Quality assurance concept,cycle & models

management of nursing services and education - Useful for B.Sc Nursing & M.Sc Nursing Students

1. Concept QA Cycle Models Mr.Visanth VS Asso.Professor IGSCON, Amethi

2. Quality Assurance -Meaning Quality assurance means the assurance to consumers that the products, components, parts and tools etc. possess specified characteristics and are fit for the intended purpose.

3. Definition “Quality assurance is defined as all the arrangements and activities that are meant to safeguard, maintain and promote the quality of care.” “Quality Assurance is an on-going, systematic comprehensive evaluation of health care services and the impact of those services on health care services.

4. Concepts of QA 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 monitor the activities of client 4

5. Objectives According to Jonas (2000), the two main objectives are; To ensure the delivery of quality client care To demonstrate the efforts of the health care providers to provide the best possible results 5

6. Purposes Rising expectations of consumer of services. Increasing pressure from national, international, government and other professional bodies to demonstrate that the allocation of funds produces satisfactory results in terms of patient care. The increasing complexity of health care organizations. Improvement of job satisfaction. 6

7. Highly informed consumer To prevent rising medical errors Rise in health insurance industry Accreditation bodies Reducing global boundaries. 7

8. Principles QM operates most effectively within a flat, democratic and organizational structure Managers and workers must be committed to quality improvement. The goal of QM is to improve systems and processes and not to assign blame. Customers define quality. Quality improvement focuses on outcome. Decisions must be based on data.

9. Approaches General Approach Specific Approach 9

10. General Approach Credentialing- It is the formal recognition of professional or technical competence and attainment of minimum standards by a person and agency. Credentialing process has 4 functional components To produce a quality product To confirm a unique identity To protect the provider and public To control the profession

11. 2. Licensure- It is a contract between the profession and the state in which the profession is granted control over entry into an exit from the profession and over quality of professional practice. 3. Accreditation- It is a process in which certification of competency, authority, or credibility is presented to an organization with necessary standards. 4. Certification 5. Charter- It is a mechanism by which a state government agency under state law grants corporate state to institutions with or without right to award degrees. 6. Recognition- It is defined as a process whereby one agency accepts the credentialing states of and the credential confined by another. 7. Academic degree 11

12. Specific Approach Peer review Standard as a device for quality assurance :- Standard is a pre-determined baseline condition or level of excellence that comprises a model to be followed and practiced. Audit as a tool for quality assurance :- Nursing audit may be defined as a detailed review and evaluation of selected clinical records in order to evaluate the quality of nursing care and performance by comparing it with accepted standards.

13. Components of QA Structure Element- The physical, financial and organizati onal resources provided for health care. Process Element- The activities of a health system or healthcare personnel in the provision of care. Outcome Element- A change in the patient‘s current or future health that results from nursing interventions.

14. Contd…….. According to Manwell , Shaw, and Beurri , there are 3A’s and 3E’s; 3A’s Access to healthcare Acceptability Appropriateness and relevance to need 3E’s Effectiveness Efficiency Equity

15. Areas of QA Outpatient department- The points to be remembered are; Courteous behavior must be extended by all, trained or untrained personnel. Reduction of waiting time in the OPD and for lab investigations by creating more service outlets. Provide basic amenities like toilets, telephone, and drinking water etc. Provision of polyclinic concept to give all specialty services under one roof. Providing ambulatory services or running day care centers.

16. Emergency medical services :- Services must be provided by well trained and dedicated staff, and they should have access to the most sophisticated life- saving equipment and materials, and also have the facility of rendering pre- hospital emergency medical aid through a quick reaction trauma care team provided with a trauma care emergency van. 16

17. In- patient services :- Provide a pleasant hospital stay to the patient through provision of a safe, homely atmosphere, a listening ear, humane approach and well behaved, courteous staff. Specialty services:- A high tech hospital with all types of specialty and super- specialty services will increase the image of the hospital. Training:- A continuous training programme should be present consisting of on the job training, skill training workshops, seminars, conferences, and case presentations. 17

