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......."Quality is never an accident; it is always the result of high intention, Sincere

effort, intellegent direction and skillful execution; it represents the wise choice of

many alternatives.

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DEFINITION

Its a proactive approach with set of procedures

developed and activities done before the

product or service is manufactured or

delivered to assure of good quality to the

customers.

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CQI is an ongoing quality improvement

measure using management and scientific

methods of quality assurance involving datacollection, its analysis, and formulating ways

to improve performance outcome according

to proposed standards.

-British Standards Institute

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OBJECTIVES

Public accountability.

Management improvement

Facilitation of adoption of

innovations

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PURPOSES/ NEED

Rising expectations of consumer of services.

Increasing pressure from national,international, government and otherprofessional bodies .

The increasing complexity of health careorganizations.

Improvement of job satisfaction.

Highly informed consumer

To prevent rising medical errors

Rise in health insurance industry

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1. Adopt the new philosophy.

2. Cease dependence on inspection to achieve

quality. Eliminate the need for massiveinspection by building quality into theproduct in the first place.

3. Minimize total cost.

4. Improve constantly

5. Institute training on the job.

6. Institute leadership.

7. Drive out fear, so that everyone may workeffectively for the company

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9. Eliminate slogans, exhortations, and targets

for the work force asking for zero defects and

new levels of productivity.

10. Eliminate work standards (quotas) on the

factory floor. Substitute leadership.

11. Eliminate management by numbers,

numerical goals. Substitute to leadership.

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12. Remove barriers that rob the hourly

worker of his right to pride of workmanship.

13. Institute a vigorous program of education

and self-improvement.

14. Put everybody in the company to work to

accomplish the transformation

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APPROACHES

GENERAL APPROACH

SPECIFIC APPROACH

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Credentialing

Charter

Certification

AccreditationLicensure

Recognition

RecognitionAcademic

degree

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SPECIFIC APPROACH

Control

committees

Services

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Steps in Quality Assurance Process

Define the Objectives

Understanding Customer Needs

Designing the Product

Product Pilot Testing

Process Development

Start Manufacturing

Life Cycle Management

QUALITY ASSURANCE V/S

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QUALITY ASSURANCE V/S

QUALITY CONTROL

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PRINCIPLE OF JCAHO

written plan

problem-

focused

approach

Annual

reassessment

of program

Measurable

improvement

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STANDARDS

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Check Sheet

Cause-and-Effect Diagram

Cause-and-Effect Diagram

Pareto Chart

Scatter Diagram

Probability Plot

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Histogram

Control Charts

Brainstorming

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FACTORS AFFECTING QUALITY

ASSURANCE IN NURSING CARE

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Lack ofResources

Lack of incidentreview

procedures

Lack ofnursing care

records

Absence ofaccreditatio

n laws

Lack of goodand hospitalinformation

system

Personnelproblems

Impropermaintenance

Unreasonable

Patients and

Attendants

Miscellaneousfactors

Absence ofpatient

satisfaction

surveys

Absence ofwell

informedpopulation

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BARRIERS IN CQI

Shewart, Walter A., Economic Control of

Quality of Manufactured Product,

Princeton, NJ: Van Nostrand Reinhold Co.

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1. Poor Planning -- The absence of a sound

strategy has often contributed to ineffective

quality improvement.

deficiencies in the original planning cause a

process to run at a high level of chronic waste.

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2. Lack of management commitment -- A

quality implementation program will succeed

only if top management is fully committed

beyond public announcements.

Success requires devotion and highly visible and

articulate champions.

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3. Resistance of the workforce -- A workforce isoften unwilling to embrace TQM for a variety ofreasons.

A TQM project must be supported by employeetrust, acceptance and understanding ofmanagement's objectives.

employees will not work to their fullest potentialwhen management defines its goals in terms ofnumbers. In this case, the focus shifts to level ofproduction instead of to quality of productionoutput.

aging workers as well as workers who suffer fromilliteracy or language barriers, may resist theimplementation of new ideas and alien concepts

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4. Lack of proper training -- There is evidence

that lack of understanding and proper training

exists at all levels of an organization, and that

it is a large contributor to worker resistance.

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5. Teamwork complacency -- Most TQM programsplace substantial emphasis on teamwork andproblem-solving groups.

Problems arise when teams feel they have noauthority, when they lack direction and purposeand when their large number causes statusconfusion.

Newall and Dale found that teams are seldomfully used, and their individual members areoften complacent.

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6. Lack of resources provided

many quality departments were over-worked andunderstaffed.

although the return on investment for a qualityimprovement project is very high, manycompanies fail to provide the resources necessaryto achieve significant results.

7. Lack of effective measurement of qualityimprovement -- TQM is centered aroundmonitoring employees and processes, andestablishing objectives that anticipate thecustomer's needs so that he is surprised anddelighted. This has posed a considerablechallenge to many companies.

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Solutions for Quality Improvements

Individual Problem Solving

Rapid Team Problem Solving

Systematic Team Problem Solving

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STANDARDS

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DEFINITION

Standards are written formal statements to

describe how an organization or

professional should deliver health service.

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Organizations

AHRQAgency for Healthcare Research and Quality

IHIInstitute for Healthcare Improvement

JCAHOJoint Commission on Accreditation ofHealthcare Organizations

NAHQNational Association for Healthcare Quality

IOMInstitute of Medicine

NCQANational Committee for Quality Assurance

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Characteristics of Standard

broad enough

realistic, acceptable, and attainable. must be developed by members of the

nursing profession.

Phrased in positive terms

must express what desirable optional level

understandable and stated in unambiguous terms.

based on current knowledge and scientific practice.

must be reviewed and revised periodically.

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Purposes of standards

Give direction and provide guidelines for performanceof nursing staff.

Provide a baseline for evaluating quality of nursing care

Help improve quality of nursing care

Improve documentation

Determine the degree to which standards of nursingcare maintained

Help supervisors to guide nursing staff to improve

performance. Improve basis for decision-making

Help justify demands for resources association.

Clarify nurses area of accountability.

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Standards of Professional Conduct

The Profession of History

Shared Values

Scholarship

Plagiarism

Teaching

History in the Public Realm

Employment

Reputation and Trust

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Classification of Nursing Standards

Normative and Empirical Standards

Process Standard

Outcome standard

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LEGAL SIGNIFICANCE OF STANDARDS

a patient-nurse relationship existed such that

the nurse owed to the patient a duty of due

care,

the nurse deviated fromthe appropriate

standard of care,

the patient suffered damages,

The patient's damages resulted fromthe

nurses deviations fromthe standard of care

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...What to change?, What to change to?,

and how to cause the change?....

If a manager doesn't know how to answer

those three questions is he or she entitled to

be called a manager?

- Albert einstein

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REFERENCE

Ward MJ, Price SA .Issues in nursing administration. St.Louis:Mosby; 1991.

Douglass L M. The effective nurse- leader and manager. 5th ed.Mosby: St. Louis; 1996.

Basavanthappa BT. Nursing Administration. 1st edn. New Delhi:Jaypee Brothers; 2000

Johnson M and Closkey J.C. The Delivery of Quality Health CareSeries on Nursing Administration. London: Mosby 1992

Koch M.W And Fairly T.M. Integrated Quality Management: The Key

To Improving Nursing Care Quality. Marquis B.L. Leadership roles and management functions in

nursing Theory and application. 5th ed. Philadelphia:

Morrison M. Professional skills for leadership. Mosby: US; 1993.

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Ho ! Ho! Ho!