EXAM REVIEW COURSE
National Exam ◘ MODULE 4
FORM B
referencsect
Administration
u Speed Reader
Examination 1
Examination 2
Examination 3
Examination 4
Stan Mucinic, LNHA
Legal Notices
Students enrolled in the “National Nursing Home Administrator Licensing Course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the national licensure exam administered by the National Association of Boards of Examiners (NAB).
This is a 5-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely.
THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM.
An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted. The student is solely responsible for licensing exam registration/testing and retesting fees.
HOW TO USE THE STUDY GUIDES
Step 1 – VERY IMPORTANT - The personalized test organizer that comes with the program is the key to your success and sets this program apart from any other. It is critical you follow the instructions and score each exam, and file the completed exams into your binder. Try to keep to the schedule and email your test results to the instructor to stay focused.
Step 2. - Speed Reader – Read the speed reader for each module once or twice before taking the module exam(s). Read the speed reader over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU LOOK IT THE MORE LIKELY YOU ARE TO REMEMBER IT.
Step 3 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over and over again until you score 100%. Make sure you score each exam and record the results in your organizer or you will not be able to gauge your progress.
The exam questions are cross referenced to the speed reader to allow you to quickly find and review material you missed on the exam as follows:
Thus, the specific material would be found on page 2 of the speed reader, section 1.8, subparagraph 13.
Contact Information
Email Stan Mucinic at with any questions and after you score each practice exam
Administration - Table of Contents
2 / Measures of Quality / 4
3 / Federal and State Standards / 4
4 / Management Information Systems / 5
5 / Medical Staffing Model / 5
6 / Management Functions Model / 5
7 / Important Trends – Forecasting / 5
8 / Important Trends – Organizing / 5
9 / Important Trends – Planning / 5
10 / Important Trends – Staffing / 6
11 / Important Trends – Directing / 6
12 / Important Trends – Evaluating / 7
13 / Important Trends – Controlling Quality / 7
14 / External Forces / 7
15 / Important Trends – Innovating / 7
16 / Important Trends – Marketing / 7
17 / Marketing Strategy / 8
18 / Marketing Challenges / 8
19 / Marketing and Public Relations / 8
20 / Consumer Decision Model / 8
21 / Decision to Enter Facility / 8
22 / Marketing Tools / 9
23 / Buyer Readiness States / 9
24 / Consumer Satisfaction Surveys / 9
25 / Conflict Resolution / 9
26 / Grievance Procedures / 9
27 / Oral/Written Communication / 9
28 / Barriers to Communication / 10
29 / Tailor Communication to Individual / 10
30 / Formal/Informal Communication / 10
31 / Flow of Communication / 10
32 / Communication Technology / 10
33 / Risk Management / 10
34 / Survey and Licensure Process / 11
35 / Survey Process / 11
36 / Quality Indicator Reports / 11
37 / Online Survey Certification Reports (OSCAR) / 11
38 / Survey Outcomes / 11
39 / Severity Levels of Non-Compliance / 11
40 / Scope of Deficiencies / 12
41 / Substandard Quality of Care / 12
42 / Remedies of Non-compliance / 12
43 / Informal/Formal Dispute Resolution / 12
44 / Accreditation Organizations / 12
45 / Organizational Concepts / 12
46 / Systems Theory / 13
47 / Policies and Procedures / 13
48 / Leadership Theories / 13
49 / Management Theories / 14
50 / Systems Theory / 16
51 / Norms, Values and Employee Motivation / 15
52 / Delegation of Authority / 17
53 / Command Concepts / 17
Administration - Table of Contents (Cont’d)
54 / Line vs Staff Authority / 17
56 / Management Levels / 17
57 / Nursing Home Management / 17
58 / Departments Functions / 18
59 / Facility Organization Chart / 19
60 / Governing Body Duties / 19
61 / Administrator Duties / 20
62 / Federal Rules / 20
63 / Nurse Aide Education/Training / 20
64 / Professional Organizations / 21
65 / OBRA ‘87 / 21
66 / Survey Deficiencies / 22
67 / Resident Care / 22
68 / Ownership Patterns / 22
69 / Payor Sources / 22
70 / Legislation / 22
71 / Occupancy Statistics / 23
72 / Demographics / 23
73 / Technology / 23
74 / Medical Director / 23
75 / Quality Assessment and Assurance Committee / 23
76 / CMS Quality Standards / 23
77 / Demming / 24
78 / Technological Support / 24
79 / Miscellaneous / 31
80 / Financial terms
Administration
1.1 - Quality of Care
1. Every facility uses some quality improvement model
2. Must monitor quality indicators, identify problems and fix them
3. Quality of care indicators:
a. Resident rights
b. Quality of life
c. Financial performance
d. Consumer satisfaction
e. Infection rates
4. Various Quality Improvement Models:
a. Performance Improvement Model
1. Least involved and effective model
2. Involves making small changes
3. Is not a comprehensive or interdisciplinary approach
b. Quality Assurance Model
1. Has its roots in quality assurance committee
2. Focused mainly on clinical issues
3. Not typically comprehensive or interdisciplinary
c. Continuous Improvement Model
1. Requires involvement of senior managers
2. Focuses on continuously improving consumer satisfaction
3. Involves an interdisciplinary effort
d. Total Quality Management Model (TQM)
