A health care organization is using the quality concepts of lean thinking and decentralization as part of their
redesign efforts. Which initiatives would this organization undertake?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Any changes to processes in the facility will be approved at the vice president level.
2. Nurses who have made over five medication errors in the last 12 months will be terminated.
3. Outcome data will be analyzed to identify successful interventions.
4. The primary focus will be on a few major initiatives.
5. Previous quality improvement efforts may or may not be discarded.
Correct Answer: 3,5
Rationale 1: Decentralization empowers staff to implement process improvements.
Rationale 2: Lean thinking focuses on the system rather than on individuals.
Rationale 3: In lean thinking, the concentration is on interventions that improve outcomes.
Rationale 4: This redesign strategy is called “big-dot focus” and may or may not reflect lean thinking.
Rationale 5: Decentralization provides a quality improvement infrastructure that disregards only previous efforts
that have not proven effective.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-5: Demonstrate how strategic planning guides the organization’s future.
Question 24
Type: MCMA
The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic
planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups?
Sullivan, Effective Leadership and Management, 8/e Test Bank
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Experts in hospital physical design
2. Other nurses who work at the hospital
3. Physicians
4. Hospital administrators
5. Representatives from local insurance offices
1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies
physicians to support nursing’s position in any disagreements.
2. When staff nurses ask for the nurse manager’s opinion on client care issues, the response is frequently, “I’ll
leave that decision up to you.”
3. Administration has developed a plan in which each week two nurses from each unit are recognized as “best
nurse of the week.”
4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift.
5. The nurse executive communicates with managers mostly by email.
1. Much of the care provided is based on standard operating procedure.
2. Information from the organization refers to the work done as “throughput.”
3. There is a well-defined chain of command in the organization.
4. During interviews with staff, the words creativity and flexibility are often used.
5. The facility’s organizational chart reveals departmentalization.
3. “Decrease the number of medication errors on the unit.”
4. “Initiate intravenous therapy within 30 minutes of the order being taken.”
5. “Use scanning mechanisms to record the numbers of supplies used.”
3. Nurses have begun questioning the wisdom of standardizing some nursing procedures.
4. Staffing has become less flexible as more nurses specialize in one aspect of care.
5. A recently updated organizational chart indicates the line authority for each position.
Rationale 3: One of the strengths of a service-integrated structure is that the same activities can occur in several
units and can be unit specific.
Rationale 4: When there are two lines of authority, as in the parallel structure, conflicts may occur at the
department or unit level.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-3: Explain how health care organizations are structured.
Question 30
Type: MCSA
Which situation reflects the primary service provided by home health care?
1. The physical therapy assistant performs range-of-motion exercises three times each week.
2. The nurse changes the client’s abdominal dressing daily.
3. Oxygen is provided in the home and managed by a durable medical equipment company.
4. Diabetic testing supplies are delivered to the client’s home each month.
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-4: Discuss various ways that health care is provided.
Sullivan, Effective Leadership and Management, 8/e Test Bank
Copyright 2013 by Pearson Education, Inc.