Question 1 (2 points)

Your ACO is going well, but the primary care chief, who provides critical leadership, decides to retire. The replacement in your succession plan, Dr. A., will be interim chief, but she declines the permanent post, saying she needs to get her kids out of high school, another two years. The senior management team is debating what to do next. What do you recommend?

Question 1 options:

1) Form a search committee and start a national search.

2) Ask the current chief to stay on for two more years.

3) Meet with the current chief, and Dr. A., to see how to make the job manageable for Dr. A.

4) Name Dr. B, the back-up on the succession plan and press on.

Question 2 (2 points)

You are staffing a PIT studying cardiology lab costs, and one member asks if the accounting department can estimate the cost of the individual processes the lab performs. “Good idea,” you reply. “Our accounting people use activity-based costing (ABC). Even if they can only allocate cost to aggregates of similar tests, the estimates will help the PIT…”

Question 2 options:

1) “…identify valid benchmarks.”

2) “…compare our internal processes to outside vendors’ bids.”

3) “…show where the fat is, so we can cut it.”

4) “…encourage service providers to think of users as customers.”

Question 3 (2 points)

Some of the surgeons in the service line you manage would like to acquire a new piece of equipment offered at $250,000. What do you say?

Question 3 options:

1) “We can probably do that, through the capital budget review. The review is competitive, based on contribution to the HCO mission.”

2) “I’ll prepare a draft capital request for you to review. We’ll need to rank-order requests within our service line first.”

3) “Gee, that’s a lot of money. I don’t know if we can do it.”

4) “You need to prepare a draft capital request and get it rank-ordered with other surgery requests.”

Question 4 (2 points)

The CIO comments in a senior leadership meeting, “We’re implementing best practice from Memorial Sugar Land (see exhibit 10.5). It does not address disaster planning, though. I’d like to form a PIT to consider implications of long-term power loss, protection of data against theft, how to coordinate transfer of data if patients must be moved and our system is down, and issues like that.” The COO says, “Sure, but…”

Question 4 options:

1) “…maybe we should dedicate a senior leadership meeting to thinking through the charge.”

2) “…we don’t have much money for consultation or travel.”

3) “…let’s include the chair of the city’s disaster team.”

4) “…I don’t think we’ll ever have to move patients.”

Question 5 (2 points)

At the senior leadership team meeting, the CFO remarks, “I’d like to move to transfer pricing for specific services wherever we can.” “Good idea,” the CEO says. “Why don’t we ask our fellow to work on a plan for transition? How could we move smoothly from what we have to a transfer pricing approach?” You, the fellow, think, “I’d better get some concepts in mind, or the CFO will eat me for lunch.” You check exhibit 12.8. There are three advantages listed, and two of them (benchmarking and bidding) relate solely to the service provider, not the user. You decide to suggest which of the following?

Question 5 options:

1) “Let’s build some unit costs for HR to see what the change might look like.”

2) “We will need to educate managers in the change and its implications. Let’s form a PIT to do some trials.”

3) “Transfer pricing is an important concept, but it’s not equally valuable everywhere. Let’s start with the most expensive services.”

4) “Transfer pricing is an important concept, but it’s not equally valuable everywhere. Let’s start with the services where the users can control the volume.”

Question 6 (2 points)

Your membership checklist for a population health advocacy group includes the following:

·         Local and state health departments

·         Competing HCOs and the county medical society

·         K–12 schools, police, and social services departments

·         United Way, chamber of commerce, and local business groups

·         Local religious leaders

·         Disease-specific support groups, such as the cancer society and arthritis foundation

The COO says it’s unmanageably long. Now what?

Question 6 options:

1) Drop the chamber, business groups, and religious leaders.

2) Tell the COO that they should all at least hear about it.

3) Drop the disease-specific groups.

4) Suggest that the HCO start by building support with the health departments, competitors, and the medical society, with plans to expand around that core.

Question 7 (2 points)

Taking over as the new COO, you’re checking out media relations. Meeting with the marketing director, you want to hear that her team…

Question 7 options:

1) …has a record of widely read releases, including social networking and damage-control for negative events.

2) …has a record of widely read releases, including damage-control for negative events, and calls on the COO frequently for quotations.

3) …has a record of widely read releases, including social networking and crisis communications plans for negative events, and calls on the COO frequently for quotations.

4) …has a record of widely read releases, including social networking, and calls on the COO frequently for quotations.

