QUALITY ASSURANCE MODELS in nursing Management

Nursing Management

1. QUALITY ASSURANCE MODELS PRESENTED BY MARY GRACE P II YEAR M.Sc NURSING, GCON, Cuddalore

2. INTRODUCTIONS Nurses who are trained as per Indian Nursing Council regulations registered with state nursing registrations, are safe to provide care. Indian Nursing Council has developed a quality assurance programme is expected to develop mechanism for ensuring quality of nursing practice.

3. DEFINITIONS Quality Quality is defined as the extent of resemblance between the purpose of health care and the truly granted care. - Shebeer K Basheer Quality Assurance A quality assurance (QA) program is an ongoing, systematic Process designed to evaluate and promote excellence in the healthcare provided to the clients. -B.T. Basavanthappa

4. DEFINITIONS cont.. Definitions of Quality Assurance: Quality assurance is defined as all the arrangements and activities that are meant to safeguard, maintain and promote the quality. -Dr. Donabedian Quality assurance is defined as a systematic process for closing the gap between actual performance and the desirable outcomes. Dr. Ruelas and Franklin Nursing quality assurance is the systematic testing or evaluation of nursing practice. Smelzer , Hinshaw and Feltman 1987

5. CONCEPT OF QUALITY ASSURANCE Quality Assurance is a dynamic process through which nurses in both academic and clinical practice assume accountability for quality of care they provide. It is a guarantee to the society that members of the nursing profession are regulating services provided by nurses. well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care.

6. OBJECTIVES OF QUALITY ASSURANCE

7. QUALITY ASSURANCE GOALS ( NASA Research Center Health Unit) To ensure the delivery of quality client care To demonstrate the efforts of the health care provider to deliver quality care To successfully achieve sustained improvement in health care, clinics need to design processes to meet the needs of patients. To design processes well and systematically monitor, analyze, and improve their performance to improve patient outcomes. A designed system should include standardized,Predictable processes based on best practices. • Set Incremental goals as needed.

8. PURPOSES OF QUALITY ASSURANCE

9. NEED FOR QUALITY ASSURANCE

10. NEED FOR QUALITY ASSURANCE

11. APPROACHES FOR QUALITY ASSURANCE

12. APPROACHES FOR QUALITY ASSURANCE GENERAL APPROACH Credentialing Licensure Accreditation Certification SPECIFIC APPROACH Peer review committee Utilization review Prospective Concurrent Retrospective

13. GENERAL APPROACH Credentialing It is a formal recognition of professional or technical competence and assignment of standards by a person. Licensure Individual licensure is a contract between the profession and the state in which the profession is having a control over the entry and exit from the profession.

14. GENERAL APPROACH cont.. Accreditation Agency's physical structure, organisational structure and personnel qualifications are evaluated. Certification Certification is a voluntary process within the profession a person's educational achievement, experience and performance on examinations or used to determine a person qualification for functioning in an identified speciality area

15. SPECIFIC APPROACHES Peer review committee Designed to monitor client specific aspects of care appropriate for certain levels of care. Audit is the major tool used to ascertain quality of care. Utilisation review Director toward assuring that car is actually needed and that cost appropriate for the level of care provided Prospective Concurrent Retrospective

16. COMPONENTS OF QUALITY ASSURANCE Everyone in the enterprise Has responsibility for enhancing the quality of a product or service Has a responsibility for maintaining the quality of a product or service understand uses and feels ownership of the systems which are in place for maintaining and enhancing quality regularly checks the validity of the system for checking the quality

17. QUALITY ASSURANCE CYCLE

18. PHILOSOPHIES OF QUALITY ASSURANCE MODELS

19. PHILOSOPHIES OF QUALITY ASSURANCE MODELS cont..

20. GOALS OF QUALITY ASSURANCE MODELS Develop confidence of the receiver(s) that quality care is being rendered as per assurance • Develop commitment of the management towards quality care Increase commitment of providers to adhere to set standards for nursing practice and strive for excellence. Strengthen the documentation of nursing care Promote optimum utilization of resources in providing cost effective nursing care

21. MODELS OF QUALITY ASSURANCE System Model ANA Model FOCUS-PDCA Model

22. MODELS OF QUALITY ASSURANCE cont.. Tracer Model Sentinel Model JACHO 10 step Model

23. SYSTEM MODEL

24. ANA Model

25. ANA QUALITY ASSURANCE MODEL STEPS 1. Identify values Identify the issue such as patients, philosophy, needs and rights.

