Quality management in nursing profession

Quality management
COTINUOUS
QUALITY
IMPROVEMENT
Prepared by: Sanjay Sir
lecturer
Govt. CON
Surat

Top priorities
 Quality and Patient Safety.
 Commitment to provide exceptional patient
care and patient service throughout all our
facilities.
 To ensure expert medical care in the safest
environment possible, in both an inpatient and
outpatient setting.

Quality Management
 Quality : Degree to which a set of inherent
characteristic fulfills requirements.
 Quality : the perception of the degree to
which the service meets the patient's
expectations.
Quality Management: Managing the
continuous improvement of service,
delivery processes and outcomes through
data-driven strategies and empowered staff
to exceed patient's expectations.

Quality management
 Quality management is a method for ensuring
that all the activities necessary to design,
develop and implement a service are effective
and efficient with respect to the system and its
performance.

Conti…
 The heart of analysis is patient’s
needs. Quality is not the absence of
errors as defined by the supplier, but
the presence of value as defined by the
patient/relatives.
Patient satisfaction is when patient’s
needs and expectations are met or exceeded.

Conti……..
 Basics : Strategize For patient's Loyalty!
Power Up Your Organization for Maximum Retention
 Handling patient's Complaints: Best Practices in
Resolving patient's Complaints
 Patients expect value for their money and count
on the existence of services when needed.

Conti…….
 patients are demanding to be informed
partners in decisions regarding their
health.
 Now patients have a right to complain,
demand, report and sue that indicate about
the significance of quality of nursing care.

Conti…….
 Responding to Angry Customers:
Understanding Hostile Customers .
Give An Angry Customer Even More Than They Asked For
 Measuring Customer Satisfaction:
Using satisfaction surveys to achieve a competitive advantag
When Should Changes Be Made to a Customer Satisfaction T

Continuous Quality Improvement
 Continuous Quality Improvement (CQI): is an
organizational process in which staff identify,
plan, and implement ongoing improvements in
service delivery.
 CQI provides a vital way to assess and
monitor the delivery of services to ensure that
they are consistent with an organization’s best
practice clinical principles.

Conti….
 The primary goal of the Quality Improvement
program is the ongoing improvement of the
delivery, quality, efficiency, and outcome of
patient care and services.

Conti…
 Quality Management System (QMS) can be
defined as a set of policies, processes and
procedures required for planning and execution
(production / development / service) in the core
area of an organization.

Continuous Improvement
Methods
 Widely used methods of continuous
improvement such as, Six Sigma and
Total Quality Management .They
emphasize employee involvement and
teamwork; measuring and systematizing
processes; and reducing variation,
defects and cycle times.

 Total Quality Management (TQM) is a management
strategy aimed at embedding awareness of quality in
all organizational processes. TQM has been widely
used in manufacturing, education, government, and
service industries, as well as NASA space and science
programs.
 Total Quality provides an umbrella under which
everyone in the organization can strive and create
customer satisfaction at continually lower real costs.

Total Quality Management (TQM )
 TQM is composed of three paradigms:
 Total: Involving the entire organization, supply
chain, and/or product life cycle
 Quality: With its usual Definitions, with all its
complexities
 Management: The system of managing with
steps like Plan, Organize, Control, Lead, Staff,

 Six Sigma is a set of practices originally
developed by Motorola to systematically
improve processes by eliminating defects.A
defect is defined as nonconformity of a product
or service to its specifications.

 The term "Six Sigma" refers to the ability of
highly capable processes to produce output
within specification. In particular, processes
that operate with six sigma quality produce at
defect levels below 3.4
defects per (one) million opportunities (DPMO).
Six Sigma's implicit goal is to improve all
processes to that level of quality or better.

Quality Improvement Heroes:
 W. Edwards Deming is best known for his
management philosophy establishing
quality, productivity, and competitive
position. He has formulated 14 points of
attention for managers, some of these
points are more appropriate for
service management .

 Break down barriers between departments;
 Management should learn their responsibilities,
and take on leadership
 Improve constantly
 Institute a program of education and self-
improvement.
 The following diagram is the (PDCA) cycle for
quality improvements, made popular by Deming.

 FOCUS on a particular issue.
 Find a process to improve
 Organize to improve a process
 Clarify what is known
 Understand variation
 Select a process improvement

 The philosophy is to keep improving the quality of
an organization. It is defined by four keys:
 Plan: Design or revise business process
components to improve results
 Do: Implement the plan and measure its
performance
 Check: Assess the measurements and report the
results to decision makers
 Act: Decide on changes needed to improve the
process

Quality management in nursing profession

 Quality Standards
 The International Organization for Standardization (ISO
) created the Quality Management System (QMS)
standards in 1987. These were the series of standards
comprising ISO 9001:1987, ISO 9002:1987 and ISO
9003:1987; which were applicable in different types of
industries, based on the type of activity: designing,
production or service delivery.

History
 the concern for high quality health care dates
back to the 5th Century BC, when Hippocrates
established a code of medical ethics, obliging
future doctors to swear "never to do harm to
anyone".
 The history of quality assurance activities in
nursing can be traced back to Florence
Nightingale's attempts to improve the conditions
of care Her standards to assess the care of the
soldiers has been established as one of the first
documented efforts of quality improvement
work as a priority for nurses throughout the
world (Kahn, 987: 21).

Improving Quality through
Nursing
 the role of nursing in providing quality health
care.
 the impending gap between the need for
nurses and the supply ,the various ways that
hospitals and other health organizations are
reducing nurse staffing and increasing nurse
workloads.