Question 8 (2 points)

One of the board finance committee’s key jobs is establishing the appropriate level of debt. Listening to the committee’s discussions as an observer, you know that long-term debt…

Question 8 options:

1) …is available to not-for-profits on the same terms as for-profits.

2) …increases financial risk and should be tested against worst-case scenarios.

3) …is generally avoided by excellent HCOs.

4) …is generally avoided unless interest rates are very low.

Question 9 (2 points)

As the intern in a large HCO, you are alone in an elevator until two patient care techs and two guests enter. The PCAs are talking about “Ms. Jones,” who apparently has some complication to her surgery. As you hear them, you decide:

Question 9 options:

1) Nothing’s wrong here.

2) To tap one on the shoulder and point to a sign that says, “Do not discuss patient matters in public”

3) To tell your preceptor about it

4) To look at their badges so you can report them for a HIPAA violation

Question 10 (2 points)

Your HCO has a number of vendors providing various products and services. A member of the PIC asks how we treat vendor employees. “Are they treated the same as our associates? Do we have the same expectations? What should be our policy?” “Our goal should be to make them full partners,” you respond. You add:

Question 10 options:

1) “They get all the data/info and support they need to do their job.”

2) “They work under vendor policies rather than HCO policies.”

3) “They follow our values and our protocols or procedures.”

4) “They’re empowered, and they follow our protocols. We should treat them as we do employed associates.”

Question 11 (2 points)

The orthopedic surgeons are worried. They think they are losing market share to a competing HCO. The chief of surgery tells the COO, “I think we should do something about it.” The COO replies:

Question 11 options:

1) “We will check our Medicare market share and any other data we have and get back to you.”

2) “We can do a promotional campaign for them.”

3) “Our marketing director and I will meet with them. Thanks for telling me.”

4) “Thanks. I’ll have our marketing director look into it.”

Question 12 (2 points)

Describing the HCO’s audit and compliance program to a new board member, you want to mention that it…

Question 12 options:

1) …covers information and contracts as well as tangible assets.

2) …is completed by an independent associate team.

3) …is checked by an outside auditor.

4) All of the above

Question 13 (2 points)

As CEO, you’re concerned with some of the results on the accounting/finance (A/F) scorecard (exhibit 13.8). The cost and quality scores are excellent, but A/F worker satisfaction is low, and customer (both patients and other HCO units) satisfaction is worse. You’ve arranged a meeting with the CFO. What is key the “takeaway” you want convey?

Question 13 options:

1) “Our HR consultants might have some useful thoughts on how to improve satisfaction scores.”

2) “The HCO cannot tolerate A/F performance that is offensive to patients and to other associates.”

3) “The A/F team needs to set and meet realistic improvement goals for next year on both associate and customer satisfaction.”

4) “It’s important for the A/F leadership team to personally reflect the behavior standards, ‘must haves,’ and AIDET (chapter 2) that we adopted from Sharp.

Question 14 (2 points)

The training program for first-line managers should demonstrate that they have learned that marketing/strategy…

Question 14 options:

1) …is available for consultation when questions arise, can help design new patient services, and help promote associate support of mission, vision, and values.

2) …is an upper management activity that the HCO pursues aggressively.

3) …is available for consultation when questions arise and can help promote associate support of mission, vision, and values.

4) …is available for consultation when questions arise and can help design new patient services.

Question 15 (2 points)

After your speech about the HCO’s expansion plans at the public library, in the Q&A, a lady asks, “We read about these disasters that occur with poisonous or dangerous materials. I know there are a lot of dangerous things in hospitals. Can we be sure we’re protected?” You reply:

Question 15 options:

1) “Our overall safety record is excellent. You don’t need to worry.”

2) “We train all our associates on safety, and we meet federal and state standards for various hazards.”

3) “We train all our associates on safety, and we meet federal and state standards for various hazards. Our overall safety record is excellent.”

4) “I can’t guarantee the future, but I can say that our HCO is as safe as any.”

Question 16 (2 points)

The VP for planning and continuous improvement always participates in the training of new first-line managers. She wants the new leaders to take away a few key concepts. She emphasizes that her team can do which of the following?

