Quality Client Care
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Quality Client Care






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Quality Client Care Quality Client Care Presentation Transcript

  • History and Evolution
    • Edward Deming
    • “Father of Quality Improvement”
    • Method for discovering how to prevent defects
    • Joseph M. Juran
    • Emphasized the meaning of the Pareto principle
    • Marked the beginning of the idea of TQM (total quality management)
    • Phillip Crosby
    • Father of “Zero Defects”
    • Proposed simplifying thing so everyone could understand
  • Key Terms
    • QI (Quality Improvement) – activities used to measure, monitor, evaluate and control services
    • DMAIC – six stigma process for improving existing processes that fall below institutional goals or national norms. Stands for define, measure, analyze, improve, control
    • Six Stigma – measurement standard initiated by Walter Shewhart- Three stigma from the mean is the point where a process requires correction (no fewer than 3.4 errors per million opportunities)
  • Key Terms cont.
    • Quality Indicator – areas of concern that have come about due to a nursing practice problem
    • Key Indicator – specific problem areas, selected based on TJC mandates, that need more extensive data collection or remedial action to resolve an identified problem
    • Metric – a measurement to determine the rate of compliance or noncompliance with an indicator
    • Pareto principle – 80% of the problems are caused by 20% of sources, people, or things. If you can fix the 20%, you can fix the system
    • Patient Safety Goals – annual goals established by TJC that highlight problematic areas in health care and describe evidence and expert-based solutions to these problems
  • Who guides quality in health care?
    • American Nurses Association (ANA) – guides Standards of Nursing Care
    • The Agency for Healthcare Research and Quality (AHRQ) – established clinical practice treatment guidelines
    • The Joint Commission (TJC) – accredits health care organizations
    • Publishes a sentinel event alert monthly to alarm the need for investigation and change
  • The Joint Commission (TJC)
    • Major accrediting body for over 15,000 health care institutions
    • Sets standards for safe practice and evaluates compliance
    • Recommends “tools” such as flow charts, Pareto charts, run charts or line graphs, control charts and histograms
    • Began instituting annual patient safety goals (NPSG) in 2001 to improve the quality of health care
    • 2008 NPSG includes 16 goals and a Universal Protocol for Eliminating Wrong Site, Wrong Procedure, Wrong Person Surgery (pg 488 Zerwekh)
  • Who Monitors Quality in Health Care?
    • QI department – receives data, analyzes trends, and recommends actions to facilitate improvement in the organization
    • CQI (Continuous Quality Improvement) Council – primary decision-making nursing team
    • QC’s (Quality circles) – review problems or indicators each month to determine whether quality care is being delivered; establish unit-specific quality indicators
  • Key Indicators
    • Part of TJC accreditation standards include certain key indicators that must be tracked on an ongoing basis.
    • Advance directives
    • Autopsy rates
    • Blood transfusion reaction rates
    • Medication error rates
    • Fall rates
    • Restraint use
    • Surgical-site infection rates
    • Pain management effectiveness
  • Barriers to Quality Improvement
    Due to decreased payments from health insurance companies as well as increased cost of doing business
    Resistance to change
    Nurses’ loyalty to old practices and failure to recognize that changes are needed
    Hospital administrators opposition to change
  • Tools for CQI – Six Stigma (SS)
    • SS Quality Improvement methods are the newest wave of change initiatives for CQI
    • TJC will most likely recommend these methods for accreditation purposes in the future
    • SS is a measurement standard: 3 stigma from the mean is where errors start to occur
    • Uses statistics to improve the efficiency of business processes
    • Primary goal is to increase profits and reduce problems by improving standard operating procedures, reducing errors and decreasing misuse of the system
  • Tools for CQI - DMAIC
    • DMAIC is a process used to guide QI projects
    D – Define – define the issue, possible causes, and goals
    M – Measure – measure the existing system with
    A – Analyze – analyze the gap between existing and goal
    I – Improve – improve the system with creative
    C – Control – Control and sustain the improvement
  • Conclusion
    All health care professionals are responsible for providing quality client care
    Agencies such as TJC set standards in health care that are continuously monitored