Leadership Exam 2 Study Guide

8/20/2019 Leadership Exam 2 Study Guide

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Leadership Exam 2 Study Guide: Cpt.6, 9, 10

Chapter 6: Patient, Subordinate, and Proessiona! "d#o$a$y:

1. "d#o$a$y:

"d#o$a$y: helping others grow/ self-actualize;

%inform others of rights; protecting one believes for others and self Leader: use risk taking, vision, self-confidence, ability to articulate needs, assertivenessManager: for all-whistleblower- legislator/media/ influence health policy

% Nurses act as advocates by helping others make informed decision,

By acting as an intermediary in the environ,

Or directly intervening on behalf of others

• &nternationa! Coun$i! o 'urses deinition o ad#o$a$y:

% blending: science/ ethics/ politics%self-initiated/ evidence based/ strategic action%help transform systems/ improve environ/policies that shape pts: behave/choices/health

% Nursing values central to advocacy emphasize caring, autonomy, respect,

empowerment.

• Leadership (o!es:

! "reate "limate-value advocacy # assoc risk taking$! %eek fairness/&ustice for those unable

'! %trengthen (t/ subordinate support systems- encourage autonomy/ decision making)! (rovide info to empower autonomy*! +ssertively advocate for others when needed! (articipate in proff nursing organize/groups that advance nursing proff ! .ole Model proactive involvement in health-care policy! %peak up to advocate for health care practices for safety/ 0uality improve1! 2elp create national/ legal binding 3ill of .ights for pts4! %ocial &ustice/ individual pt advocacy! 5ifferentiate btwn control pts/ assisting choices--- domination/dependence vs!

freedom

•

)ana*ement +un$tions:"d#o$ate or:

! pt/subordinate ade0uate info for making decisions$! (rioritize pt- rights/ values'! "onsultation for pt, if inter/intrapersonal conflict)! (romote workplace safety/health for all*! 6ncourage subord e7press concerns/ impunity for whistleblowers! 5emonstrate skills to deal w/ media/ legislators health care issues


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! +ware of current legislative that affects nursing practice/ organizational manage! 8ork environ promotes empowerment to speak up for pts, self, proff 1! %afe/ conducive for proff growth4! 9ake immediate action: illegal/ unethical/ inappropriate behave that endangers/

&eopardizes all

• 'ursin* a!ues Centra! to "d#o$a$y:

&ndi#idua!s ha#e ri*ht to:

! .ight to autonomy deciding course of action/ health-care goals$! .ight to hold personal values/ make decisions'! .ight to +ccess of info- to make informed decisions)! urses acts on behalf of those unable to*! 6mpower pts/ subordinates to make decision for their own essence of advocacy

Patient "d#o$a$y:

• 5isease/ +ging/ (hysical/ Mental 5isability can result in: dec independence, dec

freedom, dec ability to make choices alone advocacy ensures vulnerable protected Important for pt-advocate to differentiate btwn

!ontrolling pt choices "domin#dependence$

%ssisting pt-choices "freedom$

Common "reas% (e-uirin* 'urse%Pt "d#o$a$y:

1. 6nd- of life decisions$! 9echn advances'! .eimbursement- health care)! +ccess to health care*! (rovider-pt "onflicts- e7pectations/ outcomes! 8ithholding info, nsurance coverage: authorize/ denials/ delays! (t privacy/ confidentiality1! Med 6rrors4! (t grievances/ appeals! "ultural/ ethnic diversity senility$! .espect/ dignity for pts'! ncompetent 2"()! nade0uate consent*! "omple7 social probs: +5%, teen preg, violence, poverty! +ging (op

•

•

Patient (i*hts:

%Consumer i!! o (i*hts/ (esponsibi!ities Pt i!! o (i*hts: 11; laying out

rights/responsibilities of pts and hcp


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%'


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1! (romote nurse autonomy4! (rovide staff w workable systems -Managers need to establish/utilize: support systems/ ethical committees/ channels to deal

w/ ethical problems!

4hist!e b!o7in* as "d#o$a$y:

Present 8ay Ethi$a! )a!eanse: very high due to: managed care; declining

reimbursement; ongoing pressure for fiscal solvent; risk/fraud/misrepresentation

4hist!e b!o7in* needed:

2 ypes:

&nterna!: w/im organizationsExterna!: reporting from media/ elected officials

%)ana*ers must ensure no retaliation taken against whistle blowers

- &peaking out as a whistleblower is often honored more in theory than in fact pub!i$

7ants usti$e, but a!so sees 7hist!e b!o7in* as distrustu!

