THIS IS FOR ALL THE NURSING AND PG NURSING STUDENTS. AN OVERVIEW OF THE QUALITY ASSURANCE PROGRAM

1. QUALITY
ASSUREANCE
DEEPAK. K. V
M.ScNURSING
WAHE
TOPIC PRESENTATION ON

3. INTRODUCTION

4. DEFINITION OF QUALITY
“It is the degree to which health services for the
individual and populations increase the likelihood
of the desired health outcomes and are
consistent with current professional knowledge.”
-joint commission on accreditation of
health
organizations (2002)
“It is defined as the totality of features and
characteristics of a service that bears on its ability
to satisfy the stated and implied needs of the
patients.”
-international organization for

5. DEFINITION OF QUALITY
ASSURANCE
“It is an systematic, ongoing and continuous review,
analysis and evaluation of the level of compliance
with the standards set at local national and
international level.”
“It is an ongoing systematic comprehensive
evaluation of healthcare services and the impact
of those services on the health care services.”
-Kozier
“It is defined as all activities undertaken to predate
and prevent poor quality.”
-Neetvert (1992)

6. CONCEPT OF QUALITY IN HEALTH
CARE
Quality with respect to healthcare is defined as
“The quality of health activity is the complete
satisfaction of needs of those who are in most
need of health services, for the lowest
organizational costs, within the given limit and
guidelines of higher administrative bodies and
those paying.”

7. COMPONENTS OF QUALITY
HEALTH CARE
 High level of professionalism.
 Efficient use of resources
 Lowest possible risk for the patient.
 Patient satisfaction.
 A positive influence on patients state of health.

8. ROLE OF NURSE IN QUALITY OF
HEALTH CARE
 An active participation of interdisciplinary quality
improvement team.
 Develop mechanism to monitor the effectiveness
of nursing care.
 Contribute to innovation and improvements in
nursing care.
 Participate in patient safety.
 Participate in CNE and ISE.
 Participate in nursing research

9. ORGANISATIONS WHICH
DETERMINE QUALITY IN INDIA
 NATIONAL ACCERADITION BOARD FOR
HOSPITALS
 PATIENT SAFETY ALLIENCE
 NATIONAL HEALTH SYSTEM RESOURSE
CENTER

10. OBJECTIVES OF QUALITY
ASSURANCE
 Ensure quality nursing care.
 Increase the commitment of management and
provider.
 Improves and maintains patients state of
health.
 Maintains patients functional abilities.
 Develops patients psychological conditions.
 Refine existing methods for optimal quality
health care.
 Provide technical assistance in correcting
systemic deficiencies.

11. PRINCIPALS OF QUALITY
ASSURANCE
 Oriented towards meeting the needs and
expectations of the client.
 Focuses on system and process.
 Uses data to analyze service delivery.
 Encourage the use of teams in problem
solving and quality improvement.
 Effective communication for the improvement
of services.

12. CONCEPT OF QUALITY
ASSURANCE
 Is an dynamic process
 Is an guarantee to the society that services
provided are being regulated.
 It is an judgment concerning process of care.
 Monitoring the activity of client care to determine
the degree of excellence.

13. BENEFITS AND PURPOSES
 Improvement of internal quality care.
 Accountability of action
 Promotes achieving goals, strategic planning and
working according to the institutional values.
 Impact on systems

14. QUALITY ASSURANCE
PROCESS
 Setting standards.
 Determining criteria to meet those standards.
 Data collection
 Evaluating how well the criteria have been met.
 Making plans for changes based on evaluation.
 Implementation for changes.

15. APPROACHES FOR A QUALITY
ASSURANCE PROGRAM
Two major categories of approaches exist in quality
assurance
 General
 Specific

16. GENERAL APPROACH
This includes
 Credentialing
 Licensure
 Accreditation
 Certification

17. SPECIFIC APPROACH
 Peer review committee
 Audit process
 Utilization review: prospective, concurrent,
retrospective.
 Evaluation studies

18. EVALUATION STUDIES
Three major models
>Donabedian’s structure process outcome model: it
includes the following
1. Structural evaluation
2. Process evaluation
3. Outcome evaluation
>The tracer model: measures both process and
outcome of the care.
>Sentinel method: is an outcome method measure
the specific instance of client care.

