Quality assurance in nursing

Few Facts on Patients Safety About 20%–40% of all health spending

is wasted due to poor-quality care

98,000 Americans die each year in U.S. hospitals due to preventable medical errors (Institute Of Medicine, 1999).

World Health Organization2

Hospital errors rank between the 5th and 8th

leading cause of death in US (IOM, 2005)

There is a 1 in 1 000 000 chance of a traveler being harmed while in an aircraft.

In comparison, there is a 1 in 300 chance of a patient being harmed during health care

Few Facts on Patients Safety…

3

About 18 percent of patients were harmed by medical care, some more than once…2.4 percent caused or contributed to a patient’s death

— this corresponds to 155,000 deaths per year

New York Times, 2010

Few Facts on Patients Safety…

5

……HEALTH CARE

LACK OF QUALITY

6

Quality Target Is 100 % ..............

(Institute Of Medicine, 1999)

……………Not Even 99%

7

If 99.9% were good enough a major plane crash would occur every 3 days

There would be 30,000 ATM errors every hours

There would be 500 incorrect surgical operation each day

Even 99% might mean

(Institute Of Medicine, 1999)8

Even 99% might mean

At least 2 lakh wrong prescription each year

More than 2 lakh new born babies given to

wrong parent

2 to 3 rail accident every day

(Institute Of Medicine, 1999)9

Quality Assurance

Moderator Rajkumar Mehta

Associate ProfessorCON, CMCTH

SpeakerNirsuba Gurung

Roll no- 10MN 1st year

SeminarOn

10

Highlights of session Quality History Myths and truth about quality Terminology Principle of QADimensions of quality assurance QA modelFactors affecting quality assurance QA approachLegal and ethical implication Role of nursing 11

Quality Quality is measured in terms of costumer

perspective

Performance improvement consists of those activities and behaviors that each individual does to meet customers expectation

Doing things right the first time and continually striving to do better

12

A degree or grade of excellence.

Proper performance of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality , morbidity , disability and malnutrition.

Quality…….

-Roemer, M.I. and C.Montoya Aguilar, WHO, 1988.

13

Effect of Poor Quality of CarePatient Physical discomfort Mental stress Increased length of stayComplication developmentLoss of working daysIncreased expenses

14

FamilyInconvenientLoss of trust Higher expenses Family disputes

Effect of Poor Quality of Care…..

15

SocietyIncreased prevalence of disease Increased risk of certain infection

Diminished productivity, Unhealthy people is medically more demanding and economically less productive

Effect of Poor Quality of Care…

16

Hospital or institution Increased length of stay, overcrowding,

further degradation of quality careHigher rate of complication Increased risk of accidents and mishapsAdverse publicity Decreased outcome


17

Care provider/staffReduced motivation Risk of infection to staffHigh turn over rate

Burn out / frustration


18

Why Quality Assurance?Insure the right of the people to assess to

quality health servicesImprove the health status of the people Meet costumers needs and expectation Increased demand for efficient utilization of

limited resources

Increased demand for effective and appropriate care

19

Minimize waste of limited resources and reduce cost

Standardize care and control variation

Ensure safety and minimize risk

Fulfill the ethical duty of health professional

Why Quality Assurance?.........

20

History of Quality Assurance

1800 B.C. - King Hammurabi of Babylon

Laws for monitoring and controlling good and bad acts

21

1859 B.C. - Florence Nightingale

During Crimean war she noticed direct correlation between good nursing care to wounded soldiers and their low mortality rate - Developed standards for nursing practice

Concept of different wardsConcept of Intensive Care UnitFather of Hospital AdministrationMany more……………………...

History of Quality ……….

23

1895 - Dr. Abraham Flexor -Recommend a set of strict guidelines for

standard of medical education and adopted by US Government.

1910 - Ernest Codman -Suggested routine follow up to determine

the outcome of medical intervention


24

1916 - The American College of SurgeonsDeveloped the minimum standard for hospitals

1926 - In USAFirst medical standard manual was printed

1952 - Joint CommissionAccreditation of Hospital


25

1966 - Dr. Avedis DonabediaSystem model for evaluating health care

quality

1980 :WHOIntiation in Europe to introduce QA program

1986: Edward DemingThe concept of TQM was developed Introduced in health care from industry.


