Quality assurance

1. TEACHING ON
QUALITY ASSURANCE

2. INTRODUCTION
Florence nightingale introduced the concept of
quality in nursing care in 1855 while attending the
soldiers in the hospital during the crimean war.

3. INTRODUCTION
In health care quality is being demanded and expected
and providers are judged by the quality of services and
hence there is a need to sensitize and train nursing
personnel to provide quality care.

4. DEFINITION OF QUALITY
Quality is defined as the extent of resemblance
between the purpose of healthcare and the truly granted
care.
- Donabedian 1986

5. CONTINUED…
In an economic dimension quality is the extent of
accomplished relief case with a justified use of
means and services.
-Williamson 1999

6. CONCEPT OF QUALITY
ASSURANCE
Quality assurance is a dynamic process through
which nurses assume accountability for quality of
care they provide.

7. CONTINUED…
It is a gurantee to the society that
members of profession are regulating
services provided by nurses.

8. DEFINITION OF QUALITY
ASSURANCE
Quality assurance is a judgement concerning the
process of care, based on the extent to which that
cares contributes to valued outcomes.
-Donabedian 1982

9. CONTINUED…
Quality assurance is the monitoring of the activities
of client care to determine the degree of excellence
attained to the implementation of the activities.
-Bull 1985

10. PROCESS OF QUALITY
ASSURANCE
SET
STANDARD
APPRAISE
PLAN
ACT

11. PROCESS OF QUALITY
ASSURANCE
1. Setting standards:
Setting standards involve writing statements that
describe achievable and desirable levels of quality of care
. these are professional expectation of the service and
statement of intent to clients.

12. CONTINUED…
2. Appraising actual achievement:
Appraising actual achievement involves comparing
practice with the defined standards through
measurement criteria.

13. CONTINUED…
3. Plan:
Planning for improvement is necessary when after
appraisal any gap between provision and
expectation is identified.

14. CONTINUED…
4. Taking action when required:
If quality of care is below the stated accepted level,
the action is taken to raise quality until standards are
met.

15. STEPS IN DEVELOPING QUALITY
ASSURANCE IN HOSPITAL
Approval of quality assurance program.
Task force or committeee to be appointed.

16. CONTINUED…
 Orientation program to be arranged for the committee member to
familiarize with the purpose, principles , methods, etc.
 Examine the belief and behaviour concerning quality control through
workshop.

17. CONTINUED…
 Explore the difference in nursing value through open
confrontation.
Identify institutional supports and constraints within
measuring and improving nursing quality.

18. BENEFICIARIES OF QUALITY
ASSURANCE PROGRAM
The recipients of care who receive safe effective
satisfying services.
The care providers because evaluation offers
opportunity to promote personal and professional
growth.

19. CONTINUED…
 The agencies- which obtain data for planning, cost
containment and legal protection.
 The profession-quality assurance program promotes
development of standards and protocol and generations of new
knowledge.

20. MODELS OF QUALITY
ASSURANCE
Philosophy:
Indian nursing council believes that nurse will:
Do good for person/receiver of care, do not harm, maintain
respect for life and human dignity, believe in human justice and
fairness to individuals in terms of access to resources and care
and protect the vulnerable

21. CONTINUED…
Have moral obligation to provide services as per
the prescribed of the regulatory body/ health care
system/institution even if it is in conflict with her
personal beliefs and values.

22. CONTINUED….
Be responsible and accountable for providing quality care
in line with set standards
Be committed to understanding of dynamic nature of
his/her role in interdisciplinary health team

23. CONTINUED…
Have obligation to promote education of self and
others
Be commited to advancement of profession

24. PURPOSE OF QUALITY
ASSURANCE MODEL
To ensure quality nursing care provided by nurses in order
to meet the expectations of the receiver, management and
regulatory bodies.

25. CONTINUED…
It also intends to increase the commitment of the
provider and the management

26. GOALS OF QUALITY
ASSURANCE MODEL
 Develop confidence of the receiver that quality care is being rendered as per
assurance.
 Develop commitment of the management towards quality care.
 Increase commitment of providers to adhere to set standards for nursing
practice and strive for excellence.

27. CONTINUED…
Strengthen documentation of nursing care.
Promote optimum utilization of resources in
providing cost effective nursing care.