19. EVALUATION STUDIES
 Client satisfaction
 Incident review
 Risk management
 Malpractice litigation

20. QUALITY IMPROVEMENT
PRINCIPLES AND CONDITIONS
 Continuous quality improvement.
 Knowledge of customer
expectations and needs.
 Process of costumer supplier
relation.
 Belief in people.
 Statistical analysis.
 Cost of poor quality.

21. MODELS OF QUALITY
ASSURANCE
PURPOSES OF QA MODELS
 Ensure quality nursing care
provided by nurses in order to
meet the expectations of
receiver, management and
regulatory body.
 Intend to increase the
commitment of the provider and
the management.

22. MODELS OF QUALITY
ASSURANCE
GOALS
 Develop confidence of the receiver
that quality care is being rendered as
per the assurance.
 Develop commitment of the
management towards the quality
care.
 Increase commitment of care
provider to adhere to set standards
for nursing practices and strive for

23. MODELS OF QA
 System model
 ANA quality assurance model
 JCAHO quality assurance model
 ISO quality assurance model

24. SYSTEM MODEL
 Implementation of the unit based quality
assurance program.
 Involves making changes in organizational
structures and individual roles.
 Method of facilitating and structuring the
change process.
 System approach in which the task is
broken down in to manageable
components based on the defined
objectives.

25. COMPONENTS OF SYSTEM
MODEL
1. INPUT: can be compared to the
present state of system.
2. THROUGH PUT: the developmental
process.
3. OUTPUT: to the finished product.
4. FEEDBACK: it is the essential
component of the system because it
maintains and nourish the growth.

26. MODEL
INPUT
• PREVIOUS
QUALITY
ASSURANCE
PROGRAMES
PROCESS
• STRUCTURAL
CHANGES
OUTPUT
• UNIT BASED
QUALITY
ASSURANCE
PROGRAMS
FEED BACK

27. ANA QUALITY ASSURANCE
MODEL
Developed in 1977 by ANA
Used as an guide to
implement the quality
assurance program.
The first step in the
developing of an QA program
is continuing education.

28. BASIC COMPONENTS OF ANA
MODEL
 IDENTIFY VALUES
 IDENTIFY STRUCTURE, OUTCOME,
STANDERDS AND CRITERIA.
 SELECT MEASURMENT
 MAKE INTERPRETATION
 IDENTIFY COURSE OF ACTION
 CHOOSE ACTION
 TAKE ACTION
 RE-EVALUATION

29. ANA QUALITY ASSURANCE
MODEL
IDENTIFY VALUES
IDENTIFY
STRUCTURE,
OUTCOME,
STANDERDS AND
CRITERIA
SELECT
MEASURES
MAKE
INTERPRETATION
IDENTIFY COURSE
OF ACTION
CHOOSE ACTION
TAKE ACTION RE-EVALUATION

30. ASSURANCE PROGRAME
MODEL
 Select or develop a structure that fits
with the organizational structure.
 Decide on the format that makes the
best use of resources and manpower.
 Keep format simple and streamlined.
 Use a constant model throughout the
division of the nursing.

31. SELECTING AN QUALITY
ASSURANCE PROGRAME MODEL
 In an skilled nursing facility, use an
consistency model throughout the
facility.
 It is a tool for assuring and improving
the quality of care.
 Used to monitor and evaluate the
quality and appropriateness of care.
 It is an ongoing process to examine
care to find potential problems and
opportunities for improvement.

32. FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING
 lack of resources
 Personnel problems.
 Improper maintenance
 Unreasonable patients and
attendants
 Absence of accreditation law.
 Lack of incident review procedures
 Lack of a good hospital information
system.
 Absence of patient satisfaction

33. FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING
 Lack of nursing care records.
 Lack of good supervision.
 Absence about knowledge about
philosophy of nursing care.
 Lack of policy and administrative manual.
 Standard education and training.
 Lack of evaluation technique.
 Lack of written job description and job
specifications.
 Lack of in-service and continuing
educational programs

34. CONCLUSIO
N