26

Purposes of QualityIncreased demand for effective and

appropriate careNeed for standardization and variance

controlBenchmarkingNecessity for cost saving measuresAccreditation, certification and regulationsPerformance appraisal of the provider

27

Need for improvement in care and servicesEthical considerationsRequirement to define and meet patient needs

and expectations.Pressure of competition and to enhance

marketingDesire for recognition and the strive for

excellence.

Purposes of Quality………

28

Myths Truth

It leads to wasted time and increase workload

Quality means more expensive service

Quality means goodness, luxury ,shininess or weight

It build a system which leads to less time and effort

It can be improved with the same resources

Quality is never luxury,it is essential to improve health service and minimize waste

MYTHS AND TRUTH OF QUALITY

29

MythsQuality is intangible and

not measurableQuality problems are

originated by the workers.

Quality originates in the quality department.

It can be measured

The majority of the problems encountered are due to inappropriate functioning of health systems, and not necessarily the result of errors of individual workers

Quality is everybody’s job

Truth MYTHS AND TRUTH OF………..

30

TerminologyQualityThe degree of excellenceAssuranceA promise that you will definitely do the best

(provided formal guarantee)Quality AssuranceDefines performance measurements and

compare actual processes and outcomes to clinical and satisfaction indicators

31

Quality Assurance in Nursing Quality assurance is a program for formal

guarantee for provision of quality nursing care against set standards

Quality ControlInvolves performance management and

maintenance and includes systemic methods of ensuring conformance to a desired standard or norm

Terminology……

32

Quality Care - right person (health worker ) doing: The right thing (evidence based practice) In the right way (skills and competence)At the right time (providing treatment/

services when the patient needs them) In the right place (location of treatment

/services) With the right result (clinical effectiveness /

maximizing health gain).

Terminology……

33

Quality Circle A participative management approach in

which employees and manages share the responsibility for decision making and problem solving in client care

Terminology……

34

Quality Improvement (QI)is concerned with performance improvement

and is ongoing, involved with fixing problems now, costly mistakes in the future, and fostering breakthroughs.

Standard Predetermined level of excellence that serves

as a guide for perfect practice

Terminology……

35

Total Quality Management (TQM)Also referred to as continuous quality

improvementPhilosophy developed by Dr. W. Edward

DemingFirst implemented in Japan Focus on satisfying customers' expectations,

identifying problems, building commitment, and promoting open decision-making among workers.

Terminology……

36

Purpose of QA

To ensure high quality patient care,

To ensure medical surveillance

To ensure population health management

through continuous monitoring and

evaluation of the patient care

37

Principles of Quality Assurance

Focus on client needs

Focus on data as basis for decision

Focus on systems and processes

Focus on team approach to problem solving

and quality improvement

38

Dimension of Quality Assurance

Efficacy Degree to which the intervention has been

shown to accomplish the indented outcome

Appropriateness Degree to which the intervention is relevant

to client needs

39

Availability Degree to which appropriate interventions

are available to meet client needs

Timeliness Degree to which the intervention is provided at the

most beneficial time to the client

Dimension of Quality Assurance…

40

Effectiveness Degree to which the intervention is provided in the

correct manner to achieve the intended client outcome

Continuity Degree to which the interventions are

coordinated between organizations ,among care providers and across time


41

Safety Risk of an intervention and risk in the

environment are reduced for both client and health care provider

EfficiencyCare has the desired effect with the

minimum of effort , waste and expenses


42

Respect and caring Clients are involved in health care decisions

and are trusted with sensitivity and respect for their individual needs, expectations and differences by health care providers.


43

Factors Influencing Quality Improvement

Customer demand

Financial viability

Professional accountability

Regulatory requirements

Progress in quality improvement technique

Change in health care delivery44

Quality control A specific type of controlling, refers to

activities that evaluate , monitor or regulate service rendered to consumers

The criterion or standard is determined Information is collected to determine if the

standard has been metEducation or corrective action is taken if the

criterion has not been met

45

Quality Control as a Process

Establish control criteria

Identify information relevant to criteria

Determine ways to collect information

Collect and analyze the information

Compare collected information with the

established criteria 46

Make a judgment about quality

Provide information and if necessary take

corrective action regarding findings to

appropriate sources

Quality Control as a Process…..