-Proessiona! duty to: uncover, openly discuss, and condemn shortcuts that threaten pts-sense of right/wrong! "ommitment to allow prob through until accept level of resolution

reached- 'eader- managers must be willing to advocate for whistleblowers, who speak out

about organizational practices that they believe may be harmful# inappropriate

•

Proessiona! "d#o$a$y:

%State 'urse Pra$ti$e "$ts and State Listenin*: result of nurses advocating for proff

accountability%!eaders responsib!e or: collaborating defining proff; achieving legal recogn;

establishing a culture of proff nursing; proff leadership role; personal/public promise

serve others ; proff issues? always ethical; raise consciousness of colleagues

% % professional commitment means people can(t shrink from duty to )uestion#

contemplate probs that face the profession

-)an*ers duties: broaden sociopolitical knowledge; understand bureaucracies; speak out

on consumer issues; attempt to e7pand legislation; increase membership of govern health

policy-making; influence probs such as: homeless, teen preg, drug/alcohol abuse,

inade0uate health care for poor/elderly, med errors

'urse "d#o$a$y (o!e in Le*is!ation/ Pub!i$ Po!i$y:


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%&n!uen$e pub!i$ po!i$y by: active in national nursing organizations; directly lobby

legislator in person/by letter; collective influence to impact health care policy

- Nurses must e*ert their collective influence-make concerns known to policy makers

-before having a ma+or impact on political# legislative outcomes

%Po!iti$a! a$tion Committees P"C;s: of "ongress of ndustrial @rganizations- attempt

to persuade legislators to vote certain way; lobbyist of (+"As may be from: groups

interested in partic law or paid agents want bill passed/defeated% urses need to be more active in (+"%%'urse shou!d !obby or: -ua!ity o $are, a$$ess to $are, saety, restructuring, direct

reimbursement for advanced practice nurses; funding for nurse education


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-%hort-term planning: specific task, less comple7, annual/ 0uarter/ monthly/ weekly/

daily/ hourly-not planning? stressful, increased errors,-managers: need to find time to plan

ime )ana*ement: making optimal use if available time

%ood time management skills allow individual to spend time on things that matter

-optimize time manage: prioritize duties; manage/ control crises; reduce stress; balance

work/ personal time

Leadership (o!es% ime )ana*ement:

! self-aware of personal blocks/ barriers to efficient time manage$! .ecog own value system influence time use/ e7pectation of followers'! .ole model/ supporter/ resource person in setting goal setting priorities)! +ssist followers in working cooperatively- ma7 time*! (revent/ filter interruptions

! .ole model fle7ibility w/ diff people/diff time manage styles! "alm reassurance during high unit activity! (rioritize conflicting/ overlapping re0uests for time1! +ppropriately determine 0uality of work needed

• )ana*ement +un$tions% ime )ana*ement:

! (rioritize day-to-day planning meet long/short term goals$! Make time for planning during work schedule'! +nalyze how time managed B &ob analysis/ time-and-motion studies)! 6liminate environ barriers or emp!oyees to effective time*! 5o paperwork prompt/efficiently Bclean work area! 3reak large tasks into smaller Beasily accomplishable

! +ppropriate techn for timely communic/ documentation! 5iff btwn inade0uate staffing vs! inefficient use of time

• asi$ Steps: ime )ana*ement

1. ime set aside for planning/ establishes priorities2. Comp!ete 3i*hest Priority tas5 irst, then move onto ne7t. (eprioriti=e based on ne7 ino

• a5in* ime to P!an/ Estab!ish Priorities:

-planning? manage by efficiency instead of by crisis%P!annin* +a!!a$ies% believing doing the same style will result in diff outcomes, when it

didnAt work before-mana*ers: first step plan; pause/decide how people/ activities/ materials put together for

goal-nfortunately, mistakes common in planning arenderestimating importance of daily plan

Not allowing ade)uate time for planning

%S)"( p!an: think, ablaze data, envision alt, make decisions


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Ex: day-day: $har*e nurse staffing, pt care assign, coord lunch breaks,E>: sta nurse: how handoff reports given/received, timing/ methods initial assess,

coord of meds, t7, procedures, docum

• Smart "pproa$h to P!annin*:

! %et specific, clear goals$! .ecord progress measurable- maintains interest'! d steps needed to accomplish)! know specific time constraints; set goals accomplishable w/in time constraints*! set time frame/ plan for this

• ime%ei$ient 4or5 En#ironment:

!


