The first step for a multidisciplinary team tasked with evaluating delays inlaboratory turnaround time is to create a flow chart to study the process. A flow chart visually maps out the steps involved in the current process, allowing the team to understand each stage, identify bottlenecks, and pinpoint where delays might be occurring. This provides a clear, shared understanding of the process among all team members, which is essential before diving into more detailed analysis or improvements.
Conduct a failure mode and effects analysis (FMEA) (B): FMEA is a valuable tool for identifying potential failures, but it is typically used after understanding the process in detail.
See if the surgery clinic is also experiencing delays (C): While this could be useful information, the primary focus should be on the specific process under review.
Observe how the medical assistants prepare the specimens (D): Observation is important, but understanding the entire process flow is the first step.
References
NAHQ Body of Knowledge: Process Mapping and Flowcharting in Quality Improvement NAHQ CPHQ Exam Preparation Materials: Initial Steps in Process Improvement
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Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool used to identify potential failure points in a process before they occur. It is widely used in healthcare to improve patient safety and reduce errors, particularly during major system changes like EHR implementation.
Steps in FMEA:
* Map the Process: The team outlines each step in the process (already completed in the scenario).
* Identify Potential Failure Modes (Correct Answer - Option A):
* The next step after mapping the process is to analyze each step for potential failures that could cause disruptions or errors.
* Consider the Consequences (Option D): Once failures are identified, their possible impacts on patient care and workflow are examined.
* Determine Root Causes (Option B): The team investigates why failuresmight occur and identifies contributing factors.
* Calculate Risk Priority Numbers (Option C): Risk is quantified using Severity × Occurrence × Detectability, helping to prioritize issues for improvement.
* Implement and Monitor Improvements: Solutions are developed, tested, and continuously evaluated.
Why Other Options Are Incorrect:
* Option B (Determine reasons for failures): This step comes after identifying potential failures.
* Option C (Calculate risk priority numbers): RPN calculations occur after failure modes are identified and analyzed.
* Option D (Consider consequences): Consequences are evaluated after potential failure modes are identified.
Thus, the correct next step is A. Examine each step for potential process failures.
References:
NAHQ's "HQ Solutions: Resource for the Healthcare Quality Professional" Agency for Healthcare Research and Quality (AHRQ) - "Using FMEA to Improve Patient Safety"

When a nursing home has not met its goal of a 5% reduction in falls despite implementing a guideline, the next action should be to measure employee competency on understanding and use of the guideline.
Here's why:
Assessing Competency: The effectiveness of the guideline depends on how well the staff understands and applies it. Measuring competency ensures that all employees are aware of the guidelines and know how to implement them in their daily work.
Identifying Gaps: If staff members are not fully competent, this could explain why the goal has not been achieved. By identifying gaps in knowledge or skills, the organization can provide targeted training and support to improve compliance and effectiveness.
Enhancing Implementation: Understanding how well the guidelines are being followed can help the organization refine its approach, ensuring that staff are equipped to prevent falls more effectively. Linking Competency to Outcomes: By focusing on employee competency, the organization can establish a direct link between staff education and patient outcomes, ensuring that guidelines are not just implemented, but are done so correctly and consistently.
Reference: (Based on Healthcare Quality NAHQ documents and resources)
NAHQ CPHQ Study Guide, Section on Employee Training and Competency Evaluation.
Quality Improvement in Healthcare, Article on Linking Competency to Patient Outcomes.

* Incident reporting systems are tools to collect and analyze data on patient safety incidents, such as medication errors, falls, infections, and adverse events12.
* Incident reporting systems can help identify patterns, trends, and areas of improvement for patient safety and quality of care123.
* The graph shows the incident rates for one facility compared to similar facilities in four categories:
medication, falls, infection, and adverse events. The graph indicates that the facility has a higher incident rate for falls than the average of similar facilities, while the other categories are comparable or lower4.
* Therefore, the first step after reviewing the graph should be to perform additional analysis on falls data, such as the types, causes, consequences, and contributing factors of falls incidents, and compare them with the best practices and standards for falls prevention and management567.
* This will help the facility to understand the root causes of the high falls incident rate, and to develop and implement appropriate interventions to reduce the risk and harm of falls for patients567.
* Reviewing medication processes, researching best practices, and sharing data with the governing body are also important steps, but they should be done after the additional analysis on falls data, as they are more general and less specific to the problem identified by the graph4. References: 1: Patient Safety Incident Reporting and Learning Systems | WHO 2: Incident Reporting: Key to Successful Healthcare Organizations | SafeQual 3: Report a patient safety incident | NHS England 4: Data from an Incident reporting system compares Incident rates for one facility to similar facilities | User-uploaded image 5: Falls Prevention and Management | NAHQ 6: Preventing Falls in Hospitals | Agency for Healthcare Research and Quality 7: Falls Prevention and Management | Institute for Healthcare Improvement