This document outlines the steps for developing quality standards for clinical and managerial functions of healthcare services. It begins by having organizations identify high-volume, high-risk, or problem-prone functions that would benefit from quality standards. As an example, it identifies immunization services. The next steps are to identify the inputs, processes, and outcomes of the selected function, and then define quality characteristics for key elements. Finally, standards are developed by writing statements, guidelines, algorithms, or pathways to clearly define the quality characteristics. The document provides examples of applying these steps to develop quality standards for immunization services.
Quality Process And Procedures PowerPoint Presentation Slide SlideTeam
Use quality process and procedures PowerPoint presentation to eliminate the waste and increase the efficiency to meet the customers’ requirements. With the assistance of this quality improvement PPT presentation, you will be able to implement a quality control process, boost the quality of your products and deliver high-quality products to the consumers. This professionally designed quality assurance process presentation PPT makes sure that the organization must reach the optimal quality levels. This content ready quality management PowerPoint presentation covers a template on TQM pyramid, TQM model, customer focus in TQM, planning process, process management, business process improvement, involvement of people, TQM elements, determinants of product quality and service quality, importance of good quality, consequences of poor quality, principles and certification, TQM principles, ISO certificate, quality management tools, and root cause analysis. Use these quality improvement presentation slides to support your organization tasks while distinguishing the problems or challenges impacting your organization capacities effectively. You can highlight the concept of quality improvement, quality management, quality assurance using these quality process and procedures PPT slides. Rough design can kill even the best planned presentation. Our Quality Process And Procedures PowerPoint Presentation Slide will lend your projects world class design.
Quality assurance is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services to customers; which ISO 9000 defines as "part of quality management focused on providing confidence that quality requirements will be fulfilled".
Quality Process And Procedures PowerPoint Presentation Slide SlideTeam
Use quality process and procedures PowerPoint presentation to eliminate the waste and increase the efficiency to meet the customers’ requirements. With the assistance of this quality improvement PPT presentation, you will be able to implement a quality control process, boost the quality of your products and deliver high-quality products to the consumers. This professionally designed quality assurance process presentation PPT makes sure that the organization must reach the optimal quality levels. This content ready quality management PowerPoint presentation covers a template on TQM pyramid, TQM model, customer focus in TQM, planning process, process management, business process improvement, involvement of people, TQM elements, determinants of product quality and service quality, importance of good quality, consequences of poor quality, principles and certification, TQM principles, ISO certificate, quality management tools, and root cause analysis. Use these quality improvement presentation slides to support your organization tasks while distinguishing the problems or challenges impacting your organization capacities effectively. You can highlight the concept of quality improvement, quality management, quality assurance using these quality process and procedures PPT slides. Rough design can kill even the best planned presentation. Our Quality Process And Procedures PowerPoint Presentation Slide will lend your projects world class design.
Quality assurance is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services to customers; which ISO 9000 defines as "part of quality management focused on providing confidence that quality requirements will be fulfilled".
GOTS and Okeo-Tex are most widely used certified standards for quality product and processing of production to finished products of textiles.
The principle is production of textile products with in green environment and use of natural raw material as input and reduce environmental pollution.
quality assurance slides include components, models, approaches, cycle of quality assurance is included in the slides.
the slide gives a brief ides regarding all the points and gives a comprehensive picture of the topic.
SO 9001:2015 requires to address the risks and opportunities in each process of the QMS.
The principal questions of risk management are:
- Key Risks Wording and
- Risk Treatment Areas
Examples for 'Management Review', 'Technical
Maintenance', and 'Control of Personnel' processes.
Use in ISO 9001:2015 Internal auditors and personnel training.
This lesson will help the nursing students to learn and know the nursing records and reports and responsibility of the nurse in maintaining nursing records and reports in various health settings.
NURSING MANAGEMENT AND EDUCATION
INVENTORY CONTROL AND PROCUREMENT OF HOSPITAL SUPPLIES, THEIR MAINTENANCE AND KEEPING THE STOCK UP TO DATE IS ONE OF THE BASIC DUTIES OF A NURSE. KNOWING ABOUT THE PRINCIPLES AND TECHNIQUES HELPS IN EFFECTIVE MANAGEMENT OF HOSPITAL SUPPLIES AND EQUIPMENT IN THE WARD.
Quality Definition by Joseph Juran, Philip Crosby, William Stevenson, David Bentley, Characteristics of Quality, Performance,Features, Reliability, Conformance, Durability, Serviceability, Aesthetics, Perceived Quality, Quality Control, Statistical Quality control (SQC), Sampling Inspection, Consumer’s Risk, Producer’s risk,
GOTS and Okeo-Tex are most widely used certified standards for quality product and processing of production to finished products of textiles.
