Quality management in healthcare aims to minimize harm and optimize patient outcomes through administration of systems, policies, and processes. It involves continuous improvement efforts to meet expectations of customers (patients and providers), increase effectiveness and efficiency of care, and fulfill ethical obligations. Common models for quality management include the Joint Commission's 10-step process of planning, implementing, evaluating and improving care, and the PDCA (Plan-Do-Check-Act) cycle of establishing objectives, implementing plans, monitoring results, and applying lessons learned.

1. NURSING ADMINISTRATION AND WARD MANAGEMENT
QUALITY MANAGEMENT

2. DEFINITION
The quality is defined as ‘the degree to which the patient care services
increase the probability of desired outcomes and reduce the probability
of undesired outcomes given the current state of knowledge.’ —Joint
Commission for Accreditation of Health Care Organization
“Quality is the degree to which care services influence the probability of
optimal patient outcomes” —American Medical Association, 1991

3. QUALITY MANAGEMENT
 It is defined as “the process by which people are mobilized to achieve
quality goals”. Quality management becomes the umbrella under
which all processes and activities related to quality fall.
 In healthcare, quality management refers to the administration of
systems design, policies, and processes that minimize, if not
eliminate, harm while optimizing patient care and outcomes.

4. PURPOSES OF QUALITY MANAGEMENT
 To meet the needs and expectation of the customers, both external
and internal
 To meet increased demand for effective and appropriate care
 To minimize the errors and further eliminated to attain excellence in
care
 To bring improvement in care and services
 To bring efficiency in the use of health care resources and
effectiveness in the delivery of care and services

5.  To reduce the failure and appraisal costs
 Foe accreditation, certification and regulation
 To fulfill the ethical code to provide the best and most appropriate care
accessible to the patient
 To fulfill the desire for recognition and to strive for excellence
 To attract recognition in the field and will encourage other individual,
organizations or systems to emulate and follow.

6. Quality Assurance (QA)
 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. —Marker 1998
 “Quality assurance is the process for evaluating patient care in a
particular setting by developing standards of care and implementing
mechanisms for ensuring that the standards are met”. —Coyne C,
Killien M.
 According to the Joint Commission, QA was initially defined as: “The
process for objectively and systematically monitoring and evaluating
the quality and appropriateness of patient care, and for resolving
identified problems.”

7. Quality Control
It is defined as “the process by which actual performance is measure,
the performance is compared with goals, and the difference is acted
upon. The statistical methods are used to measure the quality.
Quality Improvement
The process or processes of reducing variance is quality improvement.
It is the process of attaining a new level of performance or quality that is
superior to any previous level of quality.

8. Tools of Quality Improvement
 Flowchart
A flow chart is a pictorial representation of the steps in a process. It is a
cornerstone of an analysis by clarifying the process and identifying
inefficiencies.

9.  Fishbone Diagram: This is also known as a cause-and-effect diagram.
This diagram identifies the variety of factors affecting a specific
problem. Diagonal lines are drawn off the main line depicting major
categories of causes associated with the effect.

10.  Histogram: A histogram is a graph of frequency distribution of a set of
data. It is useful in data analysis phase of quality improvement. It
provides a visual summary of the data.

11. CONTINUOUS QUALITY IMPROVEMENT(CQI)
It involves a coordinated and integrated approach for improving
processes that affect patient outcome. Performance management has
replaced later CQI. This term is specific. It encompasses three critical
programs:
a) Awareness
b) Measurement and
c) Improvement

12. Total Quality Management (TQM). TQM is an “integrated process
involving all systems and employees in a continuous effort to improve
quality, reduce cost, and enhance service to customer.”
In the health sector, it is considered more organized, a coordinated and
integrated approach to manage/improve processes that affect patient
outcomes. It is an organized and integrated system of continuous quality
improvement (CQI) aimed at meeting customers’ expectations.

