Quality Management

Khairunnisa. Mansoor Sr. Instructor –AKUSONAM

Acknowledgement: Ms. Sajida Chagani (2023)
Dr. Fozia Asif (Associate Director, Centre for patient safety)
 OBJECTIVES
❖ Describe the characteristics and process of quality management system.
❖ Define performance improvement standards.
❖ Discuss various QMS models in the health care organizations
❖ Analyze the Plan Do Check & Action (PDCA) cycle
❖ Discuss risk management
❖ Delineate the type of risk involve in health care setting.
❖ Discuss complaint handling and incident reporting.
❖ Examine the process of complaint handling and incident reporting.
❖ Identify the role of the nurse leader/manager in the quality management process.

2
Why would a customer buy if
another seller is also offering
the same product?

3
QUALITY

Attribute which
differentiates a
product or service
from its
competitors

4
SIGNIFICANCE AND PURPOSES OF QUALITY

Ensures superior quality products and service

Customer satisfaction which eventually leads to

customer loyalty
Increased revenues and higher productivity for the
organization

Reduce waste and inventory

Improve safety and reduce risk

5
6
The phrase “That’s not my job”

7
We Need To Change The Phrase

8
 TOTAL QUALITY MANAGEMENT (TQM)
A management philosophy that emphasizes a commitment to excellence
throughout the organization.

The goal of TQM is to involve all employees and empower them with the
responsibility to make a difference in the quality service they provide.

TQM philosophy as it relates to the individual’s job and the overall goals and
mission of the organization.

The creation of Dr. W. Edwards Deming, TQM was adopted by the Japanese
after World War II and helped transform their industrial development.
9
CHARACTERISTICS OF TQM
Customer/client focus

Total organizational involvement

Use of quality tools and statistics for measurement

Key processes for improvement identified

10
CUSTOMER/CLIENT FOCUS
Internal Customers External
Customers
Employees Health care organization
includes:
Departments within the
organization: patients
Diagnostic services Visitors
(Laboratory, radiology)
Care organizations
Admission office
Insurance companies
Environmental services Country’s regulatory agencies
such as the Joint Commission,
which accredits health care
organizations
Public health departments 11
THE DIMENSION OF QUALITY
For people who use services:

S: SAFE Safe:
E: EFFECTIVE Avoiding harm to people from care that is intended to help them.
E: EXPERIENCE
Effective:
Providing services based on evidence that produce a clear benefit.

Experience:
Caring.
Staff involve and treat people with compassion, dignity and
respect.
Responsive and person-centered
Services respond to people’s needs and choices and enable them
to be equal partners in their own care.
12
 QUALITY MANAGEMENT SYSTEM

A quality management system is a technique used to communicate to employees what is

required to produce the desired quality of products and services and to influence
employee action to complete tasks according to quality specifications

A quality management system (QMS) is a set of policies, processes and procedures

required for planning and execution (production/development/service) in the core
business area of an organization. (i.e. areas that can impact the organization’s ability to
meet customer requirements.)

13
QUALITY MANAGEMENT PROCESS
Performance standards
Performance measures

Quality Control

Quality Improvement

14
 STANDARDS
A predetermined level of excellence that serves as
a guide for practice.
Standards of practice allow the organization to
measure unit and individual performance more
objectively.
Examples: Policy and procedures manual

15
 PERFORMANCE MEASURES
Key Performance Indicators (KPI)
a quantifiable measure of performance over time for a specific objective
KPIs cannot improve quality, however, they effectively act as flags or alerts to identify
good practice, provide comparability within and between similar services, where there are
opportunities for improvement and where a more detailed investigation of standards is
warranted.
The ultimate goal of KPIs is to contribute to the provision of a high quality, safe and
effective service that meets the needs of service users
AKUH indicator

16
 AUDIT AS A QUALITY CONTROL TOOL
An audit is a systematic and official examination of record, process,
structure, environment or account to evaluate performance.

