

A- Bar graph
B- Control chart
C- Run chart
D- Pie chart

254- You are preparing a report to present to the Public Health Council on the
declining rates of gonorrhea in your state in both men and women over the last 10
years. Which type of graph would best illustrate the data??

a. Bar chart
b. Histogram
c. Pie chart
d. Line graph

255- Which of the following graphs is most appropriate in displaying the root
causes of adverse events that have occurred in a hospital system over the past 10
years?
A. Histogram
B. Frequency polygon
C. Line chart
D. Bar chart

256- The senior leaders of a hospital are prioritizing performance improvement

initiatives for the coming year. Which of the following tools will be most useful for
this purpose?

A. Pareto chart
B. Cause-and-effect diagram
C. Affinity diagram
D. Stratification

257- Which tool(s) or measure(s) show summary of characteristics about

population?

A. frequency distribution
B. central tendency measures
C. flow charts
D. cause and effect charts

258- A common cause variation is:

a. An intrinsic, inliers, unpredictable, chronic variation.

b. The responsibility of the process owners.
c. Correctable by top management and the team.
d. An intrinsic, outlier, unpredictable, acute variation

259- Time series plots, compared with control charts, are best used to

A. detect trends.
B. monitor process over time.
C. ensure process stability.
D. enable predictability
260- Which of the following charts is most appropriate in monitoring the number
of CT scans performed on members of health plan?

A. Run chart
B. Shewhart chart
C. Bar chart
D. Scatter chart

261- Once statistical control is established, the next step in continuous quality
improvement is to:

A. Slowly increase the rate of control monitoring

B. Rapidly increase the rate of control monitoring
C. Eliminate the need for rework
D. Improve the process by reducing variation

262- The best tool to begin investigate causes of laboratory labeling errors :

A- histogram
B- flowchart
C- affinity diagram
D- prioritization matrix

263- Leaders of a multi-hospital system are trying to prioritize the services to

introduce in the coming year based on their impact on the community. These
leaders, who work geographically apart, can arrive at a group consensus without
meeting face to face by:

A. the nominal group technique.

B. the Delphi technique.
C. brainstorming.
D. a focus group

264- Use the following data to answer the following:

Number of discharges....................... 142
Number of procedures .......................100
Arthroscopies ..................................... 20
Hip replacement ................................. 40
Surgical wound infections .................. 32
Incomplete medical records ............... 40

I. The rate of overall surgical wound infections:

a.32%.
b.23%.
c.30%
d.40%
II. The rate of overall delinquent medical record:
a.40%.
b.28%.
c.30%.
d.20%.

265- As quality management director at Sunshine Community Medical Center, you

are conducting comparative analysis of the surgical wound infection rate data
between two surgical units. The "p-value" of the chi-square test you run will help
you draw what conclusion about the relationship between the two sets of data?

a. Ratio of the two rates

b. Standard deviation of the difference from the mean
c. Proportion of the relationship
d. Significance of the relationship

266- When the health care delivered should not vary in Quality because of patient's
personal characteristics such as gender, ethnicity, geographic location, and
socioeconomic status; then this health care is

a- Safe.
b- Efficient.
c- Patient centered.
d- Equitable.

267- In response to public concern the institute of medicine, published the report
"crossing the quality chasm" The following are domains for health improvement
identified in the report except
A- safety.
B- patient-centeredness.
C- equity.
D- appropriateness.

268- Hospital Acquired infections HAI are considered as

A- Sentinel events
B- Outcome measurement
C- Process measurement
D- Near misses

269- A psychiatric hospital is reporting a significant level of patient aggression as a

quality professional the appropriate action to recommend is:

A- Generate a policy of restraining all patients

B- Switch from physical to chemical restrain
C- Adopt restrain free policy
D- Make a system of early identification of patient characteristics may be
indicative of aggression

270- The most effective role of a healthcare quality professional as a facilitator of

change to quality culture in the organization is:

a. Education of leaders
b. Education of staff.
c. Evaluation of performance.
d. Designing processes.

271- Even when appropriate process are in place, error can occur, understanding
this, leader coordinating any safety program should focus on:

a- Patient survey.
b- Time constrain.
c- Policies.
d- Performance feedback
272- Safe environment can be best achieved by involving:

a. Leaders and top management

b. Delegating the responsibility to a cross-functional team
c. Involving staff member’s organization wide in the safety initiatives
d. Establishing a specified committee to review safety issues organization-wide

273- In order to ensure patient safety as a dimension of performance within a

healthcare facility, the most effective way is to:

A- Sponsor a toll-free line for reporting problems.