The principle is production of textile products with in green environment and use of natural raw material as input and reduce environmental pollution.
quality assurance slides include components, models, approaches, cycle of quality assurance is included in the slides.
the slide gives a brief ides regarding all the points and gives a comprehensive picture of the topic.
SO 9001:2015 requires to address the risks and opportunities in each process of the QMS.
The principal questions of risk management are:
- Key Risks Wording and
- Risk Treatment Areas
Examples for 'Management Review', 'Technical
Maintenance', and 'Control of Personnel' processes.
Use in ISO 9001:2015 Internal auditors and personnel training.
This lesson will help the nursing students to learn and know the nursing records and reports and responsibility of the nurse in maintaining nursing records and reports in various health settings.
NURSING MANAGEMENT AND EDUCATION
INVENTORY CONTROL AND PROCUREMENT OF HOSPITAL SUPPLIES, THEIR MAINTENANCE AND KEEPING THE STOCK UP TO DATE IS ONE OF THE BASIC DUTIES OF A NURSE. KNOWING ABOUT THE PRINCIPLES AND TECHNIQUES HELPS IN EFFECTIVE MANAGEMENT OF HOSPITAL SUPPLIES AND EQUIPMENT IN THE WARD.
Quality Definition by Joseph Juran, Philip Crosby, William Stevenson, David Bentley, Characteristics of Quality, Performance,Features, Reliability, Conformance, Durability, Serviceability, Aesthetics, Perceived Quality, Quality Control, Statistical Quality control (SQC), Sampling Inspection, Consumer’s Risk, Producer’s risk,
Why quality management teams are the key to sellingEquiteq
It’s often said buyers buy management teams first and consulting firms second but what does that actually mean?
There’s about a 50% chance your firm will break the $4m barrier and only 1 in 20 that it will get north of $10m, which is when the bigger trade buyers start to get interested. So what are the management teams who successfully scale their firms doing that the others aren’t? How do you get the right mix of skills on the team? When and how should you share equity? Join us for the last in our series to hear about the secrets to growth so that when you exit your firm you get the best possible price.
These standards are guidelines on how to document the processes in specific industries. The goal is consistency and a set of complete, easy to follow instructions. ISO 9000 is a set of five guideline standards that define the requirements for an effective quality management system.
A NURSE IS A…..
Patient care consultant
Educator
Manager
Recruiter
Therapist
Researcher
Administrator
Case manager
The list goes on…
A simple definition
FIVE RIGHTS
THE RIGHT PATIENT,
AT THE RIGHT TIME,
IN THE RIGHT SETTING,
RECEING THE RIGHT CARE
AT THE RIGHTTIME
IN THE RIGHTCOST.
Quality assurance
“Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities”. (Bull, 1985)
Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).
QA in nursing comprise of set of related elements such as
planning for quality,
development of objectives setting and
actively communicating standards,
developing indicators,
setting thresholds,
collecting data to monitor compliance with set standards for nursing practice
and applying solutions to improve care
UALITY ASSURANCE PROCESS:
Establishment of standards or criteria
Identify the information relevant to criteria
Determine ways to collect information
Collect and analyze the information
Compare collected information with established criteria
Make a judgment about quality
Provide information and if necessary, take corrective action regarding findings of appropriate sources
Determine ways to communicate the information
1) Credentialing:
2) Licensure:
3) Accreditation:
3)CERTIFICATION
1) Credentialing
It is the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency. According to Hinsvark (1981) credentialing process has four functional components
a) To produce a quality product
b) To confer a unique identity
c) To protect provider and public
d) To control the profession.
2) Licensure
Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice. The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.
3) Accreditation:
The indian nursing council has established standards for inspecting nursing education’s programs in india(NLN-US). In the part the accreditation process primarily evaluated on agency’s physical structure, organizational structure and personal qualification
4. Certification
Certification is usually a voluntary process with in the profession. A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.
A nursing care standard
is a descriptive statement of desired quality against which to evaluate nursing care.
It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.
A NURSE IS A…..
Patient care consultant
Educator
Manager
Recruiter
Therapist
Researcher
Administrator
Case manager
The list goes on…
A simple definition
FIVE RIGHTS
THE RIGHT PATIENT,
AT THE RIGHT TIME,
IN THE RIGHT SETTING,
RECEING THE RIGHT CARE
AT THE RIGHTTIME
IN THE RIGHTCOST.
Quality assurance
“Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities”. (Bull, 1985)
Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).
QA in nursing comprise of set of related elements such as
planning for quality,
development of objectives setting and
actively communicating standards,
developing indicators,
setting thresholds,
collecting data to monitor compliance with set standards for nursing practice
and applying solutions to improve care
UALITY ASSURANCE PROCESS:
Establishment of standards or criteria
Identify the information relevant to criteria
Determine ways to collect information
Collect and analyze the information
Compare collected information with established criteria
Make a judgment about quality
Provide information and if necessary, take corrective action regarding findings of appropriate sources
Determine ways to communicate the information
1) Credentialing:
2) Licensure:
3) Accreditation:
3)CERTIFICATION
1) Credentialing
It is the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency. According to Hinsvark (1981) credentialing process has four functional components
a) To produce a quality product
b) To confer a unique identity
c) To protect provider and public
d) To control the profession.
