Active surveillance in healthcare is a proactive approach to identifying and monitoring health-related

events or diseases123. It involves the continuous, systematic collection, analysis, and interpretation

of health-related data needed for the planning, implementation, and evaluation of public health

practice1.

Option B, “Identifying disease outbreaks through public health contact tracing,” is an example of

active surveillance. Contact tracing is a key strategy for preventing the further spread of infectious

diseases. It involves identifying people who have an infectious disease (cases) and their contacts

(people who may have been exposed) and working with them to interrupt disease transmission12.

Option A, “analyzing laboratory data for disease testing utilization,” could be part of both active and

passive surveillance, depending on the context. However, it does not necessarily involve the

proactive steps typically associated with active surveillance13.

Option C, “analyzing infectious diseases based on hospital discharge final coding,” is more related to

passive surveillance, which involves the collection of data as they become available, or the data that

are passively received by health care providers or health information systems13.

Option D, “reporting of infectious diseases data quarterly to local health departments,” is also more

related to passive surveillance, as it involves regular reporting of health data from various sources13.

The most logical sequence for the phases of shifting from top-down leadership to participatory

management is to start with making the commitment, then gathering baseline data, implementing

the program, and evaluating effectiveness and improvement.

Making the commitment is the first step because it involves creating a shared vision, setting goals

and objectives, and securing support and resources for the change process12. Without a clear and

strong commitment, the other steps may not be feasible or successful.

Gathering baseline data is the second step because it helps to assess the current situation, identify

the gaps and needs, and establish a baseline for comparison and measurement13. Data can be

collected from various sources, such as surveys, interviews, observations, and records, and can cover

aspects such as organizational culture, performance, quality, satisfaction, and costs13.

Implementing the program is the third step because it involves putting the plan into action, engaging

and empowering the staff and stakeholders, and monitoring and adjusting the process as

needed14. Implementation can be done in phases, pilots, or trials, depending on the scope and

complexity of the program14.

Evaluating effectiveness and improvement is the fourth step because it helps to measure the

outcomes, impacts, and benefits of the program, compare them with the baseline data and the goals

and objectives, and identify the strengths, weaknesses, and areas for improvement15. Evaluation can

be done using quantitative and qualitative methods, such as indicators, metrics, feedback, and

stories, and can be conducted at different levels, such as individual, team, and organizational15.

Reference: 1: Participatory Leadership for Health 2: Quality improvement and person-centredness: a

participatory mixed methods study to develop the ‘always event’ concept for primary care 3: Why

healthcare leadership should embrace quality improvement 4: PARTICIPATIVE MANAGEMENT IN

HEALTH CARE SERVICES 5: [Utilization of Improvement Methodologies by Healthcare Quality

Professionals During the COVID-19 Pandemic]

Ongoing Professional Practice Evaluation (OPPE) is part of the credentialing process for medical staff

aimed at evaluating a provider’s clinical competence and professional behavior on an ongoing basis,

rather than at the time of reappointment only. OPPE is typically used to monitor providers with

identified practice issues. It involves collecting data about a provider’s performance over time,

reviewing the information regularly, and using it to ensure that the provider meets professional

standards. This proactive monitoring can lead to early identification and resolution of potential

issues.

Reference:This aligns with best practices as outlined by the Joint Commission and is reflected in the

guidelines and educational materials provided by NAHQ. OPPE is a standard element in healthcare

quality and credentialing that focuses on continuous evaluation of a provider's ability to provide

quality care.

A Gantt chart is a type of bar chart that illustrates a project schedule1. This tool is used in project

management, and it’s particularly useful in the scenario described because it can help the team

visualize their progress on different tasks1.

In this case, the team is at different stages with various tasks: they’re one-fourth finished with

identifying benchmark organizations, they haven’t started identifying the current state, and they’re

halfway through collecting public data1. A Gantt chart can help them see all these tasks and their

progress in one place, making it easier to manage their work and stay on schedule1.

While the other tools mentioned (Model for Improvement, Design of Experiments, Ishikawa

diagram) can be useful in certain scenarios, they don’t specifically address the need to visualize and

manage progress on multiple tasks23. Therefore, the Gantt chart is the most appropriate tool to

recommend in this situation1.

