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Total Quality Management (TQM) in Nursing Care

CONCEPT OF QUALITY IN HEALTH CARE Quality is defined as the extent of resemblance between the purpose of healthcare and the truly granted care (Donabedian 1986). Quality assurance originated in manufacturing industry to ensure that the product consistently achieved customer satisfaction. Quality assurance is a dynamic process through which nurses assume accountability for quality of care they provide. It is a guarantee to the society that services provided by nurses are being regulated by members of profession. Quality assurance is a judgment concerning the process of care, based on the extent to which that cares contributes to valued outcomes. (Donabedian 1982). Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities. (Bull, 1985) Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).

APPROACHES FOR A QUALITY ASSURANCE PROGRAMME

Two major categories of approaches exist in quality assurance they are :

General
Specific

A. General Approach
It involves large governing of official bodys evaluation of a persons or agencys ability to meet established criteria or standards at a given time. 1) Credentialing 2) Licensure 3) Accreditation 4) Certification

B. Specific approaches
1) Peer review 2) Standard as a device for quality assurance 3) Audit as a tool for quality assurance

MODELS OF QUALITY ASSURANCE


1. System Model Tasks are broken down into manageable components based on defined objectives. 2) ANA Quality Assurance Model The basic components of the ANA model are: Identify values Identify structure, process and outcome standards and criteria

Select measurement
Make interpretation Identify course of action Choose action Take action Reevaluate

QUALITY ASSURANCE PROCESS


Establishment of standards or criteria

Identify the information relevant to criteria


Determine ways to collect information Collect and analyze the information

Compare collected information with established criteria


Make a judgment about quality Provide information and if necessary, take corrective action regarding

findings of appropriate sources


Determine ways to collect the information

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE


1) Lack of Resources 2) Personnel problems 3) Improper maintenance 4) Unreasonable Patients and Attendants 5) Absence of well informed population 6) Absence of accreditation laws 7) Lack of incident review procedures 8) Lack of good and hospital information system 9) Absence of patient satisfaction surveys 10) Lack of nursing care records 11) Miscellaneous factors

STAGES OF THE DEVELOPMENT OF INTERNATIONAL STANDARDS


An International Standard is the result of an agreement between the member

bodies of ISO. It may be used as such, or


may be implemented through

incorporation in national standards of


different countries.

International Standards are developed by ISO technical committees (TC) and subcommittees (SC) by a six-step process: Stage 1: Proposal stage

Stage 2: Preparatory stage


Stage 3: Committee stage

Stage 4: Enquiry stage


Stage 5: Approval stage Stage 6: Publication stage

IMPACT OF ISO IN A LOCAL HOSPITAL:


Positive impacts: Nurses are accountable for their actions and, professionally, we have responsibility to evaluate the effectiveness of our care Nurses can deliver a high standard of care, and being empowered to identify and resolve

problems can add to personal satisfaction with work


Documents state clearly how the health service should perform and what the patient can expect Guaranteeing standards of care to the public must be a duty of all those who work within the health service Nurses are actively involve in audit, service reviews, standard-setting and customer relations Improves the overall quality of nursing care Improves all types of documentation and communication Helps in professional growth

Negative impacts: Lack of adequate resources

Lack of trained, skilled and motivated employees, staff indiscipline affects


the quality of care. ISO activities may overburden the nursing personnel

Nurses will not get adequate time to spent with the patient, most of the
time may be spending for recording and reporting The hospital will be restricted only to ISO standards

Hospital has to provide special training for all the staffs those who are
involved in ISO inspection All types of services will be under the control of ISO

IMPACT OF ISO IN A LOCAL NURSING EDUCATIONAL INSTITUTIONS


Positive impacts: Improves the quality of nursing education improves the quality of nursing practice Helps to maintain international standard

Helps to compare the standard with another institution


Helps in personnel development of teachers Helps to maintain all the records in time

Avoids malpractice and bias


Encourages extra-curricular activities also Act as a control for all the activities

Improves professional growth

Negative impacts: Gives more importance to documentation

Over-burden for the teachers


Teachers need to take special training in maintaining the standards Not observing the actual practice Organizational philosophy and policies has to be modified according to the ISO standards

CRITICAL ANALYSIS:
Strengths: ISO helps to improve and maintain the

quality of educational institutions and hospitals


Weakness: Standards are set by the institution

itself, it may be biased


Opportunities: Helps in professional growth Threats: Organizational philosophy and policies may not be considered

CONCLUSION
To ensure quality nursing care within the contemporary health care system, mechanisms for monitoring and evaluating care are under scrutiny. As the level of knowledge increases for a profession, the demand for accountability for its

services likewise increases. Individuals within the profession must assume


responsibility for their professional actions and be answerable to the recipients for their care. As profession become more interdependent, it appears that the power base will become more balanced, allowing individual practitioners to demonstrate their competence and expertise. Quality assurance programme will helps to improve the quality of nursing care and professional development.