Upload
doris-golden
View
221
Download
1
Tags:
Embed Size (px)
Citation preview
king Saud university college of nursing
Managing and improving quality
of patient care
Prepared by: Dr-Fatimah Baddar
Outlines
Introduction. Definitions of Quality Historical Development of
Quality . Factors contributing to Quality. Dimensions of Quality Development of Quality programs Quality control Quality assurance Approaches of Quality assurance
Models of Quality assurance Quality assurance measures
performance. Quality improvement Comparison of Quality assurance and
Quality improvement JCAHO’s model for Quality
improvement (10 steps ) Total Quality management Components of total quality management Quality improvement
tools and technique
Introduction
In today’s highly competitive health care environment, each member of the health care organization must be accountable for the quality and cost of health care , which found in the concept of total quality management ,which has evolved into a model continuous quality improvement designed to improve system and process performance .
The techniques, tools, and approaches of quality management are useful to health care providers and managers in making tough decisions about reducing costs while managing or improving access and quality.
We can see the effects of quality improvement
program in the environment through this example..
So ,What is Quality?
Fitness for purpose (Juran,1964)
Process which seek to attain the highest degree of
excellence in the delivery of patient care (lange,1995)
The effect of care in health of the individual (Rutstein).
Conformance to specification (crosby,1979).
degree of agreement between the reality and previously
set criteria. ( Donabedian,1988)
So ,What is Quality? measure of closely a good or service conforms to
specialized standard ( Tersin).
The degree to which patient care services increase the
probability of desired outcomes and reduce the probability
of undesired outcome given the current state of knowledge (JCAHO).
The ability of a product or service to meet consumer needs (George)
Historical Development of Quality Quality assessment and control in health care
dates back to the mid nineteenth century in England, where Florance Nightingale serves as a nurse during the Crimean war.
Nightingale was the first to identify a positive correlation between the introduction of adequate nursing care to wounded soldiers and the lower mortality rate among them. she attributed a positive outcome to quality of care
Historical Development of Quality In 1810, Abraham Flexner present famous report
documenting his study of physician education in U.S.A in
which he emphasized that the quality of care the patient
received is directly related to physician education and the
medical education: Education certification and licensure
become very important in qualifying health care
professional and educational institution several professional
associations were established to provide these services.
Historical Development of Quality In 1914, Ernest Codiman, surgeon at Massachusetts
general Hospital, studied general surgeries and their
follow ups. This promoted the American college of
surgeons. In 1918 to create the hospital standardization
program, which provided criteria and standard for
accreditation that were later adopted by the Joint
commission
What is health care quality? Quality means different things to
different people
To the PATIENT:
Get well – feel better – recover
Skilled and helpful staff
Effective health outcomes
Welcoming atmosphere
What is health care quality?
To the STAFF: Standards of care
Up to date and working equipment
Continuing education and training
Effective team work
What is health care quality?
To the HOSPITAL MANAGEMENT
Positive health outcomes for patients
Continuous quality development at all levels of the organization
Providing education and training for staff
Stable and trained work force.
What is health care quality ?
To the GOVERNMENT & POLICY MAKERS:
Effective health care system
Improved quality of life for people
Research-based continuous quality development
Monitoring of results/achievements and taking actions to improve outcomes
What is Healthcare Quality? Achieving and producing health and satisfaction
(Donabedian)
Health Care Quality:
The degree to which health services for individuals and
populations increase the probability of desired health
outcomes and reduce the probability of undesired
outcome , are consistent with current professional
knowledge.
(JCAHOs)
Importance of Quality
1. Need for cost containment
2. Competition
3. Desire for recognition and strive for excellence.
4. Rapid advances in medical science
5. Ethical considerations
6 .Need for continual improvement in health care
Factors contributing to Quality There are underlying factors of greater significance
in creating quality services / goods. Among these factors are policy design, equipment & tools, consumer education, and service after delivery.
Policy :-Organizational policy is a major contributor to quality. Design :-Design includes such factors as the used materials, the inner
working of the service (or product ) and the plan of its work.
Factors contributing to Quality Equipment and tools :-
High quality service cannot be achieved without high quality equipment and tools.
Consumer’s education :
The determination of quality doesn’t end with providing high-quality services. Consumer education is necessary to increase the chances that a service will be used for its intended purpose.
Dimensions of quality
High- quality care is efficacious ,
appropriate, effective, safe, efficient, and
coordinated over time and across practitioners and
settings. It is also available when needed, delivered in
a timely fashion, and perceived by the patient to be
provided in a manner that is respectful
and caring .