According to Donabedian healthcare quality can be assessed using

a three-part model based on the structures, processes and outcomes
of the healthcare system. This division of healthcare has allowed
the identification of data across the full spectrum of healthcare that
contributes to monitoring the quality of the various constituents of
healthcare delivery.
26/02/2019 17
 Quality Measures or Indicators

Structure:
Measures of infrastructure, capacity, systems,
Process:
Measures of process performance.
They tell whether the parts or steps in the system are performing as planned.
This can be “in process” or “end of process”
(e.g., timely administration of prophylactic surgical antibiotics).
Outcome:
Measures that show results of overall process or system performance
(often risk adjusted, e.g., mortality)
18
 Donabedian’s Model
Structure Process Outcome

• Structural indicators • what is done for the • to the state of health

refer to the resources service user and how of the individual or
used by an well it is done. population resulting
organization to Process indicators from their interaction
deliver healthcare measure the with the healthcare
and include activities carried out system. It can include
buildings, equipment, in the assessment lifestyle
the availability of and treatment of improvements,
specialist personnel service users and are emotional responses
and available often used to to illness or its care,
finances measure compliance alterations in levels
with recommended of pain, morbidity
practice, based on and mortality rates,
evidence or the and increased level
consensus of experts of knowledge
19
EXAMPLES OF AUDIT AT AKUH
AKUH AUDIT TOOL
1.Internal and External Audits (JCIA)
• • IPSG Audit
• • Code blue Audit (Actual)
• • Patient Family Education audit
2.Compliance to medical record reviews
• – Open
• – Closed
3. Infection control related Audits:
•Prevention and Control of Infection (PCI audits)
• Hand hygiene
• Needle stick injury
• Surgical Site Infections (SSI)
• Device Associated Infections (DAIs): • CLABSI • CAUTI • VAP
26/02/2019 20
 QUALITY IMPROVEMENT (QI)
QI is the application of tools and methods to implement, test, and improve
effective quality improvement practices.

QI efforts should be based on sound evidence, rigorous assessment,

implementation, adoption, evaluation, dissemination, and sustainability
➢Continuous quality improvement (CQI) never ending process, everything
and everyone in the organization subject to continuous efforts
➢Use of a systematic method to deal the quality issue. An example : PDSA

21
PLAN-DO-STUDY-ACT
(PDSA)
➢ Originate industry and Walter Shewhart and
Edward Deming's articulation
➢Cyclical nature of impacting and assessing
change, most effectively
➢ Repeat as needed until the desired goal is
achieved

22
PLAN-DO-STUDY-ACT (PDSA) MODEL
PLAN: Plan a change Act Plan
- Objective
DO: Carry out the plan. - What changes
are to be - Questions and
made? predictions (W hy?)
- Plan to carry out
STUDY: Look at the results. - Next cycle? the cycle
(who, what, where, when)

ACT: Standardize the

improvement or new actions Study Do
- Complete the analysis - Carry out the plan
of the data - Document problems
- Compare data to and unexpected
predictions observations
- Summarize what - Begin analysis
was learned of the data

23
STEPS FOR SUCCESSFUL CQI PROGRAM
➢ Build a team to address
➢ Define the problem
➢ Choose a target
➢ Plan the Project
➢ Choose The Tools
➢ Identify Causes
➢ Develop Solutions
➢ Implement Solutions
➢ Review Results
➢ Standardize
24
CONTINUOUS QUALITY IMPROVEMENT (CQI)
There are four major players in the CQI process:

● Resource group
● Coordinator
● Team leader
● Team

25
 PROBLEM
STATEMENT
• Why are you doing this project?
• What is the problem you are addressing?
• Who is affected?
• When is it a problem?
• Why does it matter?
• How does it affect the patient?

• Consider aligning your project with at least one of the

Institute of Medicine’s six dimensions of quality: safe,
effective, patient-centered, timely, efficient, equitable.
• Current situation is , leading to (undesirable event).
26
 AIM STATEMENT:
What are you trying to
accomplish?
• Aims should be SMART, specific, clear,
well-defined, and at a minimum describe the
target population, the desired improvement,
and the targeted timeframe.

• To improve (your process) from

(baseline)% to (target)%, by (timeframe),
among (your specific population).
• To increase / decrease:
(structure/process/outcome)
• From: (baseline %, rate, #, etc)
• To: (goal/target %, rate, #, etc)
• By: . (date, 3–6-month timeframe)
• In: (population impacted) 27
 AIM; SMART

SMART MEASURABLE ACHIEVABLE RELEVANT TIME-BOUND

Is the statement Are the objectives Is this doable in the Do you have the Do you identify the
precise about what measurable? Will time you have? Are resources needed timeline for the project
the team hopes to you know whether . you attempting too (.people, time, – when will you
achieve? the changes resulted much? Could you do support?) Aligns accomplish each part?
in improvement? more? with mission

28
❑Establish the KPI
❑Analyze the pre-intervention Data

Are changes designed to improve one part of the systemor

29
FISHBONE/ISHIKAWA DIAGRAM
What is it?
• A visualization tool for brainstorming potential causes of a problem.
• Brainstorm all possible causes of the problem and put them in the
appropriate category.
• Keep prompting, ‘why?’
• Larger categories (Can include equipment/supplies, environmental
factors, rules/policy/procedure, technology, people/staff) help with
brainstorming.

When do I use it?

Useful in brainstorming sessions to focus the conversation. *You need to
have an agreed upon problem statement.*
Helps to engage people in an in-depth discussion on the problem.
Use when you are trying to assess the root causes of the problem.

30
31
QUALITY PROJECTS EXAMPLES
https://one.aku.edu/PK/akuh/qps/Pages/world-quality-day.aspx

32
DO : INTERVENTIONS
Establishing Measures: How will you know that a change is an
improvement?
Balancing Measures (looking at a system from different
directions/dimensions) For reducing patients' length of stay in the hospital,
Make sure readmission rates are not increasing.

33
STUDY

Evaluate the post

intervention data

34
 Standardization of existing systems and
processes

SUSTAINING THE Documentation of policies, procedures,

protocols and guidelines

IMPROVEMENT Measurement and review of

PHASE interventions to ensure that change
becomes past of “standard” practice

Training and education of staff

35
CONNECTION TIME
A nurse identifies that in unit fall incidences are high she
develops a plan activities to bring improvement using
PDCA. In this nurse is at stage of ---

36
CONNECTION TIME
A nurse is working on quality improvement project on fall
prevention using PDSA she reports the improvement in
results. In this nurse is at stage of ……

37
 QUALITY IMPROVEMENT AND PATIENT SAFETY PROGRAM AT
AKUH
Tour To Quality And Patient Safety Site

https://one.aku.edu/Pages/homepk.aspx

38
 SUCCESS

“There are no secrets to success. It is the

result of preparation, hard work, and
learning from failure.”
General Colin L. Powell

39
Comprehensive Unit-based
Safety Program (CUSP)

The Role of the Nurse Manager:

CUSP Toolkit

https://youtu.be/eXWO1Lmd6pE

40
Patient feedback And Incident Reporting
• https://one.aku.edu/PK/DocumentCentre/CA/Key%20Documents/Policies,%20Procedures,%2
0Protocols,%20Clinical%20Practice%20Guideline/Patient%20Feedback%20Management%2
0policy.pdf

Complaint:
Feedback:
An expression of dissatisfaction/
The information, statements or opinions
apprehension by or on behalf of an
about services provided, that offers and
individual patient regarding any aspect
idea of whether it is satisfactory or other
of health care services provided by the
wise
hospital.

Feedback may include suggestion,

A Complaint can be raised verbally or in
appreciation and complaint
writing

41
 ROLE OF NURSE
MANAGER/LEADER
➢ Identifying and working for continuous improvement
➢ Monitoring performances
➢ Teaching and educating basic standards
➢Communication and interaction with patients, staff,
other departments
➢ Generate and test new ideas for quality improvement.
➢ Management of infrastructure for high quality care.
➢ Risks management.

26/02/2019 42
CLINICAL OBJECTIVES
❑Patient and family rights
❑All policies related to IPSG 6 goals
❑Need to unit indicator
❑Visit the patient safety website and dig more new learning
❑Incident reporting in the unit
❑Complain handling
❑Action plan
❑Observe any QI project in progress or planning phase
❑Discuss the role of Comprehensive Unit-based Safety Program (CUSP)
43
 REFERENCES
Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing

(7th ed.). New Jersey: Prentice Hall.

Huber, D. L. (2014). Leadership and nursing care management (5th ed.). Philadelphia:

Curtis Center.

Mulkey MA. Engaging Bedside Nurse in Research and Quality Improvement. J Nurses Prof Dev. 2021 May-Jun 01;37(3):138-142. doi:
10.1097/NND.0000000000000732. PMID: 33782332; PMCID: PMC8106625.

Quality Improvement Initiative (2021) Lippincott Nursing center www.nursingcenter.com

Blok, A. C., Alexander, C. C., Tschannen, D., & Milner, K. A. (2022). Quality improvement engagement: Barriers and facilitators. Nursing Management, 53(3), 16-24.

Robinson J, Gelling L. Nurses+QI=better hospital performance? A critical review of the literature. Nurs Manag (Harrow). 2019;26(4):22–28.

Jones, B., Kwong, E., & Warburton, W. (2021). Quality Improvement Made Simple: What Everyone Should Know about Healthcare Quality Improvement: Quick Guide. Health Foundation.

44
MESSAGE OF THE DAY

45