QUALITY ASSURANCE MEASURES (Quality Assurance to Quality Improvement)

Quality control
 activities used evaluate, monitor/regulate services r/t client.
Quality Audits tools in assessing quality
Quality Assurance- achieving of excellence.
A. Q of care degree health services for individuals & population increases likelihood of desired health outcomes
B. Q assurance evaluation applied to HCS & provision of HCS by health workers.
C. Q improvement umbrella program in organization extents many area purpose of accountability to consumer and
payor program continuous, ongoing measurement and evaluation process that includes structure, process, and
outcome.
Principles of Quality Assurance
A. All health professionals should collaborate
B. Coordination is essential in planning
C. Resource expend quality assurance activities is appropriate.
D. focus on critical factors (functional, activities)
E. Quality patient care is accurately evaluated
F. ability to achieve nursing objectives defends optimal fx of entire nursing process and its effective monitoring.
G. Feedback to practitioners is essential
H. Peer pressure provides the impetus to effect prescribed changes
I. Reorganization in the formal organizational structure
J. Collection and analysis of data should be utilized to motivate
Quality Assurance and Performance Evaluation
 Performance evaluation focuses on the worker.
 It asks questions about how well the worker satisfies the requirements of his/her job within the organization.
Quality Assurance Methods
 primary purpose of QA programs in nursing is to measure and improve the quality of nursing delivered in the
agency.
 Patient is the best, sometimes the only judge of the interpersonal aspects of care, example, empathy and
communication including the surroundings of patients care such as rooms and foods oftentimes called the
“hotel” services.
 Patients satisfaction is an essential goal of health care and it’s the important part of quality care.
Developing Quality Assurance Criteria
A. Structure approach physical setting, instrumentalities, and conditions through which nursing care is given such
as:
 philosophy and objectives
 building and organizational structure,
 financial resources and equipment.
B. Process Approach steps in the nursing process incompliance with established standards of nursing practice.
C. Outcome Approach identifies desirable changes in the patient’s health status such as :
 modification s/sx
 knowledge and attitudes
 Satisfaction,
 skill level and compliance w/ txt regimen.
Nursing Audit Committee
 composed of representative from all levels of the nursing staff: a member of the training staff, supervising
nurse, head nurse/senior nurse, and a staff nurse.
 In smaller hospitals, the chief nurse or his assistant may be a member of this committee.
Patient Care Audit done by peers, (employees of same profession, rank, and setting) evaluating another’s job
performance against accepted standards
A. concurrent audit pt care is observed and evaluated.
Given through:
 a review of patient’s charts during confinement
 observation of the staff as patient care is given
 inspection of patients and/or observation of the effects of patient care where the focus is on the patient, (done
during the rounds or patient interview.
B. Retrospective audit pt care is evaluated through:
 review of discharged patient’s charts and
 questionnaires sent to or interviews conducted on discharged patients.
Quality Circles
 one of the most publicized approaches to quality control.
 group of workers doing similar work who meet regularly and voluntarily on normal working time, under the
leadership of their supervisor, to identify, analyze, and solve work -related problems and to recommend solutions
to management.
Utilization of Results- given orally or written and is directed to the nursing staff in the unit who administers the care or
their immediate supervisors.
Consistent
 positive findings deserve a commendation from the nursing service.
 Negative feedback should tactfully be conveyed in a face-to-face situation so that assessment results may easily be
clarified.
Discipline- Part of Controlling process
 regarded as a constructive and effective means by which employees take personal responsibility for their own
performance and behavior, termed as self-discipline.
Some factors influence self-discipline
 Strong commitment to the vision, philosophy, goals, and objectives of the institution.
 Laws that govern the practice of all professionals and their respective Codes of Conduct.
 Understanding the rules and regulations
 An atmosphere of mutual trust and confidence.
 Pressure from peers and organization
Disciplinary Approaches- Disciplinary program must be tailored to the objectives of the institution. To include:
A. set of disciplinary policies and procedures,
B. uniform application of disciplinary rules
C. disciplinary committee, and
D. An orientation program for all employees
Disciplinary Action- employee charged must be notified in writing about the violation and given a right to counsel.
A. Counselling and Oral Warning
 best given in private and informal atmosphere.
 employee should be given a fair chance to air his/her side.
B. Written Warning
 second step in disciplinary action.
 employee must be told after the interview that he/she will be given a written warning.
 This must include the following:
 Statement of the problem
 Identification of the rule which was violated,
 Consequences of continued deviant behavior
 Employees commitment to take corrective
 action Any follow up action to be taken
C. Suspension- over minor violation is given after an evidence of oral and written warnings.
 Violation is a major infraction, suspension, rather than dismissal is applied when management feels that
the employee can still be rehabilitated.
D. Dismissal
 invoked only when all other disciplinary efforts have failed.
 very sure that the cause for dismissal conforms with the criteria of a major discipline violation.
Benchmarking
 tool to assist quality of care decision making.
 continuous process of measuring what exists against the best in search for industry best practices.
Best practice
 service, function, or process that has been fine-tuned, improved, and implemented to produce superior outcome.
 activity that leads to establishing benchmarks.
Continuous quality improvement (CQI)
 process of continuously improving a system by gathering data or performance and using multi-disciplinary team
to analyze the system, collect measurements, and propose changes.
Sentinel event
 indicators measure low-volume but serious undesirable, and often avoidable process or outcome such as falls and
medication errors.
Total quality management (TQM)
 is a way to ensure customer satisfaction by involving all employees in the improvement of the quality of every
product of service.