47

Components of Quality Management Program

Statement of purpose, philosophy and objective

Standards for measuring quality care Policies and procedureAnalysis and reporting Use of results to prioritize Monitoring Evaluation

48

Principle of TQMCreate a constancy of purpose for

improvement of the products and service

Adopt a philosophy of continual improvementsFocus on improving processesEnd the practice of awarding business on price

alone, instead minimize total cost by working with simple supplier

49

Improve constantly every process of planning , producing and service

Institute job training and retraining

Develop leadership in the organization

Encourage employees to participate actively in process

Principle of TQM……..

50

Foster interdependent co-operation

Focus on quality not on quantity

Promote team work Eliminate slogans and targets for the

workplace.

Educate to maximize personal development

Principle of TQM……..

51

Comparison of QA and QI processQAP QIP

Goal Improve quality Improve quality Focus Discovery and

correction of errors

Prevention of error

Major task

Inspection of nursing activities and chart

Review of nursing activities , innovation and self development

Quality team

QA personnel Multidisciplinary

Outcome Set by QA team Set by QI team

52

Technique for Obtaining Quality of CareObserve the behavior of the client and familyInterview Conduct focus group discussion Analyze solicited comments or letters from

client Survey

Front line people (organization)53

Employee feed back

Customer care services

Conduct telephone survey

Toll free telephone numbers

Costumer visit

Mail survey to discharged patient if feasible

Technique for Obtaining Quality of Care………..

54

Steps in Quality Improvement Process

Select a nursing activity for improvement Assemble a multidisciplinary team to review

and revise the nursing activity Describe all components of the activity using a

flow chart Collect dataDiscuss various plans to meet the standard Collect data to evaluate the implementation

55

Component of Integrated Quality Management

Quality assessment and improvement

Infection control

Utilization management

Risk and safety management

56

StandardsIt is a pre-determined baseline condition or

level of excellence that comprises a model to be followed and practiced.

Distinguishing characteristic of standard:Predetermined Established by an authorityCommunicated to and accepted by the

individuals affected by standard

57

Type of standard

Core standard

Clinical standard

58

Areas of standard

Clinical

Communication

Environment

59

Areas of standards Structure

PhysicalPersonnel organization

ProcessWhat is doneWhy is done

Outcome Effect on the health of the patient

60

Steps in standard

Identify the system

Identify the expert

Identify the input, process and output

Develop standard

Chose format

Appropriate intervention 61

The ANA standards for Practice

Standard 1: The collection of data about health status of the patient is systematic and continuous. The data are accessible, communicative, and recorded.

Standard 2: Nursing diagnosis are derived from health status data.

62

Standard 3: The plan of nursing care includes goals derived from the nursing diagnoses.

Standard 4: The plan of nursing care includes priorities and the prescribed nursing approaches or measures to achieve the goals derived from the nursing diagnoses.

The ANA standards for Practice…

63

Standard 5: Nursing actions provide for patient participation in health promotion, maintenance, and restoration.

Standard 6: Nursing actions assist the patient to maximize his health capabilities.


64

Standard 7: The patient’s progress or lack of progress towards goal achievement is determined by the patient and the nurse.

Standard 8: The patient’s progress or lack of progress towards goal achievement directs re-assessment, re-ordering of priorities, new goal setting, and a revision of the plan of nursing care.


65

QA Model in Nursing QAM in nursing is a set of elements that are

related to each other and comprise of planning for quality , development of objectives, setting and actively communicating standards , developing indicators , setting thresholds, collecting data to monitor compliance with set standards for nursing practice and applying solution to improve care

66

Purpose of QAMDevelop confidence of receivers that quality

care is being rendered as per assurance

Ensure quality nursing care

To meet the expectation of receiver, management and regulatory body

Intends to increase the commitment of provider and management

67

Cycle of Quality Assurance

Define acceptable standards of service Compare services of standardImplement developments and changes as

needed

Monitor the effects of changes and developlment

68

Models of Quality Assurance System Model for Quality assurance ANA Quality Assurance Model JCAHO Quality Assurance Model ISO Quality Assurance Model PDCA Six Sigma

DMAIC DMADDV

69

System Model Tasks are broken down into manageable

components based on defined objectives.

