Seminar on Quality Assurence

8/3/2019 Seminar on Quality Assurence

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What is this? Why it stands for ? ,what means this ?


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SEMINAR ON QUALITYASSURENCE

GUIDE :- MADAMMrs. RAVEENADUTTE

READERSHRISHANKARACHARYACOLLEGEOF NURSING


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INTRODUCTION

Quality assessment is an examination of service

where as quality assurance implies that efforts

are made to evaluate are made to evaluate and

ensure and ensure quality health care

The field of quality assurance is as old as modern

nursing. Florence nightingale introduced the

concept of quality in nursing care in 1855 whileattending the soldiers in the hospital during the

Crimean war


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MEANING

QUALITYMEANS:-

DEGREE OF EXELLENCE

Assurance: -It implies a commitment to take corrective

action of care does not meet the criteria


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CONT

To a patient :Quality meansbeing treated with empathy,respect and concern.

To a professional: Qualitymeans delivering the mostadvanced knowledge andskills to help and savepatient .

For medical audit: Qualitymeans having the bestachievable outcome foreach patient.


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DEFINITION

Bull 1985 defined quality assurance as themonitoring of the activities of client care todetermine the degree of excellence attained

to the implementation of the activities Qualities assurance is the defining of nursing

practice through well written nursingstandards and the use of those standards as abasis for evaluation on improvement of clientcare ( Maker 1998


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Need for Quality Assurance in Health

Care :

It is an important managerial function which

assures confidence among customers.

It involves evaluation in order to secure

improvement and development on a condition

basis.

It is needed to indicate standard of agency


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GOALS OF QUALITYASSURANCE

The major goal of quality assurance is to

identity areas where standards have not

been met and correct them, or in other terms

quality assurance are:-

To ensure the delivery or quality care .

To evaluate the efforts of the health care

provider to provide best possible results .


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Purpose of Quality Assurance

Help patients and potential patients by

improving quality of care.

Assess competence of medical staff, sure as animpetus to keep up to date and prevent future

mistakes.

Being to notice of hospital administration the

deficiencies and in correcting the cases factors


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PHILOSOPHY OF QUALITYCIRCLE

1) Reduce errors

2) Encourage more effective team work

3) Promote job indolent and participation4) Increase employee motivation

5) Create problem solving capability


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CONT

6) Built an attitude of problem prevention

7) Improve communication in the organization

8) Improve harmonious relationship9) Promote cost reduction

10) Bringing about attitudinal changes for better

team work


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Need for Quality Assurance in Health

Care

It is an important managerial function which

assures confidence among customers.

It involves evaluation in order to secure

improvement and development on a condition

basis.

It is needed to indicate standard of agency.


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a) To ensure the delivery or quality care.

b) To evaluate the efforts of the health care

provider to provide best possible results.


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Purpose of Quality Assurance

Help patients and potential patients by

improving quality of care.

Assess competence of medical staff, sure as animpetus to keep up to date and prevent future

mistakes.

Being to notice of hospital administration the

deficiencies and in correcting the cases factors


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ELEMENTSTHATCONTRIBUTE

TOWARDS QUALITYASSURANCE

Commitment from top level management

Commitment from all personal of the

organization /institution.

Setting clear responsibility for quality activity

willingness to change.

Accurate documentation.

Effective communications at all levels.

Ongoing training program in quality improvement


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PRINCIPLESOF QUALITYASSURENCE

1) Customer focused

2) Identify key processes to improve quality

3) Use of quality tools and statistics4) Involve all people and department to find

solution

5) Leadership


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6) Commitment

7) Individual responsibility

8) Employee empowerment9) Data driven decision making

10) Education and retaining


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Barriers to the quality Improvement

Primary barrier in implementing effective

quality improvement is cost.

Tradition and failure to realize, the charger areneeded.

Authoritative leadership style, do not value

innovators.

Lack of evidence based practice.


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5)STRATEGIES OF QUALITY

ASSURANCE:

1) Setting standards.

2) Appraising actual achievements.