2) Licensure
Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice. The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.
3) Accreditation:
The indian nursing council has established standards for inspecting nursing education’s programs in india(NLN-US). In the part the accreditation process primarily evaluated on agency’s physical structure, organizational structure and personal qualification
4. Certification
Certification is usually a voluntary process with in the profession. A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.
A nursing care standard
is a descriptive statement of desired quality against which to evaluate nursing care.
It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
IntroductionThe American Nursing Association (ANA) establish.docxbagotjesusa
Introduction
The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.
NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.
The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove, Gray, Jay, Jay, & Burns, 2015).
Nurses needs to be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.
The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.
Reference
Grove, S. K., Gray, J. R., Jay, G.W., Jay, H. M., & Burns, N. (2015).
Understanding nursing research: Building an evidence-based practice
(6th ed.). St. Louis, MO: Elsevier.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
Explain how a health care organization uses nursing-sensitive quality indicators to e.
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
1. Step 1 : Identify a Function of Service
It is of critical importance that the organizations identify
clinical and managerial function for a service(s)/system that
would require standards. For example
•Acute Respiratory Infection (ARI) case management
•Management of diarrhoea
•Immunization Services
•Family planning services
•Antenatal Care
•Emergency Obstetric Care: Performance of Caesarian
sections
2.
3. Contt…
•Newborn Care
•Non-clinical functions such as record maintenance, admissions,
logistics and supply, etc.
Prioritize which of these functions and services are performed
in high volume, and/or associated with high risk and/or
problem prone
High Volume (HV) functions are the functions that are
performed frequently or affect large number of people
High Risk (HR) functions are the functions that expose the
client to a greater risk of adverse outcomes due to nature of
disease or management process.
4. Contt…
Problem Prone (PP) functions are the functions that have
produced problems for the client of the organization in the past
The organization identify and list all functions that meet one or
more criteria described above. The focus of this process is to
identify functions that need improvement to improve quality of
services in terms of output or outcome
Some additional criteria for deciding priorities for selection of
functions for Quality Assurance, are as follows:
5. Contt…
Importance of function
Ability to implement the
process
Impact
Economic feasibility
More significance than other
functions
The organization or its
personnel can implement the
changes in the inputs and
processes
The function that produces
maximum effect
Budget availability and
financial constraints
6. Example : Step 1
Let us take example of Immunization services for children.
We want to improve quality of immunization services. It is a
high volume function and also associated with high risk of
deaths due to vaccine preventable diseases among children.
If we review the additional criteria for choosing services /
function, you will find that it is a very significant function in
the health system; it is implementable and has a high impact
on health status of children. Further it is also a cost-effective
intervention.
7. Step 2: Identify Inputs, Process and Outcomes
The next step is to identify the Inputs, Processes and
Outcomes for the function or services chosen for Quality
Assurance. To do this,
•Constitute a team or panel of experts
•Identify and list elements of Inputs, Processes and Outcomes
•Identify critical elements/activities that have impact on quality
8. Example: Step 2
In Step 1, we have selected immunization services for Quality
Assurance. Let us identify elements in Inputs, Process and
Outcomes.
INPUTS
Staff
Vaccines
Equipment
(Vaccine carrier, Ice packs Syringes/needles, Sterilizer)
Electricity
Records
IEC material
11. Step 3: Define Quality Characteristics
After Step 2, the next important step is to identify quality
characteristics for each of the element in inputs, process and
outcomes as identified. To accomplish this;
•Review all the elements for inputs, process and outcomes
for the function or service.
•Choose the key elements that are essential to achieve the
desired outcomes of the function or service;
•List the quality characteristics for the key elements and
define them appropriately
12. Example : Step 3
Once the elements in Inputs, Process and Outcomes are
Identified, the next step is to identify and define quality
characteristics for each of the element. One may decide to
choose key elements and define quality characteristics for
the selected key element(s).
16. Step 4: Develop Standards
It is important that the standards are clearly written and
documented. Writing standards is a specialist job and requires
basic skills in written communication. However, the ground rules
for writing standards are that the standards should be written in
the form of statement and in third person. To write standards;
Statement We can write standards in the form of statement.
Generally, the input and outcome standards are written in the
statement format.
Guidelines Process standards are generally described as Clinical
Protocols or Practice Guidelines to perform particular clinical
tasks or technical procedures.
17. Contt…
Algorithms Process standards may be written in the form of
Algorithm describing steps. It may be done in a graphic from
outlining the process step by step and flowcharts with directions
and decision options.
