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Quality Management

Quality Management. By Christina Lauderman RN, BSN, CEN. Quality Objectives. The learner will be able to.. Define Quality Care Identify Standards of Care/Benchmarks Identify drivers of quality and their roles in the continuous quality improvement (CQI) process.

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Quality Management

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  1. QualityManagement By Christina Lauderman RN, BSN, CEN

  2. Quality Objectives The learner will be able to.. • Define Quality Care • Identify Standards of Care/Benchmarks • Identify drivers of quality and their roles in the continuous quality improvement (CQI) process. • Describe How Total Quality and Continuous Quality Management, Six Sigma, and Lean Six Sigma Addresses Quality.

  3. Quality Objectives • Identify when an Incident report needs filed. • Perform a Chart Review on Given Stroke Charts • Develop a continuous quality improvement project on a nursing unit.

  4. What Is Quality?

  5. Quality Care • Right Care at the Right time to the Right Patient. • Compassionate/Empathetic • Competent • No Harm • Meets Standards • No Complications • Nondiscriminatory/Fair

  6. QUALITY • Involves the pursuit of excellence in the delivery of care and ongoing prevention of potential errors • The degree to which patient care services increase the probability of desired patient outcomes and reduce the probability of undesired outcomes given the current state of knowledge (JCAHO, 2009)

  7. Theoretical Framework • Florence Nightingale • Jean Watson- Theory of Caring • Dorothea Orem-Self care Deficit • June Larabee-Quality Theories

  8. Drivers Of Quality • Medicare and Medicaid • The Joint Commission (JCAHO) • State regulators • Payers • Professional groups • Patients

  9. Why Is Poor Care Sometimes Given?

  10. Possible Reasons for Poor Care • Under Or Inexperienced Staff • Human Error • Time, Money, and Space Constraints • Attitude

  11. Possible Reasons for Poor Care • Ineffective Communication • Complications • Inability To Meet Patient’s Expectations. • System Error

  12. Standard of Care • Care Deemed Appropriate Based on Scientific Evidence and Expertise of Expert Professionals in that Area of Care. • Come From JCAHO, DOH, ANA, NLN, NIH, AHA, ATA, ABA, UPMC Standards, Medicare/Medicaid, Insurance Companies etc.

  13. Where do we learn standards? • First learn standards in Nursing School. • Learn Policies and Procedures of Facility employed by. • As you incorporate Evidence Based Practice • As you become involved in Research.

  14. Types of Standards • Structure Standards- Physical Environment, Organization • Process Standards-Delivery Of Care • Outcome Standards-The End Results

  15. Examples of Standards

  16. Quality Management Programs • After the Fact Identification • Prevention of Failed Standards and Problems • Based on Data Collection and Accountability • Uses Measurement Tools • Focus on “No Blame”

  17. Total Quality Management(TQM) • 4 Characteristics • Customer/Client Focused • Total Organizational Involvement • Use of Quality Tools and Statistics for Measurement • Key Processes for Improvement Identified

  18. Total Quality Management(TQM) • Customer Client Focused • Internal Clients • Employees, lab, housekeeping • External Clients • Patients, Visitors, Physicians • Insurance Companies

  19. Total Quality Management(TQM) • Total Organizational Involvement • Team Approach • Empowerment of Employees • Management-Team

  20. Total Quality Management(TQM) • Use of Quality Tools and Statistics for Measurement • Tools such as Graphs, charts • Statistic tools such as percentages, Probability

  21. Total Quality Management(TQM) • Key Processes for Improvement Identified • Systems Related • Clinical • Managerial

  22. TQM Continued • Plan, Do, Check, Act Cycle

  23. Continuous Quality Improvement • TQM Philosophy CQI Process • Never Ending Process • Involves Evaluation, Actions, and a Mind Set to Constantly Strive for Excellence

  24. Continuous Quality Improvement • 4 Key Players • Resource Group • Coordinator • Team Leader • Team

  25. Components of Quality Management • Comprehensive Quality Management Plan • Multidisciplinary • Standards • Benchmarking • Critical Paths • Indicators

  26. Components of Quality Management • Performance Appraisals • Intra/Interdisciplinary Assessments and Improvements

  27. Quality Management Audits • Retrospective • Concurrent Peer Reviews Utilization Reviews Outcomes Management

  28. Six Sigma Uses Quantitative Data As a Measure As a Goal

  29. Six Sigma • As a Management System • Customer focus • Data Driven • Process Emphasis • Proactive Management • Boundary-less Collaboration • Aim for Perfection, Tolerate Failure

  30. LEAN SIX SIGMA

  31. National Incentives • Institute of Medicine- To Err Is Human: • JCAHO- Patient Safety Goals • Institute of Healthcare Improvement

  32. Medication Errors • Right Patient, Right Medication, Right Dose, Right Route, Right Time • Patients Involved In Own Care • Educate Patients About Medications • Errors Need Reported

  33. Risk Management • Problem Focused- • Identify • Analyze • Evaluate Risks • Develop Plan

  34. Risk Management • Education Based • Monitors Laws and Codes Related To Patient Safety. • Collects Data In Legal Complaints • Provides Reports to Administration, Medical Staff, and Board of Directors.

  35. Incident Reporting • Incident • Actual or Potential Risk. • Document in Chart and in Incident Report. • Be Factual, Non Disciplinary, Honest • Case Followed Up by Risk Management

  36. Incidents • Medication Errors • Falls • Complications from diagnostic or treatment procedures • Patient/Family dissatisfaction with care • Refusal of Treatment or to sign consent • Skin Breakdown • Iv Infiltrations

  37. Blame Free Environment • Encourage Staff To Report Incidents • No Blame or Disciplinary Action Unless Absolutely Necessary • No Finger Pointing • Encourage a Culture of Safety and Quality

  38. Handling Complaints • Clear Communication • Maintain Professional Caring Attitude • Listen to Complaints • Determine Expectations of Patient or Family • Quick Follow Up and Action

  39. Handling Complaints • Personal Contact-Utilize Charge Nurse, Nurse Manager, Nursing Supervisor. • Maintain Safety For Yourself and For the Patient. • Make Restitution/Meet Expectations When Applicable.

  40. Key Components • Meeting Standards Helps to Provide Quality • TCM- Philosophy Uses Plan, Do, Check, Act • CQM-Never Ending, Strive for Excellence. • Six Sigma- Reduce Waste Increase Productivity

  41. KEY COMPONENTS • Risk Management Role in Quality • Increase Patient Safety • Incident Reporting • Handling Complaints

  42. Questions?

  43. References • Textbook- Effective Leadership and Management in Nursing by Pearson • Google Images

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