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% &ome pro+ects are not accomplished because they aren(t broken down into

manageable tasks

(eprioriti=in*: change when new info received ; if crisis-set aside original priorities for

day/ recognize/ communicate/ delegate new plan

- No amount of planning can prevent occasional crises 8ea!in* 7 interruptions: all managers e7perience; 0uiet work place needed; develop

skills to prevent interruptions; cope w change% 'ower-'evel 0anagers e*perience more interruptions than higher-level managers

ime 4asters:

! 9echnology- internet, gaming, email, social media$! socializing'! (aperwork overload)! nterruptions% don(t need to check email 122 * per day

3o7 to pre#ent subordinates rom ta5in* mana*er time:

! 5onAt make self overly accessible$! nterrupt rambling'! 3e brief- stand up when done)! %chedule long-winded individuals

• Persona! ime )ana*ement: self-knowledge/ aware; clearly id personal goals/

priorities; greater control over e7penditure of energy; what needs to be accomplished% 0anaging time is diff if person is unsure of his#her priorities for time manage,

Including personal short# intermediate# long term goals

rans 12 3abits to )aster: Persona! ime )ana*ement:

! >avor trusting relationships$! Maintain lifestyle to ma7 energy'! Listen to biorhythms/ organize day accordingly)! set very few priorities, stick to them*! 9urn down things that inconsistent w/ priorities! set aside time for focused effort! look for ways to do things! build solid processes1! spot trouble/ solve probs immediately4! break your goals into smaller units, one at time

! >inish whets important, stop doing what is no longer worth wild- 3veryone avoids certain types of work# has method of wasting time

Produ$ti#ity s7eet spot: times of day or certain lengths of times that people work best at

%lack of punctuality suggests that you don(t value other people(s time

&nte*ratin* Leadership (o!es and )ana*ement +un$tions in ime )ana*ement:

-managing time well- reduce stress- must deal with less: status if health care; nursing shortage; decrease reimbursement


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-intrapersonal commuic skills;

Chapter 10: +is$a! P!annin*:

%4iscal planning is not intuitive5 learned skill that improves w# practice

->iscal planning- re0uires vision, creativity, knowledge pf political/ social/ economic forces that

shape health

• Leadership (o!es% +is$a! P!annin*:

! visionary/ id forecasting short/long-term; proactive instead of reactive$! Enowledgeable about pol, social, economic factors'! >le7ibility in fiscal goal setting in rapidly changing system)! +nticipates, creatively solves budget constraints*! nspires members to be active in fiscal planning

! .ecog when fiscal constraints have impaired organiz goals; communicate needs

through chain of command! (t safety not &eopardized by cost constraints! .ole models leadership needed for reform efforts1! (repares for changed rt reform # implement patient protect affordable care act

• )ana*ement +un$tions:

! d important/ develop short/long tern fiscal plan for unit needs$! +rticulate/ documents needs to higher administrators'! +ssess internal/ e7ternal environ B id driving forces/ barriers fiscal plan)! knowledge of budgeting / appropriate techni0ues*! opportunities for subordinates to Fparticipate in fiscal plan! fiscal planning congruent w/ organiz goals/ ob&ectives! assess personnel needs B pre-determined standers of pt classify systems! 5ocument ptAs needs for services- facilitate organizational reimbursement1! monitor aspects of budget control4! collaborate w hc administrators- determine how imitative GH3(, +"@s, 3undled

payment; medical home, health insuranceI impact organizational viability!

• a!an$in* Cost and ?ua!ity:

%$ost $ontainment: effective/ efficient delivery of services while generating revenues for

continual organizational productivity

%$ost%ee$ti#e: producing good results for amt for money spent; worth the cost %spending more does not always e)uate to higher )uality health outcomes

(esponsibi!ity "$$ountin*: organizationAs revenues, e7penses, assets, liabilities, is

someoneAs responsibility

+ore$astin*: making educated budget estimate by using historical data

ud*et: financial plan includes e7penses as well as income for period of time


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-6he budget(s value is directly rt its accuracy

+ixed expenses: donAt vary w/ vol

ariab!e: do vary w/ vol

Contro!!ab!e expense: varies by manager- e7: control number of staff

'o $ontro!!ab!e expense: canAt be varies, e7: number/type of supply needed by pt

Steps in ud*etary Pro$ess:

! +ssess B what needs to be covered in budget$! 57- goals and create cost efficient budget to get there'! 5evelop plan- $ months-fiscal year budget; perpetual budget- each month)! mplementation- ongoing monitoring / analysis- monthly statements/ deviations*! 6valuation- reviewed periodically/ ad&usted- Budget that is predicted too far in advance has greater probability for error