Question 16 options:

1) Do detailed activity-based costing to compare alternative solutions

2) Plan and implement marketing and promotion

3) Arrange for advice from outside consultants

4) Help a lot with process improvement, capital budget requests, and 90-day plans

Question 17 (2 points)

Senior leadership learns that several first-line managers are complaining about the goal-setting process. They say that the budget office isn’t helpful—recalculation for changes is slow, the budget office doesn’t explain changes, and one says, “The budget office is snarky.” What next?

Question 17 options:

1)Reassure the managers, saying that the budget process is stressful for everybody, and they shouldn’t worry about it.

2) Tell the CFO to retrain the budget office.

3) The COO and CFO round to the budget office. The COO speaks briefly on why prompt, responsive service is essential.

4) The COO and CFO round to the budget office. They solicit and listen to comments from the team on how the work is going. The COO speaks briefly on why prompt, responsive service is essential, and suggests that the finance team form a PIT to make sure its internal customers are satisfied.

Question 18 (2 points)

Your lunch friends—young nurses and doctors—complain steadily about the EHR. “Takes forever” and “can’t find” are common threads. You should:

Question 18 options:

1) Tell them not to whine.

2) Tell them paper records weren’t that great, either.

3) Not say anything and forget about it.

4) Find out if there are EHR OFIs about speed and search, and report back to your friends.

Question 19 (2 points)

The environmental assessment documents steady progress toward benchmark on quality, cost, and patient satisfaction, but the forecasts show a substantial decline in total revenue, driven by reduced ED usage and fewer admissions for chronic diseases that are being managed with fewer hospitalizations. There is much emotional response. The CMO says the forecasts must be wrong. The CFO says the revenue losses endanger the borrowing covenants. The CEO says, “We’d better think about it overnight, but I want to meet tomorrow to pursue it.” What should the VP planning say when the team reconvenes?

Question 19 options:

1) “We’ve checked and rechecked the numbers. It’s safer to assume they are right than to ignore them.”

2) “We need fundamental restructuring—changed services or a revised merger or acquisition strategy.”

3) “The sooner we think through what to do, the more time we have to react.”

4) “Our goal should be to reduce employment to bring the books in balance.”

Question 20 (2 points)

One of your responsibilities is linen service. It is supplied by an outside contractor on a three-year contract with 14 months to go. You receive a solicitation from a competing supplier, which claims it can cut laundry costs by 20 percent. “Thank you,” you reply. “Our current supplier has a contract through more than a year from now.” You continue:

Question 20 options:

1) “I’ll see that your company is notified when we solicit bids for the next contract.”

2) “I’ll see that your company is notified when we solicit bids for the next contract, but you should understand that we will not change suppliers without a substantial advantage.”

3) “I doubt that we’ll change suppliers; we’re quite satisfied.”

4) “I’ll see that your company is notified when we solicit bids for the next contract. You should understand that we will rate service as the prime objective—no shortages, no late deliveries, no wrong items. We will only consider bidders with a substantial record of excellent service.”

Question 21 (2 points)

You are on the team preparing for the board’s annual retreat. The intern asks you why the HCO uses “five forces” to structure strategic OFIs, instead of SWOT. You reply, “That’s a question that we’ve thought about with some care. We’ve chosen five forces because…”

Question 21 options:

1) “…it focuses a review of resource stakeholders—strategic partners and associates.”

2) “…it’s what competitors are doing.”

3) “…the detail—customers, technology, resources, competitors, and potential changes—helps review all stakeholder concerns.”

4) “…it’s what they teach at Harvard Business School.”

Question 22 (2 points)

A couple years after your fellowship at a high-performing HCO, you are offered a seat on the knowledge management planning committee. You accept, knowing that it’s a growth opportunity for you personally because the committee…

Question 22 options:

1) …is involved in many important strategic issues.

2) …makes liberal use of subcommittees, so you’ll have learning opportunities outside your own unit.

3) …supervises performance measures, so you’ll build a stronger foundation in measurement and statistics.

4) All of the above

Question 23 (2 points)

At a PIC meeting, a service line with fewer patients than their capacity asks that the HCO do more general advertising, “getting our name out in front of people, on billboards, TV, internet ads.” As VP of marketing/strategy, you recognize the request as seeking a branding campaign. It’s your job to make clear that branding…

Question 23 options:

1) …should be backed by high performance on quality and satisfaction.

2) …is resistant to competitors’ campaigns.