The basic components of the system are:1. Input (Structure)2. Throughput (Process)3. Output (Outcome)4. Feedback

Models of Quality Assurance

70

System Model

System

Environment

Environment

Transformation

Employee’s work activitiesManagement activitiesTechnology and operations methods

OutputsInputsRaw materials

Human resourcesCapital

TechnologyInformation

Products and servicesFinancial results

InformationHuman results

Feedback

71

Structural Elements…Geographical location of facilityBeds Personnel Nurse to patient ratioEquipments and supplies Space Rules and proceduresTechnologyFinance

72

Process Elements…Treatment processTechnical aspect of careAppropriatenessUse of efficacious therapyUse of diagnostic testUse of procedureTreatment delay(including waiting time)IPRConflict/grievance /readdress procedureDocumentation 73

Outcome Elements….

Death rateAdverse event ReadmissionLength of hospital stayCost of servicePatient’s satisfaction

74

ANA Quality Assurance Model

This is also based on the system model

75

Identify value

Identify structure, process, outcome standard

and criteria

Obtain measurem

ent to determine attainmen

t of standard

and criteria

Interpretation based

on measurem

ent

Identify possible

courses of action

Choose course of action

Take action

ANA QA MODEL

Evaluate Action taken

JCAHCO QA Model

77

ISO QA Model Planning

Implementation

Evaluation

Review

78

Plan Do Check Act (PDCA) Cycle

79

Six sigma Given by Bill Smith while working

at Motorola

Six Sigma describes quantitatively how a process is performing.

To achieve Six Sigma, a process must not produce more than 3.4 defects per million opportunities

80

DMAIC

Define Measure process performance Analyze the process

Improve process

Control the improved process

81

DMADDV

Define Measure of quality Analyze Design Detail Verify the definition

82

Tools to Measure Quality

Audit Client records are reviewed for compliance

to predetermined criteria that measure process and outcome of care

Peer review Care is evaluated based on the judgments of

a colleague with equal education and experience

83

Benchmarking Measuring service and practice against the

competition

Clinical pathway Measuring the performance of care

according to critical outcomes and key incident that must occur within the given time frame

Tools to Measure Quality…

84

Audit It is a systematic and official

examination of record, process or account to evaluate performance.

Structure auditProcess auditOutcome audit

85

It is the process of collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance program.

Nursing Audit

86

Purposes of Nursing AuditEvaluating nursing care given

Achieve desired and feasible quality of nursing care

Stimulant to better records

Focuses on care provided and not on care provider

Contribute to research

87

Nursing Audit ProcessSelect topicDevelop criteriaRatify the criteriaReview chartsIdentify variations Analyze the problem Develop solution Implement solution Evaluate and re-audit

88

Structure AuditPhysical facilities Equipment CaregiverOrganizationPolicies, standard management protocol ,

procedure and clinical recordsChecklist measures standard Structure should include knowledge and

experience 89

Process AuditTask orientedImplement indicators for measuring

nursing care to determine whether nursing standards are met

Retrospective, being applied to measure the quality of nursing care received by the client

The phaneuf audit seven subsection90

Phaneuf Audit…Application and execution of physician’s legal

instruction and advicesObservation of symptoms and reactionsSupervision of clientSupervision of those participating in careRecording and reportingApplication and execution of nursing procedures and

techniquesPromotion of physical and emotional health

91

Outcome AuditEvaluate by establishing client outcome criteria

National centre for health services developed an outcome criteria based on Orem’s description-air, water, food, elimination, rest, social interaction, protection from hazards, normalcy and health deviation

92

Outcome Audit…..Morbidity, disability and mortality during and

after health care service Nursing assessment and intervention Grouping items for efficiency

When outcome are not satisfactorily met, deficiencies are identified , corrected and followed up

93

Evaluated in terms of……….

Requirement is metClient has the necessary knowledge to

meet the requirementClient has the necessary skill and

performance

Client has necessary motivation

94

Methods of Auditing

A concurrent nursing audit

A retrospective nursing audit

A prospective nursing auditing

95

Types of Auditing

Internal auditing

External auditing

96

Set standards

Observe practice

Compare with standards

Implement Change

Audit cycle

97

Approaches For A Quality Assurance Program

Two major categories of approaches exist in quality assurance Program:

General

Specific

98

General ApproachIt involves large governing of official body’s

evaluation of a persons or agency’s ability to meet established criteria or standards at a given time.

