What is quality control?
management process. Performance is measured against predetermined standards and action is taken to correct discrepancies d/t standards of actual performance
quality management
refers to “philosophy” of health care culture that emphasizes customer satisfaction, innovation and employee involvement.
Quality improvement
ongoing “process” of innervation, prevention of error and staff development that is used by institutions that adopt quality management philosophy
- -circular appraisal and goal setting
- CNDN gov very involved
Benefits of quality management: 3
- greater efficiency and proactive planning
- increases PT safety with quality care
- enhanced job satisfaction
what is the main cause of medical errors?
poor processes.
Principles of quality improvement: 6
- a PT focus- address needs of PTs and staff.
- Identification of key processes to improve quality- (all activities in an org are a process). multidisc, investigate departments to improve performance.
- Use of quality tools and statistics to support improvements- rqrs tools and stats to measure improvement.
- Involvement of the HCT in problem solving
- Committed leadership
- Long term commitment
Quality control as a process: 3
- . The criteria or standard must be determined- managers know and understand the standard. Staff are aware that their performance will be measured for ability to meet standard.
- Info is collected to see if standard has been met- data analyzed and interpreted, then deficiencies identified and corrected.
- Action must be taken if criteria is unmet- (nurses) develop new knowledge and apply it to support improvement efforts
Quality improvement requires: 3
- structure
- process
- outcome
Standards for Benchmarking:3
measuring… audits
- structure audits- focus on internal characteristics of an organization and personnel. Environment to ensure quality and resources. any environments concerns. MSA has silver fish in the walls.
- Process audit- focuses on whether the activities are being conducted appropriately. delivery of care. CRNBC standards are process standards. How are you going to take a PT for an xray who is on isolation
- Outcome audit- whether the services nurses provided makes a difference. services and PT perception of care. measure effective quality and time allocated for care.
when something bad happens, how could it have been prevented?
Benchmarking:
the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers.
study will identify gaps in performance and provide options for selecting work processes to improve, ideas for redesign of care delivery and ideas for better ways to meet pt expectation’s
who is involved in quality control? 3
- organization; everyone
- Canadian Gov
- CRNBC
Canadian Patient Safety Institute: 4
- Has coordinating and leadership role across health care sectors and systems
- Promotes leading practices and raises awareness of patient safety
- Not-for-profit organization
- Inspires improvement in patient safety and quality by developing evidence-informed practices
Quality Assurance (QA): 3
- This is a method used to monitor health care.
- It focuses on clinical aspects of provider care.
- Many activities focus on standards.
Standards of practice:
Standards of practice define the scope and dimensions of professional nursing. Standards have distinguished characteristics, they are predetermined, established by authority and communicated to and accepted by the people affected by them.
–They are objective, measurable and achievable.
- -focuses on the nurse as provider,
- is process oriented
- -relates to what is expected of the provider to achieve the standard of care
standards of care:
focuses on the patient, is outcome oriented and relates to what the patient can expect
Standardized Clinical Guidelines: 4
these indicators measure outcomes of nursing care:
- High risk ( med errors, complications, falls, refusal of treatment, patient dissatisfaction etc.)
- High volume- someone calls in sick
- High cost
- Problem prone
Profession: who monitors nurses performance?
Only nursing has the expertise to evaluate nursing performance and determine the quality of care from the providers’ perspective.
Solutions to quality improvement: 3.
- mandatory continuing education, improves competency. RN responsible for own development.
- Development and use of critical paths- map out expected care patterns and outcomes for pt care. Variance from the map triggers a review and analysis and alterations in the plan of care may result.
- Risk management- to prevent undesirable events from happening and minimize the impact of unpreventable risks. incident reports, audits…
Measures to implement if Standards are not met: 3
- report and re-mediation- key element in leadership is deciding what actions to take when something goes wrong. Report and re-mediate asap to protect PT
- Reporting mechanisms set up in the system need to be followed
- Incident report and documentation- be filled out and documentation and evidence of discharge of duty in a timely and thorough manner
Goal of QI: 3
- The goal of QI programs is not to assign blame
- It is the responsibility of all nurses and seeks to improve patient care at the minimal level.
- Working together to prevent problems is far more effective than correcting or dealing with problems after they occur
Implications for PT care:
1) must be measured by the value of care
2) value is a function of cost and quality outcomes together
3) outcomes include a PTs clinical or functional outcomes
4) the cost- direct and indirect PT care needs.