B- Focus on processes and minimize individual blame.
C- Have leaders who commit to and foster a safe culture.
D- Encourage patients and families to identify risks.

274- If leadership is the critical success factor for an effective patient safety
program, what is the first key responsibility of leaders?

a. Provide resources.
b. Set strategic goals.
c. Establish the value system.
d. Designate a champion.

275- Patient safety culture characterized by:

a- Competent staff
b- Anonymous reporting
c- Mutual trust
d- Self-directed teams

276- To best achieve low rate of harm in spite of inherent risks in healthcare, an
organization must;

a- Apply principles of high reliability

b- Adopt a zero tolerance for defect policy
c- Meet at least 95% of accreditation standards.
d- Employ effective physician leaders

277- To develop a culture of safety, it is first to:

A. Make it safe to make mistakes

B. Establish a punitive reporting system
C. Blame is enough
D. Focus efforts on individuals rather than system

278- When developing a strategic plan with integration of patient safety, what is
considered to be crucial?

A- Culture of the performance improvement

B- Resources of the organization
C- Cost benefit analysis of patient safety program
D- Patient to staff ratio

279- High reporting of medical errors and near miss is a mirror of:

A. Defective system of quality

B. Feeling protected by a non-punitive culture of medical errors reporting
C. Sophisticated system
D. Conflict of interest

280- Voluntary reporting system may face under-reporting of incidents due to all
of the following except

A. Time constraints
B. Fear of shame
C. Developed safety culture
D. Blame litigation

281- Make it safe to make mistakes, Will:

A-Increase the learning state within organization

B-Increase the errors
C-Decrease the loyalty of the customers
D-Decrease the self-esteem of the staff

282- The followings can enhance the spread of the change in the organization
except:

A- Inclusion of the leaders in the planning process

B- Seeking input from the staff
C- Make punishments on errors related to the implementation of the change
D- Adopt open door policy

283- First task of a newly established quality council for implementation of safety
A- Provide protocols for rapid response teams
B- Assess preparedness and disaster plan
C- Prepare job description for quality council
D- Scan the environment for risks
284- Which of the following is true regarding medical errors

A. associated with process failure

B. prevented by review of evidence based practice
C. caused by gap between patients expectations and practice
D. avoided by uniform practice

285- The key to reliable, safe environment of patient care does not lie in exhorting
individuals to be more careful and try harder. It lies in:

A. Hiring high professionals for sensitive positions

B. High alert leaders and managers
C. Learning about causes of error and designing systems to prevent human error
whenever possible
D. Strict staff bylaws

286- An important reason for monitoring near misses is to

A. Prevent negative publicity

B. Identify incompetent staff
C. Provide lessons to the staff
D. Support disciplinary action
287- Leaders' walk rounds is an effective opportunity to:

a. Focus front-line staff on safety issues.

b. Inspect the different departments in an informal way.
c. Discuss issues of concern to staff members.
d. Identify wrong doers.

288- Patient safety program must include all of the following, but the most crucial
is

a. Identified individual or group to manage the program.

b. Defined mechanisms for support of staff responsible for the occurrence of a
sentinel event.
c. Proactive risk reduction activities.
d. Reporting mechanism
289- Which of the following is the best example of applying cultural diversity
principle to patient safety?

A. Allowing parents to perform rituals for their ill child

B. Providing interpretive service to explain medical procedures
C. Having the nutritionist discussion dietary preferences with the patients
D. performing mandatory training on culture diversity for staff

290- A CEO has challenged an organization to decrease the number of serious

safety events involving patients. The leaders have decided to review and assess
current processes to achieve this safety goal. A key element is to:

a. Ensure that the processes address prevention, detection and mitigation

b. Design processes to be reliably executed by the most experienced staff
c. Create new processes when possible
d. Use disciplinary actions to prevent errors from reoccurrences

291- Primary function of rapid response team is

a- Prevent and manage crisis in the emergency room

b- Early intervention when patient condition change
c- Manage critical patient conditions
d- Control patient safety issues

292- In order to establish a safety culture within a healthcare organization, one of

the effective actions is to:

A. punish individual employees who commit medication errors.

B. adopt anonymous free reporting of errors and adverse events.
C. segregate staff who commit errors to work in the same shifts.
D. abstain from intervention until a completion of one year to have an accurate
information about types and patterns of errors.