1. Credentialing2. Licensure3. Accreditation4. Certification5. Charter 6. Academic degree

99

1. CredentialingFormal recognition of professional or technical

competence and attainment of minimum standards by a person or agency

Credentialing process has four functional components

To produce a quality product To confer a unique identity To protect provider and public To control the profession.

100

2. LicensureIndividual licensure is a contract between

the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice.

101

Licensure of nurses has been mandated throughout the world by laws and regulations.

In Nepal : Nepal nursing council (NNC) is the governing body to regulate nursing licensure

NNC is a member of International Council of Nursing (ICN)

2. Licensure…………..

102

3. Accreditation

Accreditation is the process by which authorized body evaluates the quality of a higher education institution as a whole or of a specific educational program in order to formally recognize it as having met certain predetermined minimal criteria or standards.

103

International Accreditation organization

Joint Commission International (USA)

United Kingdom Accreditation Forum (UKAF)

Quality Health New Zealand (QHNZ)

National Accreditation Board for Hospitals & Healthcare Providers (NABH)

Accreditation Canada International (ACI)

104

4. CertificationCertification is usually a voluntary process

within the profession.

A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.

105

ISO (International Organization for Standardization )

Focus on good management practices

Ensures that the organization deliver the product or services that meet the customer's quality requirements and

Enhance customer satisfaction, and achieve continual improvement of its performance in pursuit of these objectives.

106

Standards in the ISO 9000 family include:ISO 9001:2015 - Sets out the requirements of a

quality management system

ISO 9001:2008: Quality management system

ISO 9000:2015 - Covers the basic concepts and language

ISO 9004:2009 - Focuses on how to make a quality management system more efficient and effective

ISO 19011:2011 - Sets out guidance on internal and external audits of quality management systems.10

7

Charter A charter is the grant of authority or

rights, stating that the granter formally recognizes the rights of the recipient to exercise the rights specified

108

B. Specific Approaches

Peer review

Standard as a device for quality assurance

Audit as a tool for quality assurance

109

Factors Affecting Quality Assurance In Nursing Care Lack of resources Personnel problems Improper maintenance Unreasonable Patients and Attendants Absence of well informed population Absence of accreditation laws

110

Lack of incident review procedures

Lack of good and hospital information system

Absence of patient satisfaction surveys

Lack of nursing care records

Lack of good supervision

Factors Affecting Quality Assurance In Nursing Care………………

111

Absence of knowledge about philosophy of nursing care

Lack of policy and administrative manuals.

Substandard education and training

Lack of evaluation technique


112

Lack of written job description and job specifications

Lack of in-service and continuing education and staff development program

Nurse prescription – No provision yet.


113

Legal and Ethical Implication

Law , regulation and ethics play a major role

Define professional practiceLaws define legal practice, regulation define

guideline for delivery of care and ethics define personal performance

Code of ethics and professional conduct for the nurses must be there in any country

114

The code of ethics helps to protect the rights of individuals, families, & community and also the rights of the nurse.

Code can’t be broken – should follow at any circumstances.

Failure to provide quality health care can result in law suit

Legal and Ethical Implication…

115

Nursing practice standard

Professional responsibility and accountability

Nursing practice

Communication and interpersonal relationship

Valuing human beings

Management

Professional advancement 116

Professional Responsibility and Accountability

Based on quality assurance modelProfessionally managed and ethically justifiedProvided within the legal frame workDocumented accurately and completelyResponsibility and accountability for own

actions

117

Nursing practice

Reflects adherence to practice standards

Reflects nursing process approach

Provided in a safe environment118

Communication and interpersonal relationships (IPR)

Fosters effective interpersonal relationship with individuals and families

Initiates strategies to promote the learning of individuals and groups

Nurses at all levels must have Large open/ public area or Quadrant 1 in JOHARI Model - Self awareness about the professional role.