26. ANA QUALITY ASSURANCE MODEL STEPS cont.. 2. Identify structure process and outcomes standards and criteria

27. ANA QUALITY ASSURANCE MODEL STEPS cont.. 3. Secure measurements Nursing audits Utilisation reviews Review of agency documents Self studies Evaluation of physical facilities

28. ANA QUALITY ASSURANCE MODEL STEPS cont.. 4. Make interpretations The rate of complaince compared with the expected level of criteria accomplishment 5. Identify a course of action Based on the compliance level Convey positive feedback and reinforce the theme Improve, if the efforts are below expected level Try to find the cause of the problem and it's solutions

29. ANA QUALITY ASSURANCE MODEL STEPS cont.. 6. Choose an action Select the best alternatives from various alternative courses of action after analysing the pros and cons. 7. Take action Assign each one’s responsibility and prepare a time frame to implement the proposed the course of action.

30. ANA QUALITY ASSURANCE MODEL STEPS cont.. 8. Re-evaluation Revaluate the process according to preset criteria to interpret whether the cause of action as improved the deficiency.

31. FOCUS-PDCA MODEL/QUALITY MANAGEMENT MODEL

32. TRACER METHOD It measures both process and outcome Identify the value of a client with a particular characteristics resuming specific health Care management Provides nurses with data to show the differences in outcome as a result of nursing care standards

33. SENTINEL METHOD It is an outcome of measures for examining specific instances of client care. CHARACTERISTICS Cases of unnecessary diseases disability death are counted. The circumstances surrounding the unnecessary or sentinel event are examined in detail. A review of morbidity and mortality are used as an index.

34. JOINT COMMISSION 10 STEP MODEL. (JOINT COMMISSION ON A CREDIT STATION OF HEALTHCARE ORGANISATIONS)

35. JOINT COMMISSION 10 STEP MODEL. (JOINT COMMISSION ON A CREDIT STATION OF HEALTHCARE ORGANISATIONS) cont..

36. FACTORS AFFECTING QUALITY ASSURANCE IN NURSING Personnel problems Lack of resources Improper maintenance Unreasonable patients and attendants Absence of well informed population Absence of accreditation laws Lack of Incident Review procedure Miscellaneous factors

37. Summary

38. CONCLUSION Every institutions should establish their own quality assurance strategy and develop effective teaching process, so that they produce effective and quality services

39. THEORY APPLICATION- Benner’s Novice to Expert Theory

40. JOURNAL REFERENCE TITLE: Healthcare Service Quality Measurement Models: A Review AUTHOR: Berhanu Endeshow FINDINGS: An extensive review of literature is done, by taking studies for a 36 years period from 1979 to 2015. Out of 137 studies, 74 studies were analysed . The study concluded that healthcare organisations need to develop their own models for measuring the quality of health Care services. The existing generic models no longer surface in measuring the quality of health Care services.

41. ASSIGNMENT Draw a plan for quality improvement in hospital by using anyone quality assurance model.

42. BIBLIOGRAPHY Vati J Principles And Practice Of Nursing Management And Administration second edition, jaypee brothers medical publishers private limited New Delhi Page 512 to 14 Venkatesan B Loganathan G Management Of Nursing Education And Services 3rd edition emmess publishers Bangalore page: 175-81 Basavanthappa BT Nursing Administration second edition Jaypee Brothers Medical publishers New Delhi page 729 Basheer K Shabeer A Concised Textbook On Advanced Nursing Practice Third edition, Jaypee Brothers Medical Publishers Private Limited New Delhi, Page 60-66