Pathways This is another way to standardize the process.
Pathways are used to describing optimal sequencing and timing
for diagnosis or procedure, to be followed by the health care
provider.
18. Gather background information
Before drafting the standards, it is necessary to collection
available information on standards and their formats used
elsewhere. For example WHO has developed Guidelines and
Manuals for various services and programs. Similarly various
National Governments have developed manuals to standardize
the process of service delivery and provide care.
The information can be gathered by literature review,
discussions and consultation with experts , benchmark used
elsewhere and review past experiences of implementation of
Quality Assurance.
19. Draft the Standard
After a review and consultation, draft the standard. Share the
draft with the group of experts, health care administrators and
providers.
20. Example : Step 4
Elements Quality
Characteristics
Standards
INPUTS
Staff
Vaccines
Equipment
(Vaccine carrier, Ice
packs
Syringes/needles,
sterilizer
Competent and
available
Safety and
availability of
vaccine in
adequate quantity
Available and
functional
All staff trained in technical
and Interpersonal
Communication
ALL PHC/CHC have all
the vaccines in stock for
next two months which is
potent (within expire date)
All the health facilities have
functional could chain
equipment all the time as
per RCH Guidelines
21. Contt…
Elements Quality
Characteristics
Standards
INPUTS
Records Completeness and
Availability
Records of all children are
available and complete
PROCESS
Planning of
immunization
passions
Vaccine
transportation and
maintenance
All areas to be
covered with day
and time
Safety and
potency
All villages are covered in
the immunization pain with
day and time
All vaccines transported at
optimal temperature
23. Contt…
Elements Quality
Characteristics
Standards
OUTCOMES
Access and
availability
VPD Morbidity
Coverage
The immunization
facilities are
accessible and
available with
ease
Reduction in
deaths due to VPD
High coverage
All health facilities have
immunization facilities
within 3km distance
Measles deaths reduced by
50% from the existing
levels
All children<1 year of age
are fully immunized
24. Step 5: Assess Appropriateness of Standards
Determine whether the standards are appropriate for the
organisation. The persons working in the orgtanisation,
especially the health managers and health care providers must
be consulted and asked whether the given standards are
workable, relevant and convergent with the goals and
objectives of the organisation. Their feedback must be
analysed and shared before finalizing standards.
25. Contt…
Asses validity of standards
Whether the given standards have relationship with the
expected change in the results or outcomes. Is there any
empirical evidence of relationship between the changed
outcome and the intervention?
Assess reliability
It refers to repeatability and reproducibility. The reliability
of standard would be judged by observations whether the
same results are obtained using the same standard every-time
26. Contt…
Assess standards for clarity
Clarity refers to whether the health managers and providers are
able interpret the meaning in the same way and without
ambiguity. It is important the every one explains and draws the
same meaning of the standard.
Assess whether realistic and applicable
It is doable and achievable with given resources and technology?
The standards should be applicable in the given circumstances.
Setting up high and unrealistic standards may prove to counter
productive in the system.
27. Communicate Standards
Standards are developed to improve the quality through change
in input and process at the level of health care delivery.
Therefore, it is of great importance that those who are
responsible for providing services are informed about the
standards. Communication is a vital link between development
of standard and application of standard.
How can we communicate standards? There are various
methods and approaches for communication. The health
managers need to develop a communication plan, clearly
identify the groups who need to be communicated, media
choices and source of communication, and methods. In general,
following methods be used to communicate standards.
28. Contt…
•Use of Job Aids
•Check-lists for inputs and process for chosen priority services
or functions
•Workshops and Review meetings
•Office circulars detailing the administrative and clinical
procedures
•Manuals and Guidelines
•On the job Training and Supervision
29. Exercise
You have gone through the most crucial step in the Quality Assurance
Cycle with your instructor, I.e. SETTING STANDARDS. Let attempt
to develop standards for functions/services in you own organisation.
1. Enlist functions that your organistion undertakes or services that are
provided.
2. Select and prioritize services for which you want to improve quality
Develop a Matrix HV, HR and PP for each function (You may also use
additional criteria for prioritization)
3. Identify Inputs. Processes and Outcomes and elements for each of
them.
4. Identify Key Elements that would require standards.
5. Define quality characteristics for each of the key element in Inputs.
Processes and Outcomes.
6. Write Standards for quality characteristics for each key Element.
30. INSTRUCTIONS
Identify KEY ELEMENTS in INPUT, PROCESS and
OUTCOMES for the selected function or service in your
organisation, as a first step. Share and discuss this with the
Instructor and Group Members.
Next, define quality characteristics for each Key Element
in consultation with your Group Members.
Choose format and write standards for each Key Element
keeping view quality characteristic(s)
Present the entire Matrix to the Group and discuss.