This presentation will help you to get updated with ways to sustain quality in nursing given the current scenario.

1. Sustaining Quality In Health Care
Dr. Latha Venkatesan
Apollo College of Nursing
Chennai – 95

2. Odisha fire tragedy: Protests erupt outside SUM Hospital
demanding authorities to claim responsibility.

3. Rebirth of an eagle

4. Challenges in Sustaining Health care quality

5. System Failures

6. Environment and design factors.
• Reliance on automated systems to prevent error.
• Inadequate systems to share information about
errors hamper analysis of contributory causes
and improvement strategies.
• Infrastructure failure. According to the WHO,
50% of medical equipment in developing
countries is only partly usable due to lack of
skilled operators or parts

7. Theoretical Context

8. National Accreditation For Nursing Excellence

9. Why to Empower Nurses?
Rapid changes in health care technology
Computerized patient records(EHIS)
Computerized order entry
Personal digital assistant for nurses
Tele nursing
Clinical decision support system
Robo nurse
Adequate flow of resources
To compete with other health care professionals
More time for holistic patient care
Need for clinical investigating opportunities

10. Empowering nurses to meet the future challenges
• Advances in technology
• Nurses shortage
• Work environment
• Globalization
• Patient’s awareness

11. A descriptive study on Nursing Empowerment

12. Results
Percentage Distribution of Nurses
Empowered Problem areas

13. Nursing Empowerment…

14. Establishing a culture of improvement
requires

16. The Toyota Way -A new Way of Thinking
(Excellence unlimited)
The 14 principles of The Toyota Way are organized (visually) into
four sections (The 4P’s):
1. Long-term philosophy
2. The right process will produce the right results
3. Add value to the organization by developing your people
4. Continuously solving root problems drives organizational
learning

18. Toyota Way – 14 Principles
1. Base your management decisions on a long-term philosophy, even at
the expense of short-term financial goals.
2. Create a continuous process flow to bring problems to the surface.
3. Use ‘pull’ systems to avoid overproduction.
4. Level out the workload (work like the tortoise, not the hare).
5. Build a culture of stopping to fix problems, to get quality right the
first time.
6. Standardized tasks and processes are the foundation for continuous
improvement and employee empowerment.
7. Use visual controls so no problems are hidden.

19. Slow and steady wins the race
Level out the workload (work like the tortoise, not the hare)

20. Cont…
8. Use only reliable, thoroughly tested technology that serves your people and
process.
9. Grow leaders who thoroughly understand the work, live the philosophy, and
teach it to others.
10. Develop exceptional people and teams who follow your company’s philosophy.
11. Respect your extended network of partners and suppliers by challenging them
and helping them improve.
12. Go and see for yourself to thoroughly understand the situation.
13. Make decisions slowly by consensus, thoroughly considering all options,
implement decisions rapidly.
14. Become a learning organization through relentless reflection and continuous
improvement.

22. Lean Six Sigma in Healthcare
Lean Six Sigma focuses on eliminating defects. In
healthcare, a defect can be the difference between life
and death. Use Lean Six Sigma to improve patient safety
by eliminating life-threatening errors

25. Research Studies On Process Mapping
• Pre operative, intra operative , postoperative care , high dependency unit and
radiation therapy
• Nasogastric tube insertion and feeding
• Cardiac monitoring and administration of cardiac drugs
• Care of patients with ventillator, suctioning and CVP Line
• Arterial blood gas analysis and oxygen administration
• Barrier nursing and use of personal protective equipments
• Admission procedure,discharge procedure, vital signs, transfer ,hand over and
take over of patients
• Catherization,catheter care and perineal care
• Chemotherapy, epidural anaesthesia,assist with MLC Procedures
• Hot applications, cold applications and post burn exercises

26. Clinical Pathways
A Clinical Pathway is a plan of care, drafted in advance
for predictable patient groups which is developed and
used by multidisciplinary team. It forms part of the
written documentation, includes outcomes to be
achieved and the capacity for recording and analyzing
variance.

27. Validation of nursing care
 Vital signs
 catheter care
 Nasogastric tube feeding
 Positioning of the patients-Turning schedule
 Care of ET tube
 Documentation

28. Performance indicators
1 3 5 7
2 4 6 8
9 10
11 12
13 14
15 16
31
30 29
28 27
26 25
23 21 19 17
24 22 20 18
August
Month
performance

29. Inquiry Projects
• What are your burning issues in health care, in your
advanced nursing practice (why are you here)?
• Implement innovations
• Apply evidence-based interventions
• Propose changes to care delivery models
• Implement quality improvement projects
• Develop and implement health policy
You are a Change Agent !

30. Innovations
Infusion
sets with
flow
regulators
Steam
inhaler
Electrical
hot/cold gel
pack
Empathy
kit

31. Nursing Audit

32. Kano model of satisfaction

33. Nurse Champions
To Promote nurses to champion quality improvement efforts
To train in safety issues (incidents or accidents)
To take reasonable care of the health and safety of themselves
(acts or omissions)
To report any hazard or unsafe working practices
Induction and annual update training in health and safety
matters (like fire safety drills etc,)

34. Competency matrix

35. Caring for the health care
professionals
VID-20160909-WA0014.mp4

36. Awards/ Rewards
Nursing Excellency Award
Best Leadership Award
Best Nursing Director Award
Best Nurse Educator Award
Infection Control Champion
Best Clinical Staff in all specialties
Best Nursing Tutor

37. What Are Your Experiences With Change?
• Have you ever tried to change a practice at your work
site?
• What worked?
• What didn’t?
• What was the final outcome?
• What would you do differently?
• Do facts (evidence) change behavior?

38. Conclusion
Important dilemma hospitals face is that they want their best nurses at the
bedside caring for patients and these same nurses leading their quality
improvement activities. This poses an even greater quandary when nurses are
in scarce supply.
The growing focus on providing high-quality care suggests that more
nurses will be involved in quality activities which is likely to increase the
quality of patient care and nurses will also experience more satisfaction and
joy in their work.