Dimensions of quality Accessibility. Appropriateness. Continuity. Effectiveness. Efficacy. Efficiency. Patient perspective issues. Safety. Timeliness.
JCAHOs, 1990
Dimensions of quality
Acceptability Legitimacy Equity Amenities
Accessibility
"The ease with which users "The ease with which users can obtain the care that they can obtain the care that they need when they need it" need when they need it" Physical accessibility. Financial accessibility. Organizational
accessibility. Socio-cultural
accessibility. Psychological accessibility.
Appropriateness of Care"The degree to which the correct care (the care that
is relevant to the patient’s/users medical needs) is provided, given the current state of knowledge".
Continuity of care
"The degree to which the care needed by patients/users is coordinated among practitioners, organizations and over time".
Effectiveness of Care
"The degree to which the care "The degree to which the care given to patients/users is given to patients/users is provided correctly (i.e. provided correctly (i.e. without error), given the without error), given the current state of knowledge".current state of knowledge". Doing the right thing.
Effectiveness of care has 3 components:
1. Performance of providers- Technical competence- Interpersonal relation / art of care
2. Minimizing risks to patients as far as possible
3. Documenting patient's health status and the care provided accurately and completely
Efficacy of Care
"The degree to which a service/care has the potential to meet the need for which it is planned under ideal circumstances.""The ability of the science and technology of health care to bring about improvements in health when used under the most favorable circumstances".
BACKBACK
Efficiency of Care
"The relationship between the outcomes (results of care) and the resources used to deliver the care".
"The degree to which the care received
has the desired effect with a minimum
of effort, expense or waste.“
Doing the right thing right.BACKBACK
Patient Perspective Issues Patient Perspective Issues
"The degree to which patients/users and their families are satisfied with their care and involved in the decision-making processes of their care and to which those providing the care do so with sensitivity and respect for the patient’s needs, expectations and individual difference."
BACKBACK
Safety of the Care EnvironmentSafety of the Care Environment
"The degree to which the environment is free from risk (hazard or danger) for both users and providers."
BACKBACK
Timeliness of CareTimeliness of Care
"The degree to which care is provided to patients/users when it is needed i.e., at the most beneficial or necessary time."
Acceptability:Acceptability:
Conformity to the wishes, desires, and expectations of patients and responsible members of their families.
Legitimacy: Legitimacy:
Conformity to social preferences as expressed in ethical principles, values, norms, laws, and regulations.
Equity: Equity:
Conformity to a principle that determines what is just or fair in the distribution of health care and its benefits among the members of a population.
Amenities:Amenities:
Refers to features of health services that do not directly relate to medical procedures but leads to patient satisfaction and willingness to continue and return for further health care.
Quality is free..
If you do a quality job it will not cost you, what costs you is non
quality.
BASIC CONCEPTS OF QUALITY Quality
Quality control
Quality assurance
Quality improvement
Continuous quality improvement
Quality management
Total quality management
Development of Quality programs Quality Control : It involves determining the extent to which a service match
some specific quality standard.
It focus on performance
Quality control occurs on three levels :- Pre-action control : Which include setting standard or goals of
care Concurrent control: which include monitoring of the care given Feedback control: which include evaluation the level of
practice
Development of Quality programs
Problem Identification
Selection of problem for study
Analysis by circle
Solution
Presentation tomanagement
Implementation of chosen solution
Development of Quality programs Quality Assurance :
Is the measurement of actual level of the service provided plus the efforts to modify when necessary.
It focus on process
According to JCAHO
Is the process for objectively and systematically monitoring and evaluating the quality and appropriateness of patient care, for pursuing opportunities to improve patient care, and for resolving identified problems.
Development of Quality programs
Standard : a greed level of excellence . a greed level of performance for practitioners, and offers a measure against
which current practice can be measuredCriteria: Predetermined elements of health care against which the aspects of quality
of medical service may be compared .Clinical indicator: Clinical indicator is quantitative measures that can be used as a guide to
monitor and evaluate of important patient care and support service activities.
Audit: Is evaluation of the quality of medical care as reflected in medical records-concurrent - Retrospective
Approaches of Quality assurance
Structures approaches: The structure approach focus on the characteristics
of the organization such as : Policy, procedure , rule, regulation . Size (number of beds) Ownership (private or public , for profit or not for
profit ) Fiscal resources. Types and Qualification of professionals Number and appropriateness [of non professionals &
support personnel Physical facilities and equipment.