293- Healthcare quality professional has written patient safety plan that includes:
purpose, goals, and objectives. A review of outcomes data has been completed,
which of the following additional information should be in the plan:

A- Disaster preparedness
B- Steps to improve patient satisfaction
C- Equipment management
D- Efforts to reduce harm

294- Which of the following are attributes to culture of safety?

A- Transparency & increased patient acuity level

B- Error –proof environment & empowered staff
C- Empowered staff & transparency
D- Increased patient acuity level & error-proof environment

295- Where should the surgical "time out" for a total knee replacement occur?

A- Med/Surg unit
B- Preoperative holding area
C- Post anesthesia care unit
D- Operating room

296- Which of the following is the most effective means of communicating

commitment to patient safety?
A. Articles by a CEO in the employee newsletter
B. Senior leaders having discussions on units with front line staff
C. Posters and bulletin boards on units displaying up to date patient falls data
D. CEO Presenting most recent medication error rates to the governing body.

297- The determination of annual National Patient Safety Goals is linked to

reported

A. sentinel events.
B. adverse events.
C. core performance measures.
D. claims

298- Of the followings NOT example for sentinel event

A. Patient attempt suicide

B. patient fall results in bruises in tail bone
C. death of patient due to medication error
D. surgery on wrong part of the body
299- Patient refused to bill after surgery because of postoperative infection, this
infection is:

A- Co-morbidities
B- Complication
C- Community acquired
D- Unpreventable

300- In an inpatient stay, specific patient conditions that are present on admission
and require treatment during the stay are called

a. Complications.
b. Comorbidities
c. Community-acquired.
d. Healthcare-associated.
301- In inpatient care, what is the key difference between a comorbidity and a
complication:

a. A comorbidity affects both treatment and length of stay.

b. A complication is not present at time of admission
c. A complication is preventable.
d. A comorbidity is not present at time of admission.

302- Determine process vulnerability

A- Flow chart
B- FMEA
C- RCA
D- PDCA

303- FMEA uses which type of review?

A- Concurrent
B- Retrospective
C- Proactive
D- Recurrent

304- A hospital considering changing the process of admission from emergency

department. To support patient safety when this process deployed. What should the
healthcare quality professional during redesign the process?

A. Complete FMEA of the new process

B. Analysis incidents reports of the last year using Pareto Chart
C. Examining the stability and variation of the new process by using control chart
D. Conducting RCA for predict errors of the new process

305- Under conducting a sentinel event review, a RCA:

A- Provide judgment of staff behaviors

B- Requires team consensus
C- Identifies gaps in patient care processes
D- Proactively identifies causes & effects
306- After significant unexpected event, an intensive analysis is performed to:

A. Understand the cause

B. Correct risk management data.
C. Prevent the facility from lawsuit.
D. Identify who made the error.

307- The interrelationships between people, tools they use, the environment they
work in best describe the study of:

a- Human factors/ ergonomics

b- Environment factors
c- Process mapping
d- Work engineering

308- A healthcare organization is seeking accreditation. The first step the

healthcare quality professional should take is to

A. review the organization's bylaws, rules, and regulations.

B. becomes familiar with the appropriate standards
C. establishes a quality assessment committee.
D. review the organization's policies and procedure.

309- To protect your organization against unannounced surveys the most important
to keep in your organization

A- Continuous readiness
B- All plans unannounced.
C- Patient medical records for 3 months only.
D- Copy of all incident reports.

310- The quality council decided to implement 3 initiatives in surgical

departments. The 3 initiatives are (Compliance with hand hygiene, Compliance
with surgical checklist, Compliance with guidelines) and they will reward the staff
who achieves target of (level 1) with 100$, and reward the staff who achieves
target of (level 2) with 200$.
According to the following table, who of the following staff will NOT take any
incentives?
1- Staff 1
2- Staff 2
3- Staff 3
4- Staff 4

311- In a medical group of 70 physicians, there were 10000 patients in 4th quarter
of last year with 100 complaints, the 4th quarter of this year there were 60000
patients with 360 complaints. The quality improvement team target was 5
complaints per 1000 patient. By analyzing these coordinates, what will be found?

