CCQM flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Donabedian model

Framework evaluating quality through Structure (resources and systems), Process (care delivered), and Outcome (results). Used to decide where to measure and where to intervene.

Six aims of quality

Safe, effective, patient-centered, timely, efficient, and equitable care, as defined by the Institute of Medicine. These aims frame organizational quality strategy and indicator selection.

Cost of poor quality

Sum of internal failure costs (defects found before delivery) and external failure costs (defects found after delivery). External failures usually cost far more per event.

Just culture

Accountability model distinguishing human error (console), at-risk behavior (coach), and reckless behavior (sanction). It encourages reporting while retaining individual accountability for knowingly unsafe acts.

Quality trilogy (Juran)

Juran's three managerial processes: quality planning, quality control, and quality improvement. Planning designs for quality, control maintains it, improvement raises the performance standard.

Balancing measure

A measure that confirms improvement in one area is not causing deterioration elsewhere, such as throughput gains harming readmission rates. Every improvement project should name at least one.

Indicator specification

Documented numerator, denominator, exclusions, data source, collection method, and measurement period. Without full specification, rates from different sources cannot be validly compared.

Risk adjustment

Statistical method accounting for patient factors such as age, severity, and comorbidity when comparing outcomes. Unadjusted outcome comparisons can misattribute case-mix differences to care quality.

Leading versus lagging indicator

Leading indicators predict future performance, such as hand-hygiene compliance; lagging indicators record results already occurred, such as infection rates. Use both in a balanced dashboard.

Special-cause variation

Non-random signal on a control chart, such as a point beyond three sigma, a run of six or more, or a sustained trend. It warrants investigation of the specific cause.

Small denominator instability

Rates based on fewer than about 30 events fluctuate widely by chance. Use rolling aggregation, confidence intervals, or run charts instead of direct point comparison.

PDSA cycle

Plan a change and predict the result, Do it on a small scale, Study the data against the prediction, Act to adopt, adapt, or abandon. The core engine of iterative improvement.

Model for Improvement

Three questions (aim, measurement, change ideas) paired with PDSA cycles. It connects strategic aims to tested changes rather than one-off projects.

FMEA risk priority number

RPN equals Severity times Occurrence times Detection, each scored typically one to ten. Higher scores prioritize failure modes for mitigation before harm occurs.

Pareto principle

Roughly 80 percent of effects arise from 20 percent of causes. Ranking causes by frequency identifies the vital few to address first.

Root cause analysis

Retrospective structured investigation of an event using 5 Whys and cause-and-effect diagrams. Output must be system-level corrective actions, not individual blame.

Key driver diagram

A map linking an aim to primary drivers, secondary drivers, and specific change ideas. It organizes an improvement portfolio and shows the theory of change.

DMAIC

Six Sigma roadmap: Define, Measure, Analyze, Improve, Control. It targets reduction of process variation and defects through data-driven root cause analysis.

Swiss cheese model

Reason's model in which harm occurs when holes in multiple defensive layers align. It directs attention to strengthening system barriers rather than blaming the final operator.

Hierarchy of effectiveness

Ranking of safety interventions from strongest to weakest: forcing functions, automation, standardization, checklists and rules, education, warnings. Prefer the strongest feasible control.

Sentinel event

Unexpected occurrence involving death, serious physical or psychological injury, or the risk thereof. It triggers immediate containment, notification, and root cause analysis.

High-alert medications

Drug classes carrying elevated risk of significant harm when misused, including anticoagulants, insulin, opioids, concentrated electrolytes, and neuromuscular blockers. They require independent double-checks.

SBAR handoff

Structured communication: Situation, Background, Assessment, Recommendation. Standardized handoffs reduce omission and misunderstanding at care transitions.

Prospective versus retrospective risk

FMEA analyzes failure modes before harm occurs; root cause analysis investigates after harm. A mature safety program uses both, weighted toward prevention.

Tracer methodology

Accreditation survey technique following an actual patient's care journey across departments. It tests system integration and consistency rather than isolated department compliance.

Regulation versus accreditation

Regulation is legally mandated by government authority; accreditation is third-party evaluation against standards, usually voluntary. Both can drive similar evidence requirements.

Document control

Only the current approved version is available at the point of use; obsolete versions are removed or marked. Each document has an owner, approval date, and review cycle.

Compliance program elements

Written standards, designated compliance officer, training, monitoring and auditing, reporting mechanism, enforcement and discipline, and corrective action. These seven elements form the standard framework.

Data stewardship

Role accountable for data definitions, quality, and correct use within a domain, distinct from the technical custodian. Stewards resolve conflicting definitions before indicators are published.

Inter-rater reliability

Agreement between independent abstractors measuring the same records. A kappa of 0.80 or above is generally treated as substantial agreement for indicator data.

Kotter's eight steps

Change sequence: urgency, coalition, vision, communication, empowerment, short-term wins, consolidation, and anchoring in culture. Skipping early steps produces superficial compliance.

ADKAR model

Prosci framework of Awareness, Desire, Knowledge, Ability, and Reinforcement. Resistance is diagnosed by identifying which element is missing and addressing that element specifically.