+is$a! ermino!o*y:

1. "$$ountab!e Care r*ani=ations "C;s: group of providers/service work

together to coordinate care for Medicare patients$! "$uity &ndex: weighted stat measurements, refer to illness severity to patient in

given time! "lassified by acuity; four categories! +cuity inde7?total acuity/Jof

patients'! "ordab!e Care "$t: passed march $44; all +mericans have: access to

affordable health care, reduced barriers to obtaining coverage, access to services)! "ssets: financial resources received by healthcare orgs, e7: accnt receivable@. ase!ine data: historical info on K spent, acuity level, census, resources needed,

hours of care, etc! future needs pro&ected

! rea5e#en point: point at which revenue ? cost! Must maintain high vol to

decrease unit costA. und!ed Payment: hcp receives a sum for treating overall condition instead of

individ treatments! .ewards for coordinating care, prevent complications/errors,

reduce unnecess tests!! Capitation: prospe$ti#e payment sys pps B pays health plans fi7ed amount

per enrollee per month, regardless of num of services used9. Case mix: type o patient ser#ed by p!a$e. "$uity !e#e!s, dx, tx

10. Cash !o7: rate of K recvd /dispersed

11. Contro!!ab!e $osts: varying costs! 67: wage levels, 0ual of materials$! Cost%beneit ratio: value of activity: benefits; e7pressed in fraction'! Cost Center: nursing unit, ortho center, cast room)! 8ia*nosis%re!ated *roups 8(Gs: rate setting pps used by Medicare to

determine payment rates for inpatient hosp stay based on diagnosis; flat dollar

reimbursement; costs may be higher or lower than actual costs*! 8ire$t Costs: costs attributed to specific source; goods or service


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! +ee or ser#i$e system sI: reimbursement sys after service delivered! >or profit org GfpoI: financial contributors have ownership interest; own stocks;

dividends on profits1. +u!!%time e-ui#a!en$y +E: number of hours worked by ft employee for one

week! >96 !4?* hour days ? )4 hours per week 19. 3ea!th maintenan$e or*ani=ation 3)I: prepaid org; healthcare providers

receive preset money on per person per month basis; managed care$4! 3ours per patient day hppd: hours of nursing care/ patient/day; various level

of nursing personnel$! &nternationa! C!assii$ation o 8isease $odes i$d: coding used to record

severity and treatment of d7, illness, in&uries; determines reimbursement; revision

422. &ndire$t Costs: e7ample housekeeping! ou know this!

$'! )ana*ed $are: healthcare plans that contain costs of services, maintain 0ual$)! )edi$aid: fed assisted, state administered; low income indiv; groups: elderly,

blind, disabled, families, pregnant women$*! )edi$are: nationwide; title of ssact, * and older; catastrophic chronic

illness: als, renal failure,$! 'on$ontro!!ab!e $osts: indirect e7penses, e7: rent, lighting, wear and tear of

e0uip!$! 'ot or%proit or*ani=ation: financed by several sources, contributors have no

ownership interests; profits generated go back to hosp for e7pansion/capital$! peratin* Expenses: daily costs$1! Patient $!assii$ation system: different criteria; classification of patients; acuity0. Pay or perorman$e pro*rams PDP: incentives pay to each cp to get top

clinical performance; for specific patient pop1. Pay or a!ue pro*rams: payment incentives to hcp for specific setting; increase

0ual efficiency'$! Preerred pro#ider or*ani=ation PP: contracts to give service on fee for

service sys! ncentives for consumers to use select group of preferred hcp, pay

less for services! nsurance companies promise certain vol of patients/prompt

payment for fee discounts. Produ$tion hours: total amount: reg time, temp time, over time! D. Prospe$ti#e payment system: predetermined reimbursement for services@. (e#enue: source of income/reward for patient services6. Stain* mix:

'! hird%party: usually ins co, govt agency pays patient bill'! 9urnover ratio: Gemployees leaving/Jempl remainingI744


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9. a!ue%ased Pur$hasin*: rewards 0ual of care through payment

incentives/transparency! >unction of: 0ual, efficiency, safety, costs)4! ariab!e Costs: vary with volume, e7ample: payrollD1. 4or5!oad units: patient days, Jof procedures, tests, visits

)edi$are:

Part ": 2ospital insurancePart : supply med insurance- outpatient carePart $: more choices for participating in managed carePart 8: $44; pt can buy least limited prescription drug coverage

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Leadership Exam 2 Study Guide