Improving Quality through
Nursing
 The quality of nursing is central to preventing errors in
hospitals and providing high-quality care.
 It was have demonstrated an association between
nurses’ workload and the number of deaths in
hospitals.
 It was have also shown an association between
nurses’ education and the number of deaths.
 highly dissatisfied nurses with their working conditions ,
lack of autonomy, turnover and burnout.Studies have
suggested that when nurses have more control over
their work, care improves and hospitals function better.

FACT
 Hospitals with low nurse staffing levels tend to
have higher rates of poor patient outcomes
such as pneumonia, shock, cardiac arrest, and
urinary tract infections, according to research
funded by the Agency for Healthcare Research
and Quality (AHRQ) and others.

Functions of the quality improvement
department to improve nursing quality
 Develop mechanisms for using evidence-based
practice to improve quality of care
 Support nursing staff involvement in collaborative
quality initiatives that improve organizational
performance and patient outcomes
 Assist nursing staff to interpret and use data from
internal and external sources to improve care or
resolve identified problems
 Promote safe practices by infusing a culture of safety
for both patients and staff.

 Promote the use of an institutional set of core outcome
indicators to monitor and improve care
 Facilitate performance improvement efforts of
department and interdisciplinary teams
 Coordinate or conduct interdisciplinary performance
improvements that impact patient care delivery from
multiple services
 Provide education and consultation to internal and
external constituents regarding quality and outcomes
management activities

 Promote a scientific approach to problem-
solving in management and delivery of patient
care services
 Promote discussion and exchange of
information regarding status and progress of
evidence-based practice, and process
improvement projects.

scope
 The scope of patient care services provided by
the department includes:
 Assessment of patients
 Planning, implementing, evaluating the nursing
plan of care
 Administration of medications
 Administration of treatments and therapies
 Patient and family education

Structure, Process and
Outcome
 Structure is the evaluation of the organization of the
institution delivering care; the conditions under which
care is provided and its impact on quality, i.e. buildings,
budget and equipment.
 Process concerns the evaluation of the performance of
health professionals in the management of patients
 outcome is the evaluation of the end result,
observable changes in the health status of the patient.

Quality Tools
 Cause Analysis Tools
Tips and tools for the first step to improvement
identifying the cause of a problem or situation.
Evaluation and Decision-Making Tools
Making informed decisions and choosing the
best options with a simple, objective rating
system, and determining the success of a
project.
Process Analysis Tools
How to identify and eliminate unnecessary
process steps to increase efficiency, reduce
timelines and cut costs.

Quality Tools You Can Use
Flowcharting
Fishbone diagrams
Pareto charts
SMART goals
Brainstorming
Benchmarking
Interviews
Nominal group process
Force-field analysis
Multi-voting
Cost-benefit analysis
Observation
Written standards and
procedures
Rewards
Teamwork
Questionnaires
Charts/graphs
Time-run chart

 Seven Basic Quality Tools
These seven tools get to the heart of
implementing quality principles.
These are the most fundamental quality
control (QC) tools. They were first
emphasized by Kaoru Ishikawa, professor
of engineering at Tokyo University and
the father of “quality circles.”

1. Cause-and-effect diagra
(also called
Ishikawa or fishbone
chart): Identifies
many possible
causes for an effect
or problem and sorts
ideas into useful
categories.

 Check sheet: A
structured, prepared
form for collecting
and analyzing data; a
generic tool that can
be adapted for a wide
variety of purposes.

Control Chart: Out-of-Control Signals
 Control charts: they
are also called:
statistical process
control .
 They are:Graphs
used to study how a
process changes over
time.

 Histogram: The most
commonly used
graph for showing
frequency
distributions, or how
often each different
value in a set of data
occurs.

 Pareto chart: Shows
on a bar graph which
factors are more
significant.

 Pareto chart is a bar that displays categories of data in
descending order of frequency from the left to the right.
 When analyzing data about the frequency of
problems or causes in a process.
 There are many problems or causes
 Communicating with others about your data.

 Scatter diagram: Graphs
pairs of numerical data,
one variable on each axis,
to look for a relationship.
 Is there any relationship
between product purity
(percent purity) and the
amount of iron

Stratification: technique
that separates data
gathered from a
variety of sources so
that patterns can be
seen.

Risk management
 Risk management is the human activity which
integrates recognition of risk, risk assessment,
developing strategies to manage it, and
preventing of risk using managerial resources.
 The strategies include transferring the risk to
another party, avoiding the risk, reducing the
negative effect of the risk, and accepting some
or all of the consequences of a particular risk

Steps in the risk management process
 Identification of risk in a selected domain of
interest
 1. Planning the remainder of the process.
 2. Mapping out the following: the social scope
of risk management, the identity and objectives
of stakeholders, and the basis upon which risks
will be evaluated, constraints.
 .

 3. Defining a framework for the activity and
an agenda for identification.
 4. Developing an analysis of risks involved in
the process.
 5. Mitigation of risks using available
technological, human and organizational
resources

Potential risk treatments
 Avoidance (elimination) :Includes not performing an
activity that could carry risk
 Reduction ( mitigation): Involves methods that reduce
the severity of the loss
 Retention :Involves accepting the loss when it occurs.
Self insurance
 Transfer ( buying insurance) :Means causing another
party to accept the risk, typically by contract

Quality management in nursing profession

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