Approaches of Quality assurance
Process Approaches :- Process approach examines the interaction between patient and staff. The nature and sequence of events or activities in the delivery of health care. Action that are taken by the nurse or care received by the patient.
Outcome approach :- The outcome elements are changes in patient health status that result from
nursing intervention. These changes include modification of symptoms, signs, knowledge
, attitudes, satisfaction and skills. Outcome refers to the end result. Structure Outcome measure level of improvement in health or quality of life for
the patient
Development of Quality programs
Quality improvement: Is an ongoing process of innovation , prevention of error, staff
development that is used by corporations and institution who adopt the quality management philosophy
Is a process used in a unit to systematically investigate ways to improve patient care and services.
Goals of quality improvement To achieve optimal patient outcomes in term of both improved
well being and patient satisfaction
Comparison of Quality assurance and quality improvement
Quality assurance processQuality improvement process
Goal To improve QualityTo improve quality
Focus Discovery and correction of errorsPrevention of error
Task - Inspection of nursing activities
- Chart audits
-Review of nursing activities
-innovation staff developmentQuality team Quality assurance or department
personnel
Multidisciplinary team
Outcome
Set by QA team with input from staff
Reaction
Narrow focus
Problem solving by authority
Leadership may not vested
set by QI team with input from staff and clients customers
proactive
cross – Functional
problem solving by employees at all levels
Leadership actively
JCAHO’s model for quality improvementJCAHO’S 10-STEP Monitoring and Evaluation
Process
1-Assign responsibility
2-Delineate scope of care
3-Identify important aspects of care
4-Identify indicator-(quantitative)
5-Establish threshold for evaluation
JCAHO’s model for quality improvement (cont)
6-Collect and organize data
7-Evaluate care
8-Take action to improve care
9-Assessment of action and documentation of improvement
10-Communicate information
Development of Quality programs
Continuous Quality Improvement (CQI)
Cyclical process Continuously improve Q even in absence of problems Never ending Daily part of everyday functions
Basic Principles: Teamwork Includes customer perspective Measurement of work process Willingness, even eagerness to change
CQI ask "WHY" not "WHO"
"why" the problem happens ? not "who" did it ?,
What was wrong with the system ?
What can I do to improve the system ?
Development of Quality programs
Quality management
Creating and following policies and procedures in order to ensure
that a project meets the defined needs it was intended to meet .
Example:
The nurse gives a wrong medication ,,a system must be established ,accepted and used by all the staff .
Development of Quality programs
Total Quality management:
Is holistic , organizational – wide approach to improve and maintain quality. All of organization’s activities and resources are directed toward achievement of goal that is , optimum patient outcome in terms of patient well being and customer satisfaction with care given.
"TOTAL"
Injects a system meaning of wholeness into quality.
Quality cannot be guaranteed without
involving the whole organization, across all functions and through all levels.
Benefits of Quality ManagementQuality Improvement
Improved ProductivityImproved outputs (product/service)Better resource use (Efficiency)
Decreased Production Costs
Lower Prices
Increased Customer Satisfaction
Increased Market Share/Enhanced competitive position
Increased Profit
Components of Quality management
In order to address the quality of health care services provided today, administrators must use:-
1.Quality assessment and improvement .
2. Utilization management .
3. Risk management and safety.
4. Infection control.
Development of Quality programs
Performance Improvement (PI)
Designed to replace CQI.
It focuses on measuring and improving performance, both of an individual or an organization
It is a facility- and individual-oriented tool
QC & QA focus on meet needs of patients and performance..
While
QCI & TQM focus on all quality approaches
Quality improvement tools and techniques
QUALITY TOOLS
Quality improvement tools and techniques
Tools for Definition
•IPO diagram•SIPOC diagram•Flow diagram
Tools for Measurement
•cause and effect diagram
Or(Fish bone
OrHead & tail
Or IshikawaDiagramor Six M)
•Pareto chart
Tools for Analysis
• Swot analysis•The five why
Tools for Improvement
•Brainstorming•Nominal group
Tools forControl
•Gantt chart•The PDCA
Recommendation to nursing administration
The nurse manager has to follow some step toward quality management :
ensuring that employees have the resources , knowledge , skills, and abilities to do their work.
Sharing authority with empowered employees. Increased employee participation in the matters that affect
employees is encouraged.
Involving delegation, motivation, and working in and for self- led teams.
Recognition of nursing care mistakes. Adoption & implementation of quality policy as well as its
determination and following up of its objectives. Encourage and motivation to the nurses to improve quality
and safety. Establishing of education and training about CQI.