Failure Mode and Effects Analysis (FMEA) is a systematic method for evaluating a process to identify

where and how it might fail, to assess the relative impact of different failures, and to identify the

parts of the process that are most in need of change. FMEA includes review of the following:

Steps in the process: Identify what could go wrong during each step.

Failure modes: Identify potential failure modes for each step.

Failure effects: For each failure mode, identify potential effects.

Severity: Assign a severity rating for each effect of failure.

Occurrence: Assign an occurrence rating foreach failure mode.

Detection: Assign a detection rating for each failure mode and effect.

Risk Priority Number (RPN): Calculate the RPN for each effect.

FMEA is particularly useful in healthcare for risk assessment of a new or modified process because it

not only identifies potential failures, but also prioritizes them based on their impact, frequency of

occurrence, and detectability, allowing for targeted and efficient process improvement.

Reference:

Quality improvement tools are standalone strategies or processes that can help you better

understand, analyze, or communicate your QI efforts1.

The 7 Basic Quality Tools for Process Improvement2.

A guide to quality improvement tools3.

An Ishikawa diagram, also known as a fishbone diagram, is a tool used to identify and organize

potential causes of a problem12. It’s often used by teams to graphically display the relationship of

the causes to the effect and to each other2. However, creating and interpreting an Ishikawa diagram

can be challenging if the team does not have a clear focus or agreement3.

In this case, the most likely cause for the challenge in completing an Ishikawa diagram is that the

charter did not provide a specific problem statement4. A clear and specific problem statement is

crucial as it provides the team with a clear understanding of what they are trying to solve4. Without

it, the team may struggle to identify and agree on the potential causes of the problem4.

Therefore, to overcome this challenge, the team should revisit the charter and work together to

define a specific problem statement. This will provide them with a clear focus and help them come to

an agreement on the potential causes of the problem, thereby facilitating the completion of the

Ishikawa diagram4.

:

High-reliability organizations (HROs) operate in complex, high-hazard domains for extended periods

without serious accidents or catastrophic failures1. They prioritize safety over other performance

pressures1.

The principles of high reliability go beyond standardization; high reliability is better described as a

condition of persistent mindfulness within an organization1. HROs work to create an environment in

which potential problems are anticipated, detected early, and virtually always responded to early

enough to prevent catastrophic consequences1.

One of the key characteristics of HROs is a preoccupation with failure1. Everyone is aware of and

thinking about the potential for failure1. Near misses are viewed as opportunities to learn about

systems issues and potential improvements, rather than as evidence of safety1.

Another important characteristic is deference to frontline expertise1. This means that those closest

to the work, who have the most direct knowledge of the situation at hand, have the authority to

make decisions1.

In the given scenario, meeting with the staff involved in the errors to gain additional insight (Option

B) aligns with these principles. It shows a preoccupation with failure and deference to frontline

expertise. By meeting with the staff, leadership can understand what led to the errors and how to

prevent them in the future. This approach is consistent with the principles of high reliability and is

likely to contribute to the clinic’s goal of becoming a high-reliability organization.

Tracers are a method of assessing the quality and safety of care, treatment, or services by following

the experience of a patient or a process through the entire health care delivery system1.

Tracers are used by The Joint Commission and other accreditation bodies to evaluate the compliance

of health care organizations with the standards and requirements for accreditation1.

Tracers can help identify the strengths and weaknesses of an organization’s processes and practices,

as well as the risks and opportunities for improvement23.

Tracers can also help engage staff and stakeholders in continuous improvement activities and foster a

culture of quality and safety24.

Therefore, the main purpose of conducting tracers as a part of continuous readiness is to identify

current gaps in processes of quality and patient safety that need correcting, as this will help the

organization achieve better outcomes and meet the expectations of

accreditation1234. Reference: 1: Tracer Methodology Fact Sheet | The Joint Commission 2: How

tracer rounds can support effective continuous improvement in healthcare 3: Unlocking QTRACER’s

secret to ensure continuous improvement in healthcare 4: Continuous Service Readiness | Joint

Commission Resources

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