Chapter 23 Flashcards
Exam 4 (Final)
Fifth and Final Step of the Management Process
Quality Control:
Quality Control: Fifth and Final Step of the Management Process
What is it?
Activities that are used to evaluate, monitor, or regulate services rendered to consumers
Quality Control: Fifth and Final Step of the Management Process
How is performance measured?
Performance is measured against predetermined standards.
Quality Control: Fifth and Final Step of the Management Process
What happens when there are discrepancies between standards and actual performance?
Action is taken to correct discrepancies between these standards and actual performance.
Management Controlling Functions
What is one periodically?
Periodic evaluation of unit philosophy, mission, goals, and objectives
Management Controlling Functions
What is there an measurement of?
Measurement of individual and group performance against preestablished standards
Management Controlling Functions
What is audited?
Auditing of patient goals and outcomes
Hallmarks of Effective Quality Control Programs
Include:
Support from top-level administration
Commitment by the organization in terms of fiscal and human resources
Quality goals reflect search for excellence rather than minimums.
Process is ongoing (continuous).
Quality management is what kind of process?
Quality management is an ongoing process.
Three Steps of the Quality Control Process
- The criterion or standard is determined.
- Information is collected to determine whether the standard has been met.
- Educational or corrective action is taken if the criterion has not been met.
Quality Control as a systematic process:
If defining health care quality is problematic, then what happens?
If defining health care quality is problematic, then the measurement of health care quality is even more difficult.
Quality Control as a systematic process:
To make the process more effective and efficient, what is done?
To make the process more effective and efficient, the collection of both quantitative and qualitative data is used as well as specific and systematic process
Standards #1
What is to be followed and practiced?
Predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced
Standards #1
Regarding standards, what must each org and profession do?
Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care.
What is a standard?
A standard is a level of excellence that serves as a guide for practice.
Standards:
Have distinguishing characteristics like:
Standards have distinguishing characteristics they are predetermined, established by an authority, and communicated to and accepted by the people affected by them.
Because standards are used as a measuring tool, how must they be?
Because they’re used as a measuring tool, they must be objective, measurable, and achievable.
Standards #2:
What plays a key role in developing standards for the nursing profession?
The American Nurses Association (ANA) has played a key role in developing standards for the nursing profession.
The scope and standards of practice originally published by the ANA in 1991 and revised several times since provided foundation for all registered nurses in practice. these standards consist of:
The scope and standards of practice originally published by the ANA in 1991 and revised several times since provided foundation for all registered nurses in practice. these standards consist of
standards of practice
and standards of professional performance.
Benchmarking: What is it?
The process of measuring products, practices, or services against best-performing organizations
Organizations can determine what?
Organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement.
Quality Gap
The difference in performance between top-performing health care organizations and the national average is called the quality gap.
Quality Gap
Where is it typically small? Where is variation more common?
Although the quality gap is typically small in industries such as manufacturing, aviation, and banking