This document discusses quality management and risk management in healthcare. It defines key terms like continuous quality improvement, total quality management, and quality assurance. It also outlines the six steps of the quality improvement process: identify needs, assemble team, collect data, establish outcomes, select and implement plan, and evaluate. The document then presents a case study where a hospital unit sees an increase in patient falls. It walks through the risk management and quality improvement processes the unit would take to address the problem, like assembling an interprofessional team, collecting fall data, establishing outcomes to reduce falls, and creating and evaluating a fall prevention plan.

1. Chapter 20
Managing Quality and Risk
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2. Objectives
 Apply quality management principles and
strategies to clinical situations.
 Use the six steps of the quality improvement
process.
 Practice using select quality improvement
strategies.
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3. Objectives (Cont.)
 Incorporate roles of leaders, managers, and
followers to create a quality management
culture of continuous readiness.
 Apply risk management strategies to an
agency’s quality management program.
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4. Managing Quality and Risk
 Comprehensive systematic approach
 Prevents errors before they occur
 Identifies and corrects errors
• Adverse events are decreased
• Safety and quality outcomes are maximized
 Optimizes patient outcomes
 Prevents patient care problems
 Mitigates adverse events
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5. Standards of Quality Care
 Nurse Practice Acts
 Accreditation Standards (e.g., TJC National
Patient Safety Goals)
 Governmental bodies (e.g., Agency for
Healthcare Research and Quality [AHRQ],
National Quality Forum [NQF]; the National
Institute for Occupational Safety and Health
[NIOSH])
 Healthcare advisory groups (e.g., Institute of
Medicine [IOM])
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6. Standards of Quality Care (Cont.)
 Internal or external performance
measurements (e.g., patient satisfaction
surveys, employee opinion surveys, safety
assessment surveys, patient rounds)
 Institutional Guidelines (e.g., Policies and
Procedures, Structure/Process Standards)
 Research/Evidence-based practice guidelines
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7. Quality Management Terms
 Continuous Quality Improvement (CQI)
 Total Quality Management (TQM)
 Quality Improvement (QI)
 Quality Assurance (QA)
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8. Total Quality Management
 Structure
 Facilities
 Equipment
 Staff
 Finances
 Process
 Nurses’ role/EBP
 Outcome
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9. Principles of QM and QI
 QM most effective in a flat, democratic
organization.
 Leaders, managers, and followers must be
committed to QI.
 Goal of QM is to improve systems and
processes, not to assign blame.
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10. Principles of QM and QI (Cont.)
 Customers define quality.
 QI focuses on outcomes.
 Decisions must be based on data.
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11. Comparison of QA and QI
QA Process QI Process
Goal Improve quality Improve quality
Focus Discover/correct
errors
Prevent errors
Major tasks Inspect nurse
activities; chart audits
Review nurse activities;
innovation;
staff development
Quality team QA or department
personnel
Interprofessional team
Outcomes Set by QA team with
input from staff
Set by QI team with input
from staff and patients
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12. Steps in the QI Process
 Identify needs.
 Assemble interprofessional team.
 Collect data.
 Establish outcomes and quality indicators.
 Select and implement plan.
 Evaluate.
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13. National Patient Safety Goals
 Accuracy of Patient Identification
 Effectiveness of Interdisciplinary
Communication
 Safety of Medication
 Reduced Hospital-Acquired Infections
 Identification of specific safety risks
 Suicide
 Falls
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14. Case Study
A significant increase in patient falls resulting in
injury has been reported on your unit. In
accordance with the National Patient Safety
Goals, you are assigned to an
interprofessional Quality Improvement/Risk
Management team to address the problem.
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15. Case Study: Steps in the Risk
Management Process
 Define high-risk situation.
 Patient falls
 Collect data, including frequency of falls.
 Intervene and investigate.
 Identify opportunities to improve care.
 Use steps of the QI process.
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16. Case Study: Identify Needs
 Compliance with National Safety Goals
 Reduction of hospital risk/financial loss
 Reduction in LOS after an adverse fall event
 Establish outcomes
 Nursing-sensitive outcomes
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17. Case Study: Assemble
Interprofessional Team
 Nurses
 Physicians
 Unlicensed assistive personnel
 Pharmacists
 Facility/environmental management
representatives
 QI/risk management experts
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18. Case Study: Collect Data
 Define incidence of falls.
 Benchmark using National Database of
Nursing Quality Indicators (NDNQI).
 Determine high-risk patients.
 Age
 Mental status
 History of falls
 Medication
 Physical environment
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19. Case Study: Identify Outcomes
and Indicators
 Education of 100% of all direct care providers
 Completion of Fall Risk Assessment on 100%
of patients
 Reduction in patient falls by 25% within 3
months of program
 Medical record demonstrating 100%
compliance with Fall Prevention Program
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20. Case Study: Establish Fall
Prevention Plan
 Consistent use of ID bracelets based on Fall
Risk Assessment score
 Implementation of bed alarms
 Staff education (e.g., toileting at-risk patients
routinely)
 Change of environment (e.g., vertical grab
bars)
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21. Case Study: Evaluate Change
 Change in incidence of falls (e.g., through
incident reports, sentinel event monitoring)
 Root cause analysis
 Staff compliance with Fall Prevention Plan
 Patient/family satisfaction with plan
 Reliability and validity of Fall Risk
Assessment tool
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22. Case Study: Ensuring Standards of
Care for Fall Prevention
 Nurse practice acts
 Professional organization guidelines
 Institutional guidelines (e.g., policies and
procedures, structure/process standards)
 Research/evidence-based practice guidelines
 Accreditation standards (e.g., TJC National
Patient Safety Goals)
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23. Questions to Consider
 How can a staff nurse make effective
suggestions to improve nursing practice?
 How can a culture of assigning blame for
errors be transformed into an environment
invested in improving patient care?
 How can patients’ expectations be used to
improve nursing care and promote optimal
outcomes?
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