18. Quality Assurance v s Quality Improvement Inspection oriented (detection) Reaction Correction of special causes Responsibility of few people Narrow focus Leadership may not be vested Problem solving by authority Planning oriented (prevention) Proactive Correction of common causes Responsibility of all people involved with the work Cross- functional Leadership actively leading Problem solving by employees at all levels

19. 19 Quality Assurance Cycle

20. Quality Assurance Cycle In practice, QA is a cyclical, iterative process that must be applied flexibly to meet the needs of a specific program. The process may begin with a comprehensive effort to define standards and norms as described in Steps 1-3, or it may start with small-scale quality improvement activities (Steps 5-10). Alternatively, the process may begin with monitoring (Step 4). The ten steps in the QA process are discussed.

21. Quality Assurance Cycle

22. Planning for Quality Assurance:- Planning begins with a review of the organizations scope of care to determine which services should be addressed. Setting Standards and Specifications:- To provide consistently high-quality services, an organization must translate its program goals and objectives into operational procedures. In its widest sense, a standard is a statement of the quality that is expected. Communicating Guidelines and Standards:- Once practice guidelines, standard operating procedures, and performance standards have been defined, it is essential that staff members communicate and promote their use. This will ensure that each health worker, supervisor, manager, and support person understands what is expected of him or her.

23. 4. Monitoring Quality:- Monitoring is the routine collection and review of data that helps to assess whether program norms are being followed or whether outcomes are improved. 5. Identifying Problems and Selecting Opportunities for Improvement:- Program managers can identify quality improvement opportunities by monitoring and evaluating activities. Other means include soliciting suggestions from health workers, performing system process analyses, reviewing patient feedback or complaints, and generating ideas through brainstorming or other group techniques . 6. Defining the Problem:- Having selected a problem, the team must define it operationally-as a gap between actual performance and performance as prescribed by guidelines and standards.

24. Choosing a Team:- After defining a problem, a small team should be assigned; the team will analyze the problem, develop a QI plan, and implement and evaluate the effort . Analyzing and Studying the Problem:- to Identify the Root Cause Achieving a meaningful and sustainable quality improvement effort depends on understanding the problem and its root causes. Developing Solutions and Actions for QI:- The problem-solving team should now be ready to develop and evaluate potential solutions . Implementing and Evaluating QI Efforts:- The team must determine the necessary resources and time frame and decide who will be responsible for implementation.

25. Quality Assurance Model

26. 1. Donabedian Model (1985): It is a model proposed for the structure, process and outcome of quality. This linear model has been widely accepted as the fundamental structure to develop many other models in QA.

27. 2. ANA Model: This first proposed and accepted model of quality assurance was given by Long & Black in 1975. This helps in the self- determination of patient and family, nursing health orientation, patient‘s right to quality care and nursing contributions.

28. 3. Quality Health Outcome Model: The uniqueness of this model proposed by Mitchell & Co is the point that there are dynamic relationships with indicators that not only act upon, but also reciprocally affect the various components

29. Indicators of Quality Assurance Waiting time for different services in the hospital Medical errors in judgment, diagnosis, laboratory reporting, medical treatment or surgical procedures, etc . Hospital infections including hospital- acquired infections, cross infections. Quality of services in key areas like blood bank, laboratories, X- ray department, central sterilization services, pharmacy and nursing.

30. Quality Assurance Resources The organizations providing quality indexes are; AHRQ –Agency for Healthcare Research and Quality IHI –Institute for Healthcare Improvement JCAHO –Joint Commission on Accreditation of Healthcare Organizations NAHQ –National Association for Healthcare Quality IOM –Institute of Medicine NCQA –National Committee for Quality Assurance

31. QI Process Steps Identify needs most important to the consumer of health care services. Assemble a multidisciplinary team to review the identified consumer needs and services. Collect data to measure the current status of these services. Establish measurable outcomes and quality indicators. Select and implement a plan to meet the outcomes. Collect data to evaluate the implementation of the plan and achievement of outcomes.