Quality management in nursing

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Health care delivery system and polices Quality management :

Health care delivery system and polices Quality management Presented by : Faour alshare , BSN, RN , MSN student Oncology track At Hashemite university Copyright 2011 Supervised by : professor nijmah Attyat RN , MSN , PhD


Objective Introduction Definitions Aims of quality management Quality management principles Components of quality management Quality assurance vs quality management Quality indicators Approaches of quality management Methods used in total quality management Improving Quality of Care Risk Management Programs Nurse’s Role Outline 1 2 3 4 5 6 7

Learning Objectives After completing this chapter, you will be able to: :

Learning Objectives After completing this chapter, you will be able to: Describe how total quality management, continuous quality management, Six Sigma, and Lean Six Sigma address quality. Describe the efforts that are being made to improve the quality of health care. Point out how nurses are involved in reducing risks. Explain how the nurse manager is key to reducing risks. Discuss how to create a blame-free environment. 1 2 3 4 5

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Introduction Today's health care organization witness highly level of competition, 48,000 to 98,000 lives are lost each year due to medical errors, that increase the needs to improve the quality of care. ( Kohn, Corrigan, & Donaldson, 2000 ). nursing needs to be diligent in advocating for quality patient care and must continue to e ducate the greater community on how to achieve quality and thus a safer environment for our patients

Definition :

Definition Health care quality : The degree to which health services for individuals and populations are safe , timely, efficient, equitable, effective, and patient centered (Institute of Medicine Committee on Quality of Health Care in America, 2001).


Cont,… Quality assurance Establish organizational procedures and standards for quality.( Sullivan,2009) Quality management (QM): philosophic framework for managing organization that recognizes the quality is determined by customer needs and expectations.


* A comprehensive quality management plan: systemic method to design, measure, assess, and improve performance. * Set a standard for benchmarking : standard relate to three major dimension of quality care - structure - process - outcome * Performance appraisals. * A focus on intradisciplinary assessment and improvement. * A focus on interdisciplinary assessment and improvement.

Quality indicators:

Quality indicators * Chart audits * Flowcharts * Pareto diagram * Histograms * Run charts

Quality assurance vs quality management :

Quality assurance vs quality management Quality management Quality assurance Planning oriented Inspection- oriented proactive Reactive Correction of common causes Correction of special causes Responsibility for all involve with the work Responsibility for a few people Cross functional Narrow focus Leadership actively leading Leadership may not be vested Problem solving by employee Problem solving by authority

Approaches of quality management:

Approaches of quality management A. Total quality management ( TOM) B. Continues quality improvement (CQI): C. Six sigma: D. Lean Six Sigma

Approaches of quality management:

Approaches of quality management A. Total quality management ( TOM) Is a management philosophy that emphasizes a commitment to excellence throughout the organization.

Methods used in total quality management:

Methods used in total quality management - Nursing audits - Retrospective audit is conducted after a patient’s discharge and involves examining records of a large number of cases. - Concurrent audit is conducted during the patient’s course of care Peer review. Hyrka’s et al (2003) show that peer supervision benefited nurse managers in quality management through reflection and support. - Utilization review . Based on the appropriate allocation of resources and mandated by JCAHO - Outcomes management . New technology in which costs and quality are concurrently and retrospectively measured and evaluated in order to improve clinical practice. . Outcomes are s tatistically analyzed .

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B. Continues quality improvement (CQI): it’s a process used to improve quality and performance. Its involves evaluation, actions, and a mind-set to strive constantly for excellence Continues quality improvement was integrated with patient feedback in one study ( Hyrkas & Lehti , 2003). Result revealed that nurses and patients were more satisfied when the evaluation of the quality of their care agreed.

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C. Six sigma: Six Sigma refers to six standard deviations from the mean and is generally used in quality improvement to define the number of acceptable defects or errors produced by a process


Cont,… In the Six Sigma model, the number of acceptable errors is always 3.4 per million occurrences ( close to zero tolerance).


Cont,… The method contains five steps: define, measure, analyze, improve, and control (DMAIC) . (Lee et al., 2005).