A. The rate decreased and the goal is not reached.

B. The rate increased and the goal is reached
C. The rate decreased and the goal is already reached
D. The rate increased and the goal is not reached

312- Which of the following statements about redundancies within processes is

always true?

A- They are needlessly inefficient.

B- They remove the opportunity for error.
C- They require two people to do the work of one.
D- None of the above
313- A health plan decides to use flu vaccine for the total population at their
services area. What is the intangible benefit from this decision?
A- Savings from treatment of non-infected people
B- Savings from decreased rate of infection in non-immunized people
C- Peace of mind as a result of lowest incidence of flu infection
D- Reduced hospitalization rate

314- Which of the following is the primary benefit of using external quality
consultants?

A. Bridging knowledge gaps

B. clarifying mission and vision of the organization.
C. Promoting effective communication.
D. Maintaining performance standards for the organization

315- Data about the competitors may be obtained from all of the followings
sources except:

A- National standards
B- Individual customers
C- News media
D- Surveys performed by the local government
1- D 42- A 83- A
2- C 43- C 84- B
3- B 44- D 85- B
4- C 45- B 86- A
5- C 46- B 87- D
6- C 47- D 88- B
7- A 48- D 89- A
8- B 49- A 90- D
9- C 50- A 91- D
10- B 51- D 92- D
11- D 52- A 93- A
12- D 53- A 94- C
13- A 54- A 95- B
14- B 55- B 96- A
15- B 56- B 97- B
16- A 57- B 98- D
17- A 58- A 99- C
18- A 59- A 100- B
19- A 60- A 101- A
20- C 61- D 102- B
21- A 62- B 103- C
22- A 63- A 104- C
23- A 64- A 105- B
24- A 65- A 106- C
25- B 66- A 107- D
26- C 67- B 108- B
27- D 68- C 109- B
28- D 69- C 110- D
29- B 70- D 111- B
30- A 71- B 112- A
31- C 72- C 113- D
32- B 73- C 114- B
33- A 74- C 115- D
34- B 75- B 116- D
35- B 76- C 117- A
36- C 77- A 118- D
37- B 78- C 119- B
38- B 79- D 120- C
39- C 80- C 121- D
40- A 81- A 122- D
41- A 82- A 123- B
124- B 165- C 206- A
125- A 166- C 207- C
126- D 167- B 208- B
127- C 168- C 209- D
128- B 169- A 210- A
129- C 170- C 211- C
130- D 171- C 212- C
131- A 172- B 213- A
132- D 173- C 214- D
133- D 174- B 215- B
134- C 175- B 216- C
135- B 176- C 217- A
136- C 177- A 218- B
137- C 178- C 219- C
138- A 179- A 220- C
139- C 180- A 221- C
140- C 181- C 222- B
141- B 182- C 223- C
142- B 183- C 224- B
143- A 184- C 225- C
144- B 185- B 226- B
145- D 186- B 227- A
146- A 187- D 228- A
147- A 188- C 229- C
148- B 189- A 230- C
149- A 190- D 231- C
150- B 191- C 232- A
151- A 192- B 233- C
152- C 193- B 234- C
153- A 194- A 235- C
154- D 195- C 236- B
155- D 196- C 237- A
156- B 197- C 238- B
157- B 198- A 239- C
158- B 199- C 240- A
159- C 200- D 241- D
160- B 201- C 242- B
161- D 202- A 243- D
162- D 203- C 244- D
163- D 204- A 245- B
164- A 205- A 246- B
247- C 287- A
248- B 288- A
249- B 289- B
250- A 290- A
251- D 291- B
252- D 292- B
253- B 293- D
254- D 294- C
255- D 295- D
256- A 296- B
257- A 297- A
258- C 298- B
259- A 299- B
260- B 300- B
261- D 301- B
262- B 302- B
263- B 303- C
264- A,B 304- A
265- D 305- C
266- D 306- A
267- D 307- A
268- B 308- B
269- D 309- A
270- A 310- B
271- D 311- A
272- A 312- C
273- C 313- C
274- C 314- A
275- C 315- A
276- A
277- A
278- A
279- B
280- C
281- A
282- C
283- D
284- A
285- C
286- C