3) Planning and improvement


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7)THE QUALITYASSURANCECYCLE:

Quality

care wheel

Measurement

criteria (b)

Assessment ( c)

Standards of

care (a)

Recommendationfor change (e)

Documented

problems (d)

Nursingcommittees

Nursing staff

development

Suspected

problem area

Hospital

quality

assurance

22


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APPROACHES FORA QUALITY

ASSURANCEPROGRAMME

1)General

2)Specific


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1)General

CREDENTIALING:

LICENSURE:

ACCREDITATION

CERTIFICATION


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SPECIFIC APPROACHES

Peer review committee

There are designed to monitor client specific aspects of care

appropriate for certain levels of care. The audit has been the

major tool used by peer review committee to ascertain quality

of care

The audit process (Stanhope-Han caster 2000)

Utilization review (UR)

Types of UR

Prospective Concurrent

Retrospective


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EVALUATIONSTUDIES

THREEMAJORMODELSHAVEBEEN USEDTO

EVALUATE QUALITYTHEYARE

DONABEDIANSSTRUCTURE PROCESS OUTCOME

MODEL

THETRACERMODEL

THESENTINELMODEL


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(1)DONABEDIANSSTRUCTURE

PROCESS OUTCOMEMODEL

introduced 3 major methods of evaluating

quality care

a) Structural evaluation

b) Process evaluation

c) outcome evaluation


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2) The Tracer Method

It is used to identify persons with certain

illness such as HT, Ulcers, UTI and to establish

criteria for good medical and nursing

management of the illness have used the

trace methods


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3) The Sentinel Method

It is an outcome measure cases of

unnecessary disease, disability death are

counted.

Client satisfaction: - it can be assessed using

person or telephone interventions and mailed

questionnaire. Data from client satisfaction

surveys are used to measure structuresprocess and outcome of care given


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PRINCIPLESANDCONDITIONS FOR

TOTAL QUALITYMANAGEMENT

Principles-

Continuous quality improvement

Knowledge of customers expectation needs.

Processes of customers supplies relationship.

Belief in people.

Statistical analysis.

Costs of poor quality


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Conditions

Employer involvement

Improvement

An environment that supports risk taking

Team work

Data collection and analysis skills

Group interaction skills

Structure and management to enableimprovement

Tools to facilitate the improvement


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framework for quality assurance

Quality in nursing practice:

The point commission on accreditation of health

care organization (JCAHO)1997 defines quality

improvement (QI) as an approach to the

continuous study and improvement of the process

of providing health care services to meet the

needs of client and others.


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STEPSIN QUALITYIMPROVEMENT

1)Professional standards:

2) Outcomes

.3)Developing quality improvement team:


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1)Professional standards:

They are authoritative statements used by the

professional in describing the responsibilities

for which its practitioners are accountable

(Peter 1995)

A)Policies

b)Job descriptions


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2) Outcomes

Outcomes are the conditions to be achieved

as a result of care delivery. An outcome tells

what interventions are effectiveness, whether

clients progress, how well standards are being

met. and whether changes are necessary.

a)Professional outcome

b)Client outcome:


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.3)Developing quality improvement

team:

This team composed of staff from alldepartments with in a hospital


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FACTORSCONTRIBUTING THE

SUCCESS OF THE QUALITY

ASSURANCEPROGRAM

Philosophy and commitment of management

Stability of the management and continuity

of leadership for the program

Clarity of organizational and operational goals

Establishment of targets, yardsticks


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Involvement of employees in respect

department and QAP

Motivation and commitment of employers

Documentation and reporting system

Feedback systems to management and

employers

Action plans, implementation, review systems

Incentives and recognition system


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10) QUALITYASSURANCE

COMMITTEE (QAC):

Medical administrator

Two senior clinicians

Pathologist Radiologist

Nurse administrator (Matron)

Medical records officer- Secretary


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SPECIFIC FUNCTIONS OF QAC:

1)Coordination:

Collecting information

Consider activates that should be related, eg.

quality appraisal or continuing education.

Communicate across patient care.

Coordinate the action with hospital authority


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2)Information:

Collect data reports about medical records.

Interaction between the patient and the care

provider.

Information regarding response to treatment


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3)Planning- Establish priorities.

4)Prodding- Insist on effective, productive,

efforts from all hospital components.

5)Consultation Provide specific assistance

usually through the coordinator. .


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6)Response:A) Internally provide importance to individual and

department.

B

)E

xternally provide organizational home for respondingto quality requirement of external agencies, e.g.medical companies.

7)Search for expertise: Operate openly notbehind closed doors.

