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Exam Code: C-ONQS
Certification Name: NCC Certified Obstetric and Neonatal Quality and Safety (C-ONQS)
Issuing Organization: National Certification Corporation (NCC)
Exam Type: Computer-based, multiple-choice questions
Number of Questions: ~150-175 (including unscored pilot questions)
Duration: 3 hours
Passing Score: Scaled score (typically around 70-75% correct)

I. Methods to assess organization, institutional and environmental culture and patient experience
- Healthcare quality improvement goals
- Domains of quality
- Timeliness
- Effectiveness
- Patient centered
- Efficiency
- Safety
- Equitability
- Dimensions of quality (Donabedian)
- Structure
- Process
- Outcome
- System goals
- Population health
- Patient experience
- Healthcare

- Adverse events and event reporting
- Monitoring and procedure surveillance
- Incident/safety reports
- Near misses
- Root cause analysis
- Mortality and morbidity
- Methods of event reporting
- Video
- Direct observation
- Auditing
- Patient reported events
- Institutional processes and priorities
- Regulatory
- Certifications
- Accreditation
- Peer-review
- Assessment strategies
- Defining population
- Assembling teams
- Reviewing literature
- Identifying measures
- Assessing patient/family perspective
- Assess and improve organizational culture
- Culture
- Just culture

II. National Quality and Safety Standards and Clinical Guidelines
- Awareness of legal/statutory and national quality and safety standards and clinical practice guidelines in obstetrical and neonatal care
- Perinatal core measures
- GBS guidelines
- Guidelines to prevent hospital associated infections
- Guidelines for perinatal care current edition
- AWOHNN guidelines Maternal health

III. Quality and Safety metrics to identify state of performance, gaps and opportunities
- General quality and safety principles and terminology
- Quality assurance versus quality improvement
- Quality versus safety
- Metrics
- outcome
- process
- structure
- access
- Risk adjustment
- Benchmarking
- Gap analysis
- Participation and shared decision making
- Systems thinking
- Methodologies of data display
- How to implement and evaluate data collection strategies
- Process tools
- Huddle tools
- Trigger tools
- Chart review

I. Quality and Safety aims, tools, checklists and communication strategies
- Human psychology and cognition
- Situational awareness
- Violations of process/protocols
- Risk taking
- Fear of repercussions
- Cognitive biases
- Attention and distractions
- Stress
- Burn out and fatigue
- Safety climate
- Briefings
- Family involvement councils
- Committees
- Collaborations and effective communication strategies
- Standardized communication
- Handoffs
- SBAR
- I-PASS
- Debriefing
- Care transitions

II. Team function, leadership, empowerment
- Leadership skills
- Self-awareness/management
- Mentoring
- Sustainability
- Succession and transition planning
- Communication and conflict management
- Change management
- Principles and concepts of teams
- Team development
- Structures and function
- Diversity and inclusivity
- Collaboration
- Mutual respect
- Information diffusion
- Team meetings
- Code of conduct

III. Training exercises, learning principles, mock codes and simulation
- Effective learning/teaching principles
- Adult learning principles
- Generational learning styles
- Remote or distance learning methodologies
- Interprofessional
- Use and principles of simulation
- Unit drills
- Simulated care processes

IV. Advocating for ongoing resources, risk management
- Methods for determining human resource needs
- Hours per patient day
- Work hours per unit of service
- Work hours per birth
- Clinician to patient ratio
- Standards for staffing
- Human factors that impact the work environment
- EMR
- Medical devices
- Alarm fatigue
- Distractions
- Interruptions
- Overcrowding
- Noise
- Ergonomics of procedures
- Patient census acuity
- Staffing
- Fatigue
- Work arounds
- Design of systems and processes
- Relevant aspects of structural design standards
- Layout and design
- Resource placement
- Lighting
- Signage and way finding

V. Inform and disseminate outcome data, benchmarking and transparency
- Various methods for educating and disseminating QNS data to various stakeholders
- Annual reports
- Presentations
- Publications
- Public reporting
- Websites
- Social/other medias
- Share data on key quality indicators with colleagues/organizations to improve
- Education campaigns
- Peer
- Benchmarking/accountability