119

Valuing Human BeingsEnhances the dignity, individuality and self

esteem of individuals and groupsReflects active pursuit for rights of all

individuals and in particular the vulnerable groups

Reflects gender sensitivity towards the needs of women related to their health

120

Management

Reflects use of effective techniques

Reflects use of quality assurance model.

Organizes and utilizes resources efficiently

Ensures disaster preparedness 121

Management…

Contributes to development and implementation of institutional policies in conformity with statutory regulations

Develops and implements staff development and welfare programs.

122

Professional advancement

Reflects the commitment to ongoing education and professional growth of self and others.

Includes activities which focus on the advancement of profession

123

Nursing Theories and Quality Theory development in 1950’s

Hildegard E. Paplau: Interpersonal relationship in nursing, 1952

Virgenia A Henderson :Independence theory:1955Theory in the 1960’s:

Faye Glenn Abdellah: Patient centred approach theory, 1960

Ida Jean Orlando : Nursing Process Theory-1961Dorothy E Johnson : Behavioral system model

for nursing ,1968

124

Theory in the 1970’s Sister Callista Roy: Adaptation model ,1970Dorothea E Orem: Theory of self care deficit ,

1971Betty Neuman : Neuman system model ,1974M Jean Watson: Theory of human caring ,1979

Theory in the 1980’sMadeleine M Leininger : Culture care diversity

and universality , 1985 & so on……………..

Nursing Theories and Quality…..

125

Role of Nurse in Quality Assurance

Maintenance of a current knowledge base and competencies

Interpersonal skillsCaring and compassionMutual decision making with client and nurseIndividualized treatmentStrive for excellence in everything that is done

(Nurses, Nurse manager or clinician, team member )

126

Nurses role in legal complication

Review nursing practice periodicallyKnow their job descriptionFollow nursing standardsFollow …. RightsUse professional judgment before

implementingDo not attempt anything beyond level of

competence

127

Federal regulation (International ) Social security act (1965,1972)Consolidated omnibus budget reconciliation

act(COBRA) 1985,1986Health care quality care improvement (1986)Clinical laboratory improvement amendment

(CLIA)Patient self determination act(1990)Safe medical device act (1990)Occupational safety and health administration

(1991,1993)128

Regulations in India –NABH standard

1992:Quality council of IndiaEstablishment of national accreditation

board of hospital and health care provider(NABH)

Access, assessment and continuity of care (AAC)

Patient right and education(PRE)Care of patient (COP)

129

Management of medication (MOM)Hospital infection control (HIC)Continuous quality improvement (CQI)Responsibility of management (ROM)

Facility management and safety (FMS)Human resource management (HRM)Information management system (IMS)

NABH standard…………

130

Constitution of Nepal: Mentioned about Quality Care

Ministry of HealthMinistry of EducationNepal Nursing Council (NNC)Nursing Association of Nepal (NAN)Nepal Medical Council (NMC)Nepal Health Professional Council (NHPC)Nepal Pharmacy Council

QA in Nepal

131

QA in Nepal…..

1991 – Family planning services focused in quality

In 1993 health institution and manpower development division was created

1993/94 -National workshop on QA in health service.

132

1994-plan of action to strengthen QA activities

1994/95 – reviewed and developed standard guideline for SHP ,HP and PHC level

1999- developed nursing procedure manual

90’s- workshop for awareness of QA in health service in 5 developmental region

QA in Nepal…..

133

In 9th (1997-2002) health plan policy “improving public health and related indicator and providing quality health, service are the long term objective

2009- Policy on quality health service,2064

2014-Minimum service standard ,2071

QA in Nepal…..

134

QA in CMCTH

QA committee

Infection prevention committee

Incidence report

Nursing manual -2014

136

Research Input

137

Journal of Taibah University Medical Sciences (2015) 10(4), Implementation of total quality management in hospitals

Emad A.S

70% of variance in implementing TQM can be achieved by following the principles of TQM(continuous improvement, teamwork, training, top management commitment and customer focus.)

Continuous improvement was the most significant factor in explaining variance in implementing TQM principles

138

International journal for quality in health careVol 18 ,Issue 6 Pp. 414 - 421 (2006)

Towards patient-centered health services in India—a scale to measure patient perceptions of quality

Rao K D.,PetersD H

Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.