3) …will generate a prompt, positive response

4) All of the above

Question 24 (2 points)

The CFO reports that negotiations with private insurers are going badly. “Inflation has driven up purchase prices, and new care guidelines are more costly than earlier ones. Our largest payer is saying, ‘No more.’ They claim our competitors can live with it, and we should, too.” Senior leadership rank-orders the following responses. Which of the responses do you argue is the most important?

Question 24 options:

1) Consider merger discussion with a competitor.

2) Review our benchmarking and shortfalls; fix or close our biggest losing services.

3) Adjust the LRFP to the insurer’s best offer, and report the results to the board finance committee without recommendation.

4) Adjust the LRFP to the insurer’s best offer, and report the results to the board finance committee with a recommendation to pursue both a and b.

Question 25 (2 points)

You’re the fellow, invited to sit in with the team preparing the strategic review for the board retreat. The VP marketing/strategy is chairing. During a break, she asks you if you can evaluate the HCO’s risk posture. “No,” you say, being candid, “but I did learn a framework for understanding risk—analyzers, prospectors, defenders, and reactors.” Choose your best next comment:

Question 25 options:

1) “Risk can’t be avoided. The risk of inaction—no change—may be greater than the risk of a planned change. The right path balances the risks of change with the risks of inaction.”

2) “Prospectors move into untried fields at very high risk. It’s important but might not be prudent for a not-for-profit HCO.”

3) “Analyzers deliberately balance innovation with excellence, looking for tested, low-risk change. Some research supports analyzers as the best posture for NFP HCOs.”

4) “Reactors can be overcome by competitors who examine future opportunities and implement them more aggressively.”

Question 26 (2 points)

As COO, you know that internal consulting manages the epidemiologic planning model and that the applications drive scorecards and a great many decisions. You decide to review model application procedures with IC staff. You want to be sure that the statistical model incorporates multiple variables contributing to the demand for care and…

Question 26 options:

1) …is inexpensive and easy to use.

2) …is supported by experts and is regularly updated.

3) …cannot be sold to the HCO’s competitors.

4) …is the most accurate on the market.

Question 27 (2 points)

Briefing new first-line managers on the capital budget procedure (exhibit 14.9), you explain that the board finance committee must approve all capital projects. It…

Question 27 options:

1) …starts with the competitive ranking prepared by management and can change the final ranking only with full board approval.

2) …pays special attention to larger projects and those near the expected cut-off and can “drill down” to any level of detail on specific projects if it needs more information.

3) …focuses mostly on establishing the available funds and does not spend much time on the projects themselves.

4) …looks carefully at all the projects and often revises the order submitted by management.

Question 28 (2 points)

While you’re lunching with a group of young nurses, one of them says, “On my unit, we seem to have had an increase in catheter-associated urinary tract infections (CAUTIs), but the rate on monthly report does not show it. My nurse manager says not to worry about it. Do you think she’s right?” You respond:

Question 28 options:

1) “Yes, she’s right. We can’t chase what’s just luck.”

2) “I’ll ask an expert from KM to look at it. A run of increases could be significant when the individual values are still within confidence limits.”

3) “No, any increase is bad news.”

4) “Maybe not. Do you have any idea why it’s changing?”

Question 29 (2 points)

You’re on the search committee to replace the CIO at a high-performing HCO. The leading candidate asks you, “How can I be sure that your HCO will provide adequate capital investment funds?” You reply:

Question 29 options:

1) “Here’s our record, KM department expenditures for the last several years.”

2) “The board’s policy is (state what the policy is—so much per year earmarked for IT or to judge IT requests with all capital needs). Here’s our record in recent years.”

3) “You tell us what’s missing. We’ll fill any reasonable request.”

4) “Don’t worry about it. If you see any specific needs, let’s discuss them.”

Question 30 (2 points)

You are staffing a PIT making sure that the HCO utilities (power, water, sewage, fuel) are best practice. Your mental checklist includes which of the following?

Question 30 options:

1) Compliance with code, very low failure rate

2) Compliance with code, very low failure rate, dual or triple sources

3) Compliance with code, very low failure rate, dual or triple sources, disaster drills and failure simulations

4) Compliance with code, very low failure rate, dual or triple sources, disaster drills and failure simulations, plans for catastrophic or extended failures

Question 31 (2 points)

Your CEO asks you how to evaluate progress of the local community health group. You say that an effective group should…

Question 31 options:

1) …decide for itself what success is.

2) …establish quantitative goals for incidence and prevalence of preventable disease.

3) …be a unit of the HCO, with a unit scorecard and a few lines on the strategic scorecard.