Cont,… Six themes of six sigma - Uses quantitative data to measure progress - Customer ( patient) focus - Greater emphasis on management monitoring performance and ensuring results - Process emphasis - Boundary-less cooperation - Aim for perfection; tolerate failure

D. Lean Six Sigma :

D. Lean Six Sigma - Focuses on improving process fl ow and eliminating waste - Provides tools that can be used with Six Sigma system DelliFraine ; Langabeer II; Nembhard , 2010 assessing the evidence of six sigma and lean in the health care industry and found that there are very weak evidence that SS/L improve health care quality.

Improving Quality of Care:

Improving Quality of Care Donald Berwick (2002) Organizational approach to health care’ problems by focusing on the patient, Kaissi (2006) Culture of safety, rather than a culture of blame, characterizes an organization where everyone accepts responsibility for patient safety


Cont,… * National Initiatives - Culture of safety and quality permeates many efforts at the national level - Joint Commission has adopted mandatory national patient safety goals * Quality measures can reduce costs * Increased nurse staffing results in better patient outcomes * Patients must become more involved in managing their own care * Providers must help educate patients as well as helping them to educate themselves

Improving Quality of Care (continued):

Improving Quality of Care (continued) * National Initiatives (continued) - Institute of Healthcare Improvement (IHI) goals - No needless deaths - No needless pain and suffering - No helplessness in those served or serving - No unwanted waiting - No waste

Risk Management Programs:

Risk Management Programs Are problem focused Identify, analyze, and evaluate risks Develop a plan for reducing the frequency and severity of accidents and injuries Involve all departments of the organization Monitor laws and codes related to patient safety Eliminate or reduce risks Review the work of other committees to determine potential liability Identify needs for patient, family, and personnel education Evaluate the results of a risk management program Provide periodic reports to administration, medical staff, and the board of directors

Nurse’s Role:

Nurse ’ s Role * Implement risk management program - Need clear understanding of the purposes of the incident reporting process - Objective reporting necessary - Never use report for disciplinary action

Reporting Incidents:

Reporting Incidents Discovery Notification Investigation Consultation Action Recording

Examples of Risk:

Examples of Risk - Medication errors - Complications from diagnostic or treatment procedures - Medical-legal incidents - Patient or family dissatisfaction with care - Refusal of treatment or refusal to sign consent for treatment

Nurse Manager’s Role:

Nurse Manager’s Role Individualize care Handle complaints Set tone for a safe and low-risk environment Create a blame-free environment

Blame-Free Environment:

Blame-Free Environment - System-wide policies in place for reporting errors - Staff encouraged to report adverse events Staff encouraged to help find solutions to prevent future mistakes - Nurse manager . Identifies problems . Encourages culture of safety and quality

Summary and conclusion:

Summary and conclusion Quality management is an important issue that play a major role in increasing the effectiveness of health care services, decreasing cost, and improving performance by decreasing errors. A successful quality management should be based on clients needs and evidence based practice. Nurses have an important role in quality management through applying risk management program.

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Thank a lot for your attention Questions? Comments?

References :

References Sullivan, E.J., Decker, P.J. (2009). Effective Leadership and Management in Nursing (7 th ed.) Upper Saddle River, New Jersey: Pearson Education Inc. Cherry, B., & Jacob, S.R (2008). Contemporary Nursing: Issues, trends, & management (4 th ed.). St. Louis: Mosby. Patronis Jones, R.A . (2007). Leadership and Management Theories, Processes and Practice . West Suburban College of Nursing Oak Park, IL.


Cont,… Poksinska, B. (2010). The Current State of Lean Implementation in Health Care: Literature Review. Quality Manage Health Care.(19). 4. 319–329. Hyrka,S., Koivula,M., Lehti,k., & Paunonen-Ilmonen, M. (2003). Nurse Managers' Conceptions of Quality Management as Promoted by Peer Supervision. Journal of Nursing Management, (11), 48–58. DelliFraine, J.L., Langabeer II, J.R., & Nembhard, I.M.(2010). Assessing the Evidence of Six Sigma and Lean in the Health Care Industry. Quality Manage Health Care. ( 19).3, 211–225 .

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