I. Selecting and monitoring key quality metrics
- Prioritize opportunities for improvement
- Relative importance to different stakeholders
- Patient, family, provider, facility, healthcare, system, payor
- Develop goal statements
- Specific
- Measurable
- Achievable
- Relevant
- timebound
- Types of metrics
- Outcome
- Process
- Structure
- Access
- Patient experience
- Patient satisfaction
- Balancing measures and metrics
- Unintended consequences of metrics
- Balancing measure to mitigate unintended consequences
- Outcome, process and structure measures
- Familiarity with common methods for quality and safety improvement initiatives
- Models for improvement
- PDSA/PDCA
- Improve
- Six sigma
- Lean

II. Identify population, measures and data collection
- Project team formation and dynamics
- Identification of stakeholders
- Identification of champions
- Influencer model
- Patient/family perspective
- Appraise and prioritize literature relevant to project
- Randomized trials
- Meta-analysis
- Expert opinion
- Observational studies
- Consensus documents

- Improvement process
- Selection of interventions
- Planning implementation
- Tracking of improvements
- Data definitions
- Data collection
- Data quality assurance
- Graphs and tables
- Analysis
- Interpretation

III. Integration into workflow, error prevention strategies and auditing
- Errors and Risk reduction strategies and use of cognitive aids
- Bundles
- Checklists
- Flow sheets
- Timeouts
- Guidelines
- Structured communication
- Patient identification
- Barcodes
- E-prescribing
- Computerized physician order entry
- Medication administration processes
- Human milk handling processes
- Blood product administration processes
- Food and nutrition safety
- Errors and Risk reduction strategies and use of cognitive aids
- Feedback
- Surveillance

I. Tools of evaluation (Fishbone, flow chart, run chart, control charts)
- Evaluation of outcomes and performance improvement
- Run charts
- Control charts
- Dashboards
- Interpret data
- Role of technology in quality improvements
- Data standardization and retrieval
- Standardization of EMR

II. Evaluate the balance between quality, outcomes and cost
- Understanding the interplay between costs, quality and value from the perspective of various stakeholders
- Monetary
- Non-monetary
- Patient and family experience
- Value equals quality divided by cost
- Identification of waste
- Duplication
- Tools to identify waste
- Wait times

III. Strategies for sustainment and positive change
- Recognition of threats to implementation and sustainability
- Fatigue
- Project fatigue
- Backsliding
- Knowledge exclusivity
- Large scale implementation without testing
- Research models
- Knowledge degradation
- Lack of upper-level support/commitment
- Lack of team integrity
- Lack of personnel
- Competing priorities
- Disruptive behavior
- Hierarchical professional behaviors
- Steps in project sustainability
- Communication
- Reporting
- Ongoing ownership
- Celebration of success
- Modification of data collection and review

I. Adverse events, disclosures, transparency, patient trust and risk mitigation
- Elements of effective disclosure
- Mandatory versus voluntary disclosure
- Disclosure of errors and near misses
- Explanation as to why error occurred
- How effects will be minimized
- Steps to prevent recurrences
- Apology
- Acknowledgement of responsibility
- Distinguishing different types of error including system error, blameless human error (inadvertent), and accountable human error (at risk, reckless, intentional harm)
- Differentiating human error from system error
- Differentiate between human error, at risk behavior, and reckless behavior
- Understanding and mitigating psychological harm experience by the patient and second victims
- Second victims
- Debriefing
- Communication strategies
- Counseling, employee assistance
- Support groups
- Emotional support

II. Professional and ethical issues
- Ethical principles as they apply to patients, families, providers and organizations
- Patient/family access
- Fairness, truthfulness, justice, beneficence, nonmaleficence, autonomy
- Awareness of differences between quality improvement projects and research
- Human subject protections
- IRB or local approval mechanism
- Compare research to quality improvement