4) …not try to measure outcomes, but judge its success on broad-based community support.

Question 32 (2 points)

Your HCO has offered free screening for all comers at health fairs, county fairs, and similar events, with weight and body mass index, blood pressure, diabetes, prostatic cancers, and cholesterol. The health department representative on the newly formed community population health committee says, “That’s not population health; it’s care promotion. It raises community health costs without noticeably impacting disease. You should redesign the program, drop several of those tests, and make the rest age and sex specific.” What is your response?

Question 32 options:

1) “Most HCOs do these programs, and they are very popular. We feel we should continue them.”

2) “You’re right, but everybody does them.”

3) “You’re wrong. Those programs save lives through early detection.”

4) “You might be right. It will take some study, but let’s work out a stronger offering.”

Question 33 (2 points)

Your community’s population health council was formed as a voluntary association. It has no corporate status, but it has made significant progress, establishing a set of measurable goals and a strategy for each. One goal, “Coordinate our FQHCs, HCOs, and ACOs to provide appropriate care for all citizens,” will be measured by hospitalization rates of ambulatory care–sensitive diseases and a household survey administered by the local health department. At the council meeting, the chair, who is the county public health officer, proposes that all three of the county’s HCOs meet to discuss how to serve the entire city with ACOs. As the representative of one HCO, you reply:

Question 33 options:

1) “I’m afraid that would be a violation of the antitrust act, but I’ll confer with our counsel.”

2) “We welcome such a discussion. To make sure we’re complying with the law, I’ll ask our HCO’s general counsel to confer with you.”

3) “Our HCO has made substantial plans. We can share our intentions with the committee, but we think a competitive model is best.”

4) “Our plans for an ACO are not yet complete. We’re not ready for such a discussion.”

Question 34 (2 points)

You’re starting a campaign to “brand” your ACO, population health mission, and community health coalition. A professional promotional firm will help you. They ask you for a central theme statement. Which of the following is best? “Our new ACO will…”

Question 34 options:

1) “…meet environmental, educational, personal assistance, and healthcare needs.”

2) “…provide effective, economical care for many diseases that impair our citizens’ health.”

3) “…help with chronic disease and end-of-life issues.”

4) “…expand our award-winning, high-quality, patient-sensitive care. We’re proud to be part of a community-wide effort toward good health.”

Question 35 (2 points)

In your internship at Sutter Health, the VP for environment asks you how you would evaluate their materials management. You reply:

Question 35 options:

1) “Materials management should have its own unit scorecard. I’d look for benchmarks and OFIs.”

2) “Being low cost and on time are what’s important.”

3) “Internal auditing should monitor loss, theft, bribery, and waste.”

4) “I’d emphasize 100 percent ‘delighted’ and zero complaints from clinical units.”

Question 36 (2 points)

You meet weekly with the COO, who seems to be preparing you for promotion. One day she says, “We buy most environment of care services from outside vendors, but we have a few services that we make. Why should we make those? What are the criteria that determine whether we make or buy a specific service?” You reply, “Well, of course we want low cost, but just low cost could get us into trouble. Let me think about it till next week.” Which approach should you use at your next meeting?

Question 36 options:

1) “Fail-safe service is more important than cost. The contract should go to the provider closest to fail-safe—us or a vendor, in spite of costs.”

2) “Maybe our outside vendor policy is wrong. We could end up getting trapped with a short list of very expensive bidders. We should make it ourselves unless there are two or more fail-safe vendors.”

3) “Supplier change (either way) is an OFI if there’s a substantial price advantage or a reliability advantage, or if we are far from benchmark costs.”

4) “We should always go with the lowest cost supplier that can meet fail-safe standards.”

Question 37 (2 points)

The external audit report suggests that the auditing firm sells software that is “bullet-proof” on upcoding but maximizes income. The finance committee receives and discusses the report. The most recently appointed member says, “I move we ask the CFO to install the software.” As CEO, you say:

Question 37 options:

1) “Let’s investigate it a step further. I’d like the CFO to check for competing products. She can report next month.”

2) “I second the motion. It’s easy to miss some diagnoses and report patients as less complex than they really are. ”

3) “I think we can leave that to the CFO’s discretion. The auditor seems to have a conflict of interest peddling their software in the audit report.”

4) Remain silent, waiting for someone else on the committee to second or the chair to rule the motion inappropriate.

