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Chapter 23

Chapter 23. Quality Control. Quality Control: Fifth and Final step of Management Process. Activities that are used to evaluate, monitor, or regulate services rendered to consumers Performance is measured against predetermined standards

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Chapter 23

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  1. Chapter 23 Quality Control

  2. Quality Control: Fifth and Final step of Management Process • Activities that are used to evaluate, monitor, or regulate services rendered to consumers • Performance is measured against predetermined standards • Action is taken to correct discrepancies between these standards and actual performance

  3. Management Controlling Functions • Periodic evaluation of unit philosophy, mission, goals, and objectives • Measurement of individual and group performance against pre-established standards • Auditing of patient goals and outcomes

  4. Hallmarks of Effective Quality Control Programs • 1. Support from top-level administration • 2. Commitment by the organization in terms of fiscal and human resources • 3. Quality goals reflect search for excellence rather than minimums • 4. Process is ongoing (continuous)

  5. Three Steps of the Quality Control Process • The criterion or standard is determined • Information is collected to determine whether the standard has been met • Educational or corrective action is taken if the criterion has not been met

  6. Steps in Auditing Quality Control

  7. Reminder The ANA has played a key role in developing standards for the profession

  8. The difference in performance between top-performing health-care organizations and the national average is called the quality gap Quality Gap

  9. Question What is the quality gap? • The difference between the highest-performing and lowest-performing health-care organizations • The difference between the highest-performing and the average health-care organizations • The difference between the actual health-care standard and the desired standard

  10. Answer Answer: Rationale:

  11. Benchmarking • The process of measuring products, practices, or services against best-performing organizations • Organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement

  12. Analysis • Critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur

  13. Audits Frequently Used in Quality Control • Structure—monitor the structure or setting in which patient care occurs • Process—measure the process of care or how the care was carried out • Outcome—determine what results, if any, followed from specific nursing interventions for patients

  14. Outcomes • There is growing recognition that it is possible to separate out the contribution of nursing to the patient’s outcome; this recognition of outcomes that are nursing sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession

  15. Standardizing Nursing Languages and Measures • NANDA International (NANDA-I) • Nursing Interventions Classification (NIC)  • Nursing Outcomes Classification (NOC)  • Clinical Care Classification System (CCC)  • The Omaha System  • Perioperative Nursing Data Set (PNDS)  • International Classification for Nursing Practice (ICNP) • Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)

  16. Standardizing Nursing Languages and Measures—(cont.) • Logical Observation Identifiers Names and Codes (LOINC) • Nursing Minimum Data Sets (NMDS) • Nursing Management Minimum Data Sets (NMMDS) • ABC Codes Source: National Association of School Nurses (2012). Standardized nursing languages. Retrieved June 23, 2013 from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/48/Standardized-Nursing-Languages-Revised-June-2012

  17. Standard • Predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced • Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care

  18. Question Standards must be: • Subjective • Uniform across all organizations • Attainable • All of the above

  19. Answer Answer: Rationale:

  20. Clinical Practice Guidelines • Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care • Also called standardized clinical guidelines • Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices

  21. Quality Improvement Models • Over the past several decades, the American health-care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI) • The difference between the two concepts is that QA models target currently existing quality; QI models target ongoing and continually improving quality • Two models that emphasize the ongoing nature of QI include total quality management (TQM) and the Toyota Production System (TPS)

  22. Quality assurance models seek to ensure that quality currently exists, whereas quality improvement models assume that the process is ongoing and that quality can always be improved Quality control in health-care organizations has evolved primarily from external forces and not as a voluntary effort to monitor the quality of services provided Quality Assurance

  23. Total Quality Management • Also referred to as continuous quality improvement (CQI) • Developed by Dr. W. Edward Deming • Based on the premise that the individual is the focal element on which production and service depend • Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving

  24. Toyota Production System • Customer-focused quality improvement model • Production system built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible • Adopting TPS in an organization requires a substantial commitment of leadership time and resources

  25. Quality Measurement as an Organizational Mandate • External impacts on quality control • Professional Standards Review Organizations • The Joint Commission • ORYX • Core measures • National Patient Safety Goals

  26. Centers for Medicare and Medicaid Services • Plays an active role in setting standards for and measuring quality in health care • With the introduction of the Medicare Quality Initiative (MQI) in November 2001 (now called the Hospital Quality Initiative (HQI)), health outcomes were targeted as the data source • As part of the HQI, easy-to-understand data on health-care quality from nursing homes, home health agencies, hospitals, and kidney dialysis facilities are made available to all consumers via a variety of media

  27. CMS: Setting Standards and Measuring Quality in Health Care • Pay-for-performance/quality-based pricing • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS surveys) • National Committee for Quality Assurance (NCQA) • Maryland Hospital Association Quality Indicator Project (QI Project) • Multistate Nursing Home Case Mix and Quality Demonstration • Report cards

  28. A plethora of studies across the past two decades suggests that medical errors are rampant in the health-care system Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems Medication Errors

  29. Strategies to Prevent Medication Errors • Better reporting of the errors that do occur • The Leapfrog initiatives • Reform of the medical liability system • Other point-of-care strategies • Bar coding • Smart IV pumps • Medication reconciliation

  30. Leapfrog Group • Computerized Physician–Provider Order Entry • Evidence-based hospital referral • ICU physician staffing • The use of Leapfrog safe practices scores

  31. Six Sigma Approach • Sigma is a statistical measurement that reflects how well a product or process is performing • Higher sigma values indicate better performance • Historically, the health-care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six • Organizations should aim for less errors by carefully applying the Six Sigma methodology to every aspect of QI

  32. THE END

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