SECTION A

(MULTIPLE CHOICE QUESTIONS)

A.1
Each health care organization must anticipate and respond to the community’s changing needs and health status by:

1. reviewing environmental trends
2. collecting information on the determinants of health
3. reviewing feedback from clients and the community on its services
4. working with the community to identify priority needs

a) all of the above
b) 1 and 3
c) 1 and 4
d) 3 and 4

A.2
From this list of points below, what best describes the role of the Deputy Minister in a Ministry of Health?

a) Implement ministerial direction.
b) Overall departmental management.
c) Briefing the Minister on major issues.
d) Preparing and presenting the departmental budget.

A.3
When an organization strives to function in an environmentally friendly way, this is evidenced in:

1. policies and procedures
2. staff and volunteer training
3. communication with community partners
4. application of legislation/regulations

a) all of the above
b) 4
c) 1 and 4
d) 1, 2 and 4

A.4
In order to ensure commitment to the vision from those who work in the organization and the external community, it is imperative to:

a) Involve senior management and community representatives in the initial planning.
b) Test a draft vision developed by senior management on the staff and community.
c) Design cross-functional teams made up of representatives across the organization and from the community to contribute to the development of a vision.
d) All of the above.

A.5
You are the newly appointed CEO of a 250-bed long-term care organization which has a long history of providing excellent care. The organization operates under a typical pyramid administrative structure and departments are defined along functional lines. The organization has experienced financial difficulties in the past, which it overcame through a variety of means. It is again in a deficit budget position and there is no immediate answer to resolving this situation.

As the new CEO, you have several years of experience and an enviable record in management. However, you have not had extensive hands-on experience in long-term care. As a result, when your appointment was announced by the board, the staff became very apprehensive and became protective of their departmental functions. Adding to the staff’s sense of unease is a rumour that you are going to implement a strategic planning process and move towards a client-centred model of operation. Staff members perceive all of these changes as threats to their individual and departmental autonomy.

As the CEO, your first responsibility is to:

a) learn about long-term care and how it differs from other health care organizations
b) meet with the staff and learn about their work and departmental/service responsibilities
c) meet with the board and agree upon goals and objectives for the coming year
d) meet with individual staff members and agree upon ways to reduce the deficit

A.6
In an attempt to reduce the size of her organization, the administrator has found herself in a position of unresolved conflict. This conflict has polarized the staff that the delivery of health care is adversely affected. The conflict has arisen among herself, the Chief of Staff, Director of Nursing, Personnel Director and the Chief Financial Officer, after the Chief of Staff sought to prevent the decrease in the number and quality of nursing and administrative personnel assigned to a specific clinic. To support his position, the Chief of Staff has cited data that the hospital was caring for 300 outpatients daily and it was only admitting approximately 2-4 patients to the inpatient services.

Which of the following people should have the delegated authority to resolve this particular problem?

a) The Personnel Director and the Chief Financial Officer, by delegation of the CEO, since personnel and money are both involved.
b) The Chief of Staff, by delegation of the Board, subject to constraints on money and personnel.
c) The Director of Nursing, by delegation of the CEO, subject to constraints on money and personnel.
d) The Chief Executive Officer, utilizing the coordinated efforts of all staff.

A.7
You are the administrator of your community hospital. Your board of directors consists of a cross section of community leaders representing major businesses and organizations. It includes the elected representatives of the medical and professional staff. You are meeting with your board chairman to develop the agenda and various items for the next board meeting. An item for review, discussion, and approval is the new contract negotiated by your predecessor with the pathology group. One of the physician board members is president of the radiology group, with which preliminary contract discussions have begun. In addition, the board chairman indicates his concern that the hospital really has never developed any organized future planning.

Managing equitable and fair relationships with hospital-based physicians is the responsibility of the administrator. In order to assure that proper consideration and decision-making will occur with regard to the pathology group, you should:

a) Exclude the radiologist board member from any contract discussions involving other physicians and/or groups.
b) Establish an organized well-defined format and methodology for contract negotiation and approval which is to be followed in all contractual relationships.
c) Secure board approval appropriately for all contract negotiations and agreements.
d) Alert the board at their next meeting that the physician members may be in a conflict-of-interest situation.

A.8
Which of the following is true about the process of conciliation:

1. it is a process by which a trade union and employer who have reached an impasse in negotiations for a collective agreement ask the Ministry of Labour to help in the resolution of outstanding issues
2. Conciliation is mandatory
3. The process often results in penalties to either party
4. Conciliation is discretionary

a) 1 & 2
b) 1 & 3
c) 1
d) 1 & 4

A.9
The Canadian Human Rights Act (June 1998) requires employers to provide accommodation to a person with a disability short of:

1. high cost to accommodate
2. workplace tolerance to accommodation
3. undue hardship
4. physical plant restrictions

a) a & b
b) c, only
c) all of the above
d) c & d

A.10
What is the most important of the following information system selection criteria?

a) meets functional requirements
b) meets technical requirements
c) meets growth and integration requirements
d) is easy to use

A.11
Your organization has recently had its accreditation site visit and the CCHSA's final report has just arrived. As the senior manager responsible for leading your organization in quality, there are several different approaches that you could take in addressing the report's findings. Which of the following approaches is likely to be successful in realizing improvement opportunities? (In each case, the team will be supported by a facilitator and will be requested to report on their progress at regular intervals.)

a) Share the report's findings widely within your organization, through general staff meetings, memos and postings. Identify areas where potential improvements are possible. Encourage people to indicate their interest in participating on teams that will be formed to address select opportunities. Strike teams based upon the interest shown.
b) Share the report's findings with your Board of Directors and senior team, identifying the areas where potential improvements are possible and that have the highest risk associated with the current situation. Form teams to tackle each of these potential opportunities, including broad stakeholder representation.
c) Share the report's finding with your management team, identifying opportunities for improvement with them. Ask them to share the results with staff in their departments through departmental meetings, and form teams to tackle opportunities within their scope of influence.
d) All of the above.

A.12
During an investigation into a criminal event in your community, the Chief of Police calls and informs you that his investigating officers have complained that your hospital emergency staff are not cooperating with the criminal investigation by providing information to them.

In response you:

1. Offer to set up a meeting with his staff and the emergency department staff in order to cooperate and build community partnerships.
2. Advise the relevant medical and nursing department staff of the public concerns and the need to cooperate.
3. Explain to the Chief the need for a subpoena.
4. Offer empathy for his concerns and ask him under what legislative authority are your hospital staff required to provide his officers with this information.

a) 1 & 2
b) 2, 3 & 4
c) 3 & 4
d) All of the above

SECTION B

(SHORT ANSWER QUESTIONS)

Following are short answer questions. Please list your answers in point form.

B.1
List three determinants of health, which are considered to have an impact on the likely use of health services in a community.

B.2
Briefly describe a generic quality improvement process.

B.3
You were recently involved in a series of job interviews for a position which involved quite a bit of travel. One of the candidates was a young woman. One of the interviewers asked the following question: "Do you have young children?" trying to prompt the idea that travel might be a problem because of her family situation. Under human rights legislation this question is discriminatory. Under what grounds is it discriminatory?