Question 38 (2 points)

You’re staffing a PIT to review internal consulting (IC) services. At the first meeting, you explain that a sound plan for the PIT should include which of the following

Question 38 options:

1) Review of the performance measures and available benchmarks on IC’s scorecard (exhibit 14.10)

2) Answer a, plus an HCO-wide survey of managers’ perceptions of IC

3) Answer b, plus interviews of associates working in IC

4) Answer c, plus an effort to identify best practices of similar, noncompeting HCOs

Question 39 (2 points)

Attending a meeting of your HCO’s primary care physicians, you hear a lot of complaints. “The EHR’s a pain”; “I can’t spend the time I should with patients”; “You have to check every box, ‘No, this man is not pregnant. Yes, this 80 year old has arthritis. It’s a waste of time.’” You decide:

Question 39 options:

1) To explain once again that data show the EHR is improving patient care

2) To propose using nurses to complete the EHR in a patient interview before seeing a practitioner

3) To ask patients to complete a history with these questions which the practitioner can review

4) To ask the practitioners if they would serve on a PIT to make the EHR less obtrusive

Question 40 (2 points)

You are the fellow at an HCO like Sharp HealthCare, in a city like San Diego, and your HCO is promoting its ACO. It wants to attract as many healthy and moderately ill patients as possible to balance those with chronic disease. The marketing VP tests you by asking, “What do we need to think about with this campaign?” You say:

Question 40 options:

1) “That’s a really complicated question. I’m not sure I know the answer.”

2) “We will refer our own patients, but we need to reach healthy citizens who may not now have providers.”

3) “We need culturally competent messages for specific ethnic communities.”

4) “We should advertise at sites where people tend to be healthy. Maybe health and fitness clubs, churches, and senior citizen activities.”

Question 41 (2 points)

PT has come in with a solid forecast of increased demand. Moving Social Service and expanding PT will meet their needs. If they get the new space, they are committed to making substantial gains in patient satisfaction and improvements in some patient outcomes. The orthopedics surgery service passed a resolution that expansion is a must. Social Service must move to a location on the second floor, and farther from the main entrance. Social Service is very upset. “Our patients need easy access, too,” the chief says. “You’re just giving it to PT because they make money and we don’t. Our HCO’s value of compassion is being ignored!” You reply:

Question 41 options:

1) “I understand. I’ll have the space management team go over the decision again.”

2) “I understand. Let’s ask the senior management team to review the decision. Kate Strate, in internal consulting, works on space planning. She can help you prepare your case.”

3) “I understand, but the PT proposal is carefully documented. It will increase our income, but it also will help a lot of patients recover fully. I don’t think you have a case for further review.”

4) “I understand, but you made those points to space management when the proposal was being developed. We’re sympathetic with your concerns, but the alternatives are painful, too.”

Question 42 (2 points)

On rounds, a service line manager tells the COO, “Internal consulting told us that our new equipment proposal wasn’t good enough. The IC staff said it was ‘hopeless,’ so we dropped it. I still think it would have improved outcomes and patient satisfaction.” What should the COO do and say?

Question 42 options:

1) “I think you should go to Jenny J., the IC manager, and ask for help to think through the proposal again, with a different staff.”

2) “I will tell IC to come back and help you develop your best proposal.”

3) “I will ask Jenny J., the IC manager, to meet with you. We’ll work together to implement best practice.”

4) “That’s unfortunate. Maybe next year you can develop a stronger idea.”

Question 43 (2 points)

One of your first-line nursing managers is new. She’s taken the HR budgeting course, using a software tool that allows her to track implications of changing staff and supply costs, but she says to her supervisor, “Why change? We don’t need more people, and we’d be pressed with fewer.” The supervisor should reply:

Question 43 options:

1) “If your cost per case is close to benchmark, and you are sure you can you make your quality and satisfaction goals, you can propose to stay the same as this year.”

2) “What would be the result of one fewer tech on your cost and quality goals?”

3) “If your cost is not benchmark, it must come down.”

4) “If your quality and satisfaction is not benchmark, would extra staff help?”

Question 44 (2 points)

The chief of orthopedics drops by your office. “I hear you chair our HCO’s space management program,” he says. “Ortho is growing steadily. Our PTs do a good job, but the space is crowded, not as comfortable for patients as our biggest competitor, City-Wide PT. I note that the Social Service Department space next to PT isn’t used all that much. Could you relocate them and give us their space?” “We can certainly look into it,” you reply. You continue:

Question 44 options:

1) “It wouldn’t be hard to move Social Service.”

