Quality assurance in
health care
Quality Assurance system
• Is a range of activities including ( review, evaluation, surveillance,
appraisal and monitoring) which collectively comprise the intelligence
gathering arm of quality assurance.
• These are:
Quality: consists of doing those things necessary to meet and exceed
needs and expectations of those we serve and doing the right things in
the right time.
Review: is the process of critical reflection used by clinicians wishing to
assess their own(or their peers) performance
Audit: is the activity of review when conducted on a continuous and
routine basis.
Evaluation: is one-off assessment of the impact of service on indoces of
health
Surveillance: is a routinely repeated evaluation
Appraisal: is ad hoc data collection and analysis by management in
relation to health care delivery
Monitoring: is on going appraisal
What is quality assurance:
• It involves continuous monitoring, assessment, and improvement of
healthcare processes to minimize errors, prevent adverse events, and
optimize patient outcomes. QA aims to enhance patient satisfaction,
increase healthcare efficiency, and promote evidence-based
healthcare practices.
What is quality?
• Quality is not a number but is a function of positive perception.
• Quality simply means that a product should meet ones requirements
• Quality id the inherent characteristics and distinctive attribute that
makes a product different from others
• Ensure conformity to requirements
• Products and services should be essentially free from defects, thereby
becoming coast effective
• Quality consists of doing those things necessary to meet and exceed the
needs and expectations of those whom we serve and doing those right
thigs right every time
What is quality?
• It is the result of good intension, sincere effort, intelligent thinking
and skillful execution
• All dimensions like accessibility, appropriateness, continuity,
effectiveness and efficiency must be given equal importance in
quality.
Quality management
• It is a holistic approach to the art of managing quality out put
considering together the people, process and products rather then
independent factors and driven towards the objective with effective
and efficient performance output.
Quality Requirements:
• Customer participation in QM
• Leadership for the steering of quality
• Personnel as a prerequisite for high quality
• QM for preventive as well as other activities
• Management of processes as abasis for quality management
• Information as a basis for the continuous enhancement of quality
• Systematization of QM
• Feedback and detailed recommendations
• Quality criteria support quality management
Why Quality
• Rapid advance in health care sector
• Rapid development in diagnostic and operation technology
• Increased awareness of people about health
• Improved communication technology and roll of media
• Provided by a team of highly skilled to non skilled group of doctors,
nurses and other medical staff
• The type of function is multicentric and multifaceted.
• The overall objective is good patient care up to their level of
satisfaction
Different perceptions of quality:
• Provider
• Receiver
• Organizer
Perception of provider:
• To provide care as per established norms
• Doing the right thing in the right way at the right time at the first time
without exceeding cost
• Availability of adequate resources
• Satisfaction with final outcome
• Helps in improving skills, efficiency and experience
Receiver:
• Accessibility
• Affordability
• Prompt attention
• Less waiting time
• Receiving the right service
• Being satisfied that their needs have been met
• Early cure and return to normal life
• Being treated with integrity, courtesy and respect
Organizer:
• Social equity
• Effective public resource utilization
• standardized care
• Cost contentment
• Satisfaction of both provider and receiver
• Fruitful outcome
• Profit margin
Dimensions of quality
• Safety
• Efficacy
• Continuity
• Respect and caring
• Effectiveness
• Availability
• Timelines
• Efficiency
• Appropriateness and equality
Advantages of quality programs
• Reduction in wastage
• Better team spirit
• Less staff conflict, enhanced job
• Increased efficiency
• Confidence to clients
• Less customers complains
• lower rejection rates
• Improved care
• Shorter lead times
• Better relations with clients
• Reduced cost and increase profit
• Improved systems and standardized procedures
Quality requirements
• Customer participation in QM
• Leadership for the steering of quality
• Personnel as prerequisite for high quality
• QM for preventive as well as other activities
• Management of processes as basis for quality management
• Information as basis for the continuous enhancement of quality
• Systematization of QM
• Feedback and detailed recommendations
• Quality criteria support quality management
Parts of the quality system
• Organization.
• personnel.
• Equipment
• Purchasing and inventory
• Process control
• Information management
• Documentation and record
• Occurrence management
• Assessment
• Processes improvement
• Customer services
• facilities and safety
Hospital quality system
• Internal quality system:
includes organizational structure, safety, effectiveness, timelines,
patient focus, equity
• External quality system:
Includes hospital accreditation including ISO or other quality programs,
external medical audit
Quality system
• Quality does not happen by chance
• Quality needs to be systematically developed
• With objective planning, staff involvement and considering patients
needs
Developing quality system:
• Quality system adoption
• Quality manual
• Quality procedures
• Quality plan
• Quality audit
Quality management
• It is a holistic approach to the art of managing quality output
considering together the people, process and products rather than
independent factors and driven towards the objective with effective
and efficient performance output.
Components of quality management
system
• Quality planning
• Quality control
• Quality improvement
• Quality assurance
All these will lead to patient need satisfaction under total quality
management program
• Formulation of criteria and standards for each quality component will
lead to develop standards and criteria for evaluation of quality
• Quality managers are responsible for monitoring and updating
policies and procedures to include regulatory changes.
• Their role is to facilitate the implementation of all quality peogram.
Risk Management Programs
• Are problem-focused
• Identify, analyze, and evaluate risks
• Develop a plan for reducing the frequency and severity of accidents
and injuries
Risk management programs:
• Appraise safety of patient care procedures and new programs
• Monitor laws and codes related to patient safety
• Eliminate or reduce risks
• Review the work of other committees to determine potential liability
Risk management programs:
• Identify needs for patient, family, and personnel education
• Evaluate the results of risk management program
• Provide periodic reports to administration, medical staff, and board of
directors
Nurses role in risk management
program
• Implement risk management program
• Need clear understanding of the purposes of the incident reporting
process
• Objective reporting necessary
• Never use report for disciplinary action
High risk areas in health care
• Medication errors
• Complications from diagnostic or treatment procedures
• Falls
• Patient or family dissatisfaction with care
• Refusal of treatment or refusal to sign consent for treatment
Reporting incidents
• Discovery
• Notification
• Investigation
• Consultation
• Action
• Recording
Nurses managers role in risk
management
• Individualize care
• Handle complaints
• Set tone for a safe and low-risk environment
• Create a blame-free environment
Blame-Free Environment
• Just culture
• Allows reporting of errors without fear of retribution
• System-wide policies in place for reporting errors
• Staff encouraged to report adverse events and help find solutions to
prevent future mistakes
Blame-Free Environment
• Nurse manager
• Identifies problems
• Encourages culture of safety and quality