8) Follow up: Insert of report provideimplemented change


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Functions ofCommittee members

To coordinate, not to control

To inform, not to scold

To plan and suggest priorities, not to dostudies

To recommend and report, not to intervene

directly


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11) QUALITYASSURANCEMODEL

Nurses who are trained as per Indian NursingCouncil recreation and registered with statenursing registration councils are safe to providecare. Quality assurance model in nursing is the

set of elements that are related to each other andcomprise of planning for quality, development ofobjectives, setting and actively communicatingstandards, developing indicator, collecting data to

monitor compliance with set standards, fornursing practice and applying solutions toimprove care


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PURPOSE OF QUALITYASSURANCE

MODEL:

To ensure quality nursing care provided by

nurses in order to meet the expectations of

receiver, management and regulatory body, It

also intends to increase the commitment of

provider and the management


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MODEL:

Develop confidence of the receiver (s) thatquality care is being rendered as per assurance.

Develop commitment of the managementtowards quality care.

Increase commitment of providers to adhere toset standards for nursing practice and strive forexcellence.

Strengthen documentation of nursing care.

Promote optimum utilization of resources forproviding cost effective nursing care.


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12)MODELS OF QUALITY

ASSURANCE:

The basic components of the system are:

a)Input

b)Throughput

c) Out put

d) feed back


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SYSTEM MODEL

Input

Previous qualityassurance program

Output

Unit Based qualityassurance program

Through put

Structuralchange process

Feedback


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SYSTEM BASE FOR UNIT BASED

QUALITY ASSURENCE

American Nurses Association model


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H. REEVALUATE

G. TAKE ACTION

A. IDENTIFY VALUES

B . IDENTIFY

STANDARD & CRITERIA

F.

CHOOSEACTION

E . CAUSES OF

ACTION

C. SECURE

MEASUREMENT

D. MAKE INTERPRETATION


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Identify value

: In the ANA value identification looks as such issue

as patient/ client philosophy, needs and rights from

an economic, social, psychology and spiritual

prospective and value philosophy of the health careorganization and the provides of nursing sciences.


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Identify structure, process and

outcome standards and criteria:

The focus may be the staff, the clients, theorganization or all three or any combination ofthe three.

Standards and criteria: although the focus ofthe QA activity is decided, standards must beselected or formulated. Standards are definedas an agreed upon, level of practice. These

standards generally are broad statements thatreflect values and the level of care.


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Select measurement needs to

determine degree of attainment of

criteria and standards Measurement are those tools used to gather

information or data, determined by the selections ofstandards and criteria.

The approaches and techniques used to evaluatestructural standards and criteria are nursing audit,utilizations reviews, review of agency documents, selfstudies and review of physical facilities

approaches and techniques for the evaluation processstandards and criteria are peer review clientsatisfaction survey, direct observation, questionnaires,interviews, written audits and videotapes


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Make interpretations:

predetermined criteria are met is the basis for

interpolation about the strength and

weakness of the program. The late of

compliance is compared against the expected

level of criteria


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Identify course of action:

the compliance level is above the normal or

the expected level, there is great value in

conveying positive feedback and

reinforcement. If the compliance level is

below the expected level, it is essential to

improve the situations, it is necessary to

identify the cause of deficiency


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Take action

important to firmly establish accountability for

the action to be taken. It is essential to answer

the questions of who will do? What? By

when?


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Reevaluate:

final step of QA process involves an evaluation

of the results of the action. The reassessment

is accomplishment in the say same way as the

original assessment and begins the QA cycle

again


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. Maxwell six dimension model(1984)

Relevance in the needs.

Accessibility

Equality

Effectiveness

Acceptability

Efficiency and Economy


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Joint commission model:

1. Establish responsibility and accountability for a QI program.2. Define the scope of service for a clinical area.

3. Define the key aspects of service for the clinical area.

4. Develop quality indicators to monitor the outcomes and

appropriateness of care delivered.5. Establish threshold for evaluation of indicators.

6. Collect and analyze data from monitoring activities.

7. Evaluate results of monitoring activities to determine the

need for change in practice.8. Resolve problems through development of action plans.

9. evaluate to determine if the plan was successful.

10. communicate QI results to the agencies


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PROGRAMEVALUATIONMODEL

(PEM)

two major types of program evaluation:

Formative evaluation

Summative evaluation


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Program evaluation includes

Determine focus

Establish purpose

Define appropriate type of evaluation.

Formulate data gathering questions.

Gather data.

Make data based judgment. Formulate report.


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FACTORSAFFECTING QUALITY

ASSURANCEINNURSINGCARE

Lack of resources

Personnel problems.

Improper maintenance.

Unreasonable patients and attendants.

Absence of well informed population.

Absence of accreditation laws. Lack of incident review procedures


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Lack of good and hospital information system.

Absence of patient satisfaction surveys.

Lack of nursing care records.