1. Most effective and comprehensive
2. Comprehensive, interdisciplinary approach to continuously improve all facets of operations and consumer satisfaction
3. Takes 5-10 years to implement
4. Requires total involvement of management
5. Empowers frontline staff
6. Requires intensive training of staff
7. Objective is to exceed customer expectations
8. Must improve quality totally, continuously and forever
Ø Section 2 - Measures of Quality
2.1 - Measures of Quality
1. Structure – Staff, building equipment
2. Process – Policies and procedures
3. Outcome – Quality of life of residents (pressure sores, dehydration)
Ø Section 3 - Federal/State Standards
3.1 - Federal/State Standards
1. Federal/State standards supersede corporate policies
2. Survey and inspections are an important form of external feedback on quality
Ø Section 4 – Management Information Systems
4.1 - Management Information Systems
1. Must have a system to organize and prioritize flow of information in facility
2. Must determine what information to receive, where it comes from, the priority and process to receive it.
Ø Section 5 - Facility Medical Staffing Models
5.1 - Facility Medical Staffing Models
1. Open Staff Model – Any physician can attend residents (most used)
2. Closed Staff Model – Only approved group of doctors can see residents – used in facilities with hundreds of patients
Ø Section 6 - Management Functions Model
6.1 - Management Functions Model1. Forecasting – Project trends and needed resources and services
2. Planning – Identify objectives and desired outcomes
3. Organizing – Determine the structure of the organization and ensure work is done without duplication
4. Staffing – Hiring the right people for the right job
5. Directing – Explain what needs to be done and help staff accomplish it
6. Evaluating – Compare actual results to planned results
7. Controlling Quality – Taking necessary corrective action
8. Innovating – Constantly improving the ways things are done
9. Marketing – Attracting people to the facility
Ø Section 7 - Important Trends – Forecasting
7.1 - Important Trends – Forecasting
1. Prior to 1987 and the shift to the prospective payment system, change was slow and gradual
2. Retrospective payment Is based on actual expenses and produced huge profits for nursing facilities
3. Rapid changes can be expected now and in the future
4. During 70’s and 80’s, administrators could make long term decisions and plans
5. Today, change happens too quickly to know what reimbursement rates be tomorrow
6. Lifespan of new technology is 18 months
7. The core business of long term care may be entirely different in 2020
8. Nursing staff is experiencing culture shock
9. Mankind’s knowledge is expected to double every 5 years
10. Survival tomorrow is based on accurately forecasting trends
11. Must change constantly to adapt to changes in environment
12. If you don’t fix it all the time, it will break
Ø Section 8 - Important Trends – orgANIZING
1. Ensuring work gets done
2. Breaks work into tasks to be handled by one person
3. Ensures no duplication of work
Ø Section 9 - Important Trends – Planning9.1 - Important Trends – Planning
1. Planning expresses organizational goals
2. Planning involves an integrated decision system
3. Planning aids managers in coping with uncertainty
4. Planning makes possible comparing expected results with actual results
5. Strategic planning is critical to survival
6. Planning forces an assessment of what services the market will need tomorrow
7. Planning moves from the general to the specific
Ø Section 10 - Important Trends – Staffing
10.1 - Important Trends – Staffing
1. Staffing involves hiring the right person for the right job
2. A job interview is not a predictor of future performance
3. Adequate staffing is critical to success in a nursing home
4. Resident interaction with staff determines resident quality of life
5. Resident acuity level determines staffing needs
6. Must hire department heads with expertise because of the complexity of regulations
7. The number of registered nurses is key to quality care
Ø Section 11 - Important Trends – Directing
11.1 - Important Trends – Directing
1. Directing involves communicating to employees what needs to be done
2. Directing involves developing policies and procedures that allow employees to make the same decisions given the same circumstances
3. It is possible to develop policies and procedures to direct employee behavior 24 hours a day and communicate exactly what management expects
Ø section 12 - Important Trends – Evaluating
12.1 - Important Trends – Evaluating
1. Must compare expected results to actual results
2. Policies and plans of action are the guidelines to compare outcomes to expectations
3. Policies are broad statements of goals
4. Guidelines are step-by-step instruction on how to do something
5. A plan of action has specific procedures to implement a policy
6. Benchmarking involves:
a. Comparing current business practices with the “best practices” of other organizations
b. Benchmarking process involves:
1) Deciding what to benchmark
2) Forming a team
3) Selecting partners
4) Collecting and analyzing info
5) Implementing new methodologies
c. Should adapt the “best practices” of other organizations and must not adopt them in total since they may not work the same way for your organization (different culture)
d. Enablers are practices leading to exceptional performance
7. Controlling quality has always been an elusive aspect of successful management
8. Organizational pathology deals with illnesses that affect an organization
9. Key quality indicators of a nursing home:
a. The number of registered nurses
b. The nursing process itself
Ø section 13 - Important Trends – Controlling Quality
13.1 - Important Trends – Controlling Quality
1. Control is the act of taking corrective action after evaluating expected to actual results
2. Control involves modifying policies and processes
3. Need to provide clear and accurate info to employees
4. Corrective action must be taken consistently and timely
5. Make clear what is relevant and what can be discarded
6. Control mechanisms must be seen as legitimate and relevant
7. Managers who avoid confrontation fail to take action
Ø section 14 - External Forces
14.1 - External Forces
1. Opportunities in the environment include an aging population and managed care contracts
2. Constraints in the environment include government regulation
Ø section 15 - Important Trends – Innovating
15.1 - Important Trends – Innovating
1. If you don’t fix it all the time, it will break
2. The administrator does not need to be the innovator but must foster change and be an agent of change
3. Do not make policies but give employees a sense of direction
4. Do not make policies that inhibit change
5. Make policies that foster innovation
6. Tom peters - Innovation is critical to success and must be continual
7. Government standards are now considered maximal standards as opposed to minimal standards
8. Staff will only become agents of change if they believe changes are necessary
9. Implement both good and bad employee suggestions
10. Must make changes even if staff is not ready (change is not a comfortable process)