139

British Medical Journal 2012;344:e1717 Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients

Aiken L H et al

Nurse burnout (10% (Netherlands) to 78% (Greece)

Job dissatisfaction (11% -Netherlands) to 56% (Greece), and

Intention to leave (14% (US) to 49% (Finland, Greece)

140

Common wealth fund ,2004 Hospital quality: ingredients for success—

overview and lessons learned Jack A. (2004)

Essential elements of a successful strategy, according to the study, include Developing the right culture, Attracting and retaining the right people, Devising and updating the right in-house

processes, and Giving staff the right tools to do the job.

141

Satisfaction with Health Care Services of Out Patient Department at Chitwan Medical College Teaching Hospital,

Nepal

Rajbanshi L et al. (2014)Total sample :776Satisfaction level was 75.9%Level of satisfaction

Access to care: 98.5% quality of care : 91.5%physical facility: 56.3% cost of healthcare: 61.3%courtesy of healthcare provider:50.8%

142

Satisfaction with Health Care Services of Out Patient Department at Chitwan Medical College Teaching Hospital, Nepal

Reasons for turn over among the nurses working at BPKIHS

Mehta R S et al. Sample:150Reasons for leaving institution

Higher educationNegative attitude of nursing leader Inadequate salaryProper promotion opportunity

-Nursing and Midwifery Research Journal, April 2005, Vol-1, No. 2,

143

Stress Among Nurses Working In Critical Care Areas At A Tertiary Care Teaching

Hospital Nepal

Level of stressModerate stress: 56% had Mild stress :34%, Severe stress: 6%,No stress :4%

144

The Internet Journal of Healthcare Administration™ ISSN: 1531-2933

Effects Of Nurse Prescribing Of Medication: A Systematic Review

Citation: L. M. Van Ruth, P. Mistiaen & A. L. Francke : Effects Of Nurse Prescribing Of Medication: A Systematic Review . The Internet Journal of Healthcare Administration. 2008 Volume 5 Number 2

145

Clinical outcomes of patients being prescribed by Nurses or Physicians -Most of the studies found no differences between

prescribing nurses and GPs and some found that the patients who were given prescriptions by nurses had better clinical parameters.

Satisfaction with care-Most of the studies found that patients being treated

by nurses were just as satisfied or more satisfied than patients being treated by physicians

146

Patient enablement-Studies report that patient enablement, i.e. the

extent to which patients understand their illness and are able to cope, is similar for nurse practitioners and GPs

Quality of care –Most of studies in primary care report that

quality of care provided by nurses is similar to or better (in some cases) than that provided by GPs.

147

Consultation time-Most of studies reporting on consultation times

found that nurses generally spent more time with patients.

Information and documentation-Nurses were found to give more advice than

GPs about home remedies, self-medication and general self-management.

Patients managed by nurse practitioners reported receiving more information about their illnesses and well documented.

148

Effects on costs and other characteristics of health care system-

Netherlands showed that the costs incurred for personnel were lower for the group of patients being treated and prescribed for by the specialist nurse.

149

Quality History Myths and truth

about quality Terminology Principle of QADimensions of

quality assurance

QA modelFactors affecting

quality assurance QA approachLegal and ethical

implication Role of nursing

Winding Up

150

Take home message TQM is a new wave of nursing managementCustomer is anyone who uses the products,

services or process within an organizationQuality management programs make certain

that the patient care delivered meets established standards

Doing things right the first time and every time.

151

FINE QUALITY INPUT CAN ONLY GIVE

FINE QUALITY OUTPUT

153

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Meheta, R.S., & Pokheral, T. (2012). Leadership and Management (3rd ed.). Makalu Publication: Kathmandu.

Wolper,L. (2004). Health Care Administration (3rd ed.). Jones and Bartlett Publication: Masschesetts.

156

Sakharkar,B.M. (2008). Principles of Hospital Administration and Planning (5th ed.). Jaypee Publication: New Delhi, India.

Sah, A.P. (2011). Essential of Health Management (1st ed.) Vidyarthi Pustak Bhandar: Kathmandu.

Peter, R.K. (2007). Essential Managed Health Care (5th ed.). Jones Barllett Publishers sudbury: Massachusetts.

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Quality assurance in nursing

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