Legal redness

Delay in attendance by doctors, nurses andhelpers.

Miscellaneous factors. Lack of good supervision


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Lack of policy and administrative manners.

Substandard education and training.

Lack of evaluation technique.

Lack of written job description and job

specifications.

L

ack of in service and continuing educationalprogram


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QUALITYASSURANCESETTING

STANDARDS

For more than 100 years, a authors have

written about the evaluation of nursing

practice as a process with minimal elements

of

Setting standards

Comparing nursing practice to such standards.

Instituting changer to increase the adherence tothe standards.


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Definition:

Standards is an established rule as basis of

comparison in measuring or finding capacity,

quality context and value of objects in the

some category. Standard is a broad statementof quality


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Professional nursing standards in

nursing practice

a standard in model of established practice

which has general recognition and acceptance

among registered professional nurses and its

commonly accepted as correct standards ofpractice are agreed n levels of competence as

determined by the ANA and specially nursing

ranizations (ANA-1996)


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Standards are defined as authoritative

statements that describe a common level of

care as performed by which the quality of

practice can be determined or measured.standard help define professional practice

(hubes -1996)


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IMPORTANCEINSTANDARDSIN

NURSING

It is the authoritative statement by which the

quality of nursing practice, service and

education can be judged

In nursing practice, standards are established

criteria for the practice of nursing

It is a guideline and a guideline far is a

recommended path to safe conduct an aid toprofessional performance


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It provides a baseline for evaluating quality of

nursing care, increase effectiveness of care andimprove efficiency

Standard helps supervisors to guide nursing staffsto improve performances

Standard may helps to clarify nurses area ofaccountability

Standards may helps nursing to clearly definedifferent levels of care

standard s a device of quality assurance andquality control


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Purpose:

Improve the quality of nursing.

Decrease the cost of nursing.

D

etermine the nursing negligence


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Characteristics of standard

statement must be board enough to apply a widevariety of settings

must be realistic, acceptable and attainable

nursing care must be developed by members ofnursing profession

must be understandable and stated correctknowledge and scientific practice

Must be based on current knowledge and scientific

practice must be reviewed and revised periodically

must be directed towards an optimal standard


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SOURCES OF NURSINGSTANDARDS

Professional organizations like TNAI

Licensing bodies IC, MCI and DCI etc.

D

epartments of the institution. Patient care unit.

Individual personal standard

Government unit at national, state and localgovernment unit


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Classification of standards

1)Physical standardWhich includes patients activity rating toestablish nursing care hours per patient per

day

2)Cost standard

Which includes cost per patient per day

3)Capital standard

Which include the review of monitoryinvestments as new program

4)Revenue standardsWhich includes the revenue per patient day of nursing care


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5)Program standards

Which guide the development and implementation ofprogram to meet clients need

6)Intangible standard

Which guide the development of personal orientationcost

7)Goal standard

Which outlines qualitative goal in short and long termplanning

8)Strategies plan standardThis outlines check point in developing andimplementing the organization strategic plan

ROLE OF NURSE IN QUALITY


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ROLE OF NURSEIN QUALITY

ASSURANCE

Professional nurses have an obligation to ensure that thecare they provided is evidence based.

Ensure services provided is consumer centered.

Provide quality care to the individual and to the public in

reality with the desired outcome. Care provided should be consistent with current

professional knowledge.

Functions as leader and managers in various health caresettings which provide quality care.

Responsible to promote standards, measurement andinvolve in continuous quality improvement.

Effective care to the clients should be the primary focus ofall nurses

R l f d i i t t i


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Role of nurse administrator in

implementing quality assurance

Initiator:-

Creates an awareness or sensitizes the nurses aboutthe importance of quality assurence

Facilitator:- She facilitates to develop, implement, monitor and

evaluate standard of nursing practice in all times

Coordinator

She coordinates the different units of qualityassurance programe and coordinates the activitieswith hospital quality assurance program


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Educator

She gives orientation to nursing personal regarding thenees

Leader

She communicate the quality message to all nursing staffs

Evaluators

She evaluates the implementation of nursing practice

Supervisor

She supervise the activities of the differentcommittees,she supervises the nurses firstand secnd levelof leadership positions

IN A NUTSHELL QUALITY ASSURANCE


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INANUTSHELL, QUALITYASSURANCE

PROMOTES

Comprehensive, cost effective and contractual

aspect.

Accessible, accredited, acceptable.

Relevant, reliable, resourced.

Efficient, equitable and effective care.

Seminar on Quality Assurence

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