13. Key Principles of TQM
The principles of TQM are focused on work processes, customer
orientation, and statistical data analysis are as follows:
• Management accountability
• Teamwork
• Continuous improvements

14. QUALITY MANAGEMENT MODELS
Joint Commission 10 – Step Process Model
This model includes 10 steps for quality assessment/ assurance and
quality management/ quality improvement. These steps provide a
systematic methodology for quality management. This model is used for
monitoring and evaluation of services. The steps are as follows:
1. Assign responsibilities
2. Delineate scope of care /service
3. Prioritize aspects of care/service.
4. Establish indicators for identified Projects

15. 5. Establish thresholds for evaluation based on customer expectations
6. Collect and analyze data
7. Evaluate effectiveness of care and document the level of
improvement
8. Determine and implement appropriate actions
9. Evaluate effectiveness of action and document the level of
improvement
10. Communicate results
11. Continuous monitoring/ improving on the process

16.  FOCUS – PDCA MODEL ‘Find. Organize, Clarify, Understand,
Select, Plan, Do, Check, Act’ Model was devised in 1930, has the
following concepts:
• Find a process to improve
• Organize a team that knows the process
• Clarify current knowledge of process
• Understand causes of variation PDCA (Plan-Do-Check-Act) is a four-
step problem-solving process. It is used in quality control. It is also
known as the Shewhart Cycle, Deming Cycle, Deming Wheel, or Plan-
DoStudy-Act

17.  Plan: Establish the objectives and processes necessary to deliver
results in accordance with the specifications.
 Do: Implement the processes.
 Check: Monitor and evaluate the processes and results against
objectives and specifications and report the outcome.
 Act: Apply actions to the outcome for necessary improvement.
Dr W. Edwards Deming, later modified PDCA Plan, Do, Study, and Act
(PDSA) so as to better describe his recommendations. In six- sigma,
PDSA cycle is called ‘Define, Measure, Analyze, Improve, and Control’
(DMAIC).

19. American Nurses’ Association (ANA) Model
 This model is given by Long & Black in 1975. This is a cyclic model. It
helps in self-determination of patient, and family, nursing health
orientation, patients’ rights to quality care and nursing contributions.
The basic components of the ANA model can be summarized as
follows:

20. 1. Identify value: In the ANA value identification looks as such issue as
patient/client, philosophy, needs and rights from an economic, social,
psychology and spiritual perspective and values philosophy of the health
care organization and the provider of nursing services.
2. Identify structure, process and outcome standards and criteria:
 Identification of standards and criteria for quality assurance begins with
writing of philosophy and objectives of organization.
 The philosophy and objectives of an agency serves to define the structural
standards of the agency.
 Standards of structure are defined by licensing or accrediting agency.

21. 3. Select measurement needed to determine degree of attainment of
criteria and standards:
 Measurements are those tools used to gather information or data,
determined by the selections of standards and criteria.
 The approaches and techniques used to evaluate structural standards
and criteria are, nursing audit, utilization’s reviews, and review of
agency documents, self-studies and review of physicals facilities.
4. Make interpretations: The degree to which the predetermined criteria
are met is the basis for interpolation about the strengths and
weaknesses of the program.

22. 5. Identify course of action:
 If the compliance level is above the normal or the expected level,
there is great value in conveying positive feedback and reinforcement.
 If the compliance level is below the expected level, it is essential to
improve the situations.
 It is necessary to identify the cause of deficiency. Then, it is important
to identify various solutions to the problems.

23. 6. Choose action:
In the recent that more than one cause of the deficiency has been
identified; action may be needed to deal with each contributing factor.
7. Take action: It is important to firmly establish accountability for the
action to be taken. This step concludes with the actual implementation
of the proposed courses of action.
8. Revaluation: The final step of QA process involves an evaluation of
the results of the action. The reassessment is accomplishment in the
say same way as the original assessment and begins the QA cycle
again.