2) “PT will need to prepare a new operating plan, get a solution from the space committee, and defend the cost of implementing the new plan in the capital budget request competition.”

3) “Internal consulting can help PT plan the space, prepare a formal proposal, and also forecast the impact on the unit scorecard. I’ll ask Sarah Smart, the leader there, to meet with you. The space committee will review the proposal. We have a good record of working out solutions.”

4) “Orthopedics is important to us. I’m sure we can work something out.”

Question 45 (2 points)

In your fellowship at a high-performing HCO, the CIO asks, “Is our communication to associates what it should be? Ideally, every associate should know all the general policies related to their job. How could we identify communications OFIs? Give me your thoughts on that, to help me decide whether we should do a more extensive review.” You go back to your office and start a list of ways to assess HCO-to-associate communication. Your initial thoughts include the following options:

1—Every PIT could report to KM planning on what they feel are communication OFIs.

2—Add questions to the employee satisfaction survey.

3—Study unexpected-event reports to identify cases where communication failed.

4—Offer all intranet users a voluntary follow-up survey, “Was this the info you needed?”

5—Ask senior management to ask first-line managers on rounds, “What do associates not know but should?”

6—Ask for comments in exit interviews of voluntary terminations.

Now report the three best back to the CIO. Which do you choose?

Question 45 options:

1) 1, 2, and 3

2) 1,3, and 5

3) 2, 4, and 5

4) Some other combination

Question 46 (2 points)

In a PIT reviewing procedures for using external consultants, you are prepared to argue that the following step helps ensure high value for dollars spent:

Question 46 options:

1) Outside consultants should be selected by bid—lowest qualified bidder gets the contract.

2) Outside consultants should be hired through and supervised by internal consultants.

3) There is no need for a conflict-of-interest prohibition.

4) Clinical service lines can hire outside consultants if they are dissatisfied with internal results.

Question 47 (2 points)

An orthopedist on staff says, “My residency hospital in the Intermountain system used some patient recovery measures that aren’t on my unit’s scorecard. They were helpful, because they focused on improving function.” You reply:

Question 47 options:

1) “We have a lot of measures already. It will be hard to add any.”

2) “You can write a memo to the KM planning committee. It would be smart to get approval from the chief of orthopedics and the nurse managers on your floor.”

3) “Tell me about them, and I’ll take them to the KM planning committee.”

4) “Can you explain them to me? I’ll check the literature and draft a proposal for your review. It will have to be reviewed by orthopedics and the KM planning committee.”

Question 48 (2 points)

You are staffing a PIT to implement an accountable care organization. The PIT’s initial list of criteria for success include team care, emphasizing clinical support service professionals; holistic care plans; community support; and an outcomes-oriented scorecard. You consider proposing…

Question 48 options:

1) …adding palliative and end-of-life care, because it’s a critical element for many patients.

2) …dropping community support, because it will be complicated to build.

3) …substituting “evidence-based” for “holistic” care plans, because it’s not clear how the HCO can build holistic plans.

4) …dropping the scorecard until the ACO is established, because it will be less important until the organization stabilizes.

Question 49 (2 points)

Community health needs assessments (CHNA) are required of all 501c3 hospitals at three-year intervals under the Affordable Care Act (see You are preparing the CHNA for your HCO. Following the spirit of the law, you assemble the HCO’s demand forecasts for preventable chronic disease and post-acute services. Your assessment should also include information about:

Question 49 options:

1) Relations with other agencies committed to community health, local plans to address health disparities, and an explicit HCO community health mission

2) Local plans to address health disparities, and an explicit HCO community health mission

3) Relations with other agencies committed to community health and an explicit HCO community health mission

4) Relations with other agencies committed to community health, and local plans to address health disparities

Question 50 (2 points)

People’s reaction to disaster planning is usually a form of denial: “It can’t happen here, so why should I take the disaster procedures seriously?” As a representative of management, you need several good answers on the tip of your tongue. They include:

Question 50 options:

1) “It can happen here. It’s happened in dozens of places; in ways you never expect.”

2) “If we do it right, we’ll save lives. If we’re not prepared, those lives will be lost.”

3) “It’s part of our accreditation requirements, and our friends and neighbors expect us to be ready.”

4) All of the above

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