28. A SY STEM MODEL FOR
IMPLEMENTATION OF UNIT BASED
QUALITY ASSURANCE
The implementations of the unit based quality assurance
program, like that of any other program, and involve
making changes in organizational structure and individual
roles.

29. CONTINUED…
One method of facilitating and structuring the
change process is the system approach in which the
task is broken down into manageable components
based on defined objectives.

30. CONTINUED….
The basic components of the system are:
1. Input
2. Throughput
3. Output
4. Feedback

31. CONTINUED…
 The input can be compared to the present state of systems,
the throughput to the developmental process and output to
the finished product. The feedback is the essential component
of the system because it maintains and nourishes the growth.

32. AMERICAN NURSES
ASSOCIATION MODEL
 The ana has developed qa model in 1977 which has wide
spread applicability in any healthcare setting and can be used
as guide to implement qa program.
 The first step in developing qa program is continuing
education.

33. CONTINUED….
 The basic components of the ana model are summarized as follows:
1. Identify values
2. Identify structure, process and outcome standards and criteria
3. Select measurement
4. Make interpretation

34. CONTINUED
5. Identify course of action
6. Choose action
7. Take action
8. Reevaluate

35. CONTINUED….
1. Identify values:
In the ana value identification looks as such issue as
client, philosophy, needs, rights from an economic , social,
psychology and spiritual perspectives.

36. CONTINUED…
2.Identify structure, process and outcome
standards and criteria:
Identification of standards and quality assurance
begins with writing of philosophy and objective of
organization.

37. CONTINUED…
3. Select measurement:
Measurement are those tools used to gather information or
data, determined by the selections of standards and criteria.

38. CONTINUED…
4. Make interpretations:
The degree to which the predetermined criteria are
met is the basis for interpretation about the
strengths and weaknesses of the program.

39. CONTINUED….
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
situations.

40. CONTINUED…
6. Choose action:
Usually various alternative course are available to remedy a
deficiency. Thus it is vital to weigh the pros and cons of each
alternative while considering the environmental context and
availability of resources.

41. CONTINUED…
7. Take action:
It is important to firmly establish accountability for the
action to be taken. It is essential to answer the questions of
who will do?What?By when?It concludes with the actual
implementation of the proposed courses of action.

42. CONTINUED…
8. Reevaluate:
The final step of qa process involves an evaluation
of the results of the action.

43. FACTORS AFFECTING
QUALITY ASSURANCE
Lack of resources-infrastructure, equipment
Personnel problems-lack of trained, skilled and
motivated employee, indiscipline etc.

44. CONTINUED…
 Improper maintenance-leakage of roofs, cleaning of bathrooms etc.
 Lack of good hospital information system-
 Workload, statistics, admission,bed occupancy, length of stay
 Activity, audit scheduling of procedure.

45. CONTINUED…
Absence of conducting patient satisfaction survey-
Delay in attendance by doctors, nurses
Lack of amenities
Incident of incorrect treatment

46. CONTINUED…
Lack of nursing care records-
Detail of patient’s condition
Document all significant interaction between
patient and the nursing personnel

47. CONTINUED…
 Miscellaneous factors-
 Lack of good supervision
 Lack of policy and administrative manuals
 Lack of procedure manuals
 Substandard education and training
 Inadequate quality and number of professionals

48. CONTINUED…
 Lack of coordination between and within department
 Lack of evaluation technique
 Lack of written job description and specification
 Lack of in-service and continuing education

49. SUMMARIZATION
 Today i have discussed about quality assurance-
 Introduction
 Concept
 Definition
 Process
 Steps
 Models
 Factors

50. RECAPTULIZATION
1.What do you mean by quality assurance?
2.What is the process of quality assurance?
3.What are the various models of quality assurance?
4.What are the components of ana quality assurance model?
5.What are the various factors affecting quality assurance?

51. BIBLIOGRAPHY
 Kaur sukhbir.Kaur jagjit.Textbook of nursing management and services.1st edition. New
delhi.JAYPEE PUBLISHER;2013: pp: 144-151
 Cherry barbara. Jacob r.Susan.Contemporary nursing issues, trends & management.2nd
edition.Usa.Mosby;2002:pp:459
 Vati jogindra.Principles & practice of nursing management & administration.1st
edition.NEW DELHI:JAYPEE publisher;2013:pp:96-103
 Jooste karein.Leadership in health services management.3rd edition.Lansdowne:the republic
of south africa;2008:pp:263