Quality Management
Quality Management
Quality Management
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Why would a customer buy if
another seller is also offering
the same product?
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QUALITY
Attribute which
differentiates a
product or service
from its
competitors
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SIGNIFICANCE AND PURPOSES OF QUALITY
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The phrase “That’s not my job”
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We Need To Change The Phrase
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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.
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CHARACTERISTICS OF TQM
Customer/client focus
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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.
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QUALITY MANAGEMENT SYSTEM
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QUALITY MANAGEMENT PROCESS
Performance standards
Performance measures
Quality Control
Quality Improvement
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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
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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
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AUDIT AS A QUALITY CONTROL TOOL
An audit is a systematic and official examination of record, process,
structure, environment or account to evaluate performance.
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)
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Donabedian’s Model
Structure Process Outcome
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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
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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)
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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
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CONTINUOUS QUALITY IMPROVEMENT (CQI)
There are four major players in the CQI process:
● Resource group
● Coordinator
● Team leader
● Team
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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?
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❑Establish the KPI
❑Analyze the pre-intervention Data
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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.
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QUALITY PROJECTS EXAMPLES
https://one.aku.edu/PK/akuh/qps/Pages/world-quality-day.aspx
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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.
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STUDY
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Standardization of existing systems and
processes
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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 ---
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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 ……
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QUALITY IMPROVEMENT AND PATIENT SAFETY PROGRAM AT
AKUH
Tour To Quality And Patient Safety Site
https://one.aku.edu/Pages/homepk.aspx
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SUCCESS
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Comprehensive Unit-based
Safety Program (CUSP)
https://youtu.be/eXWO1Lmd6pE
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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.
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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.
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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)
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REFERENCES
Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing
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.
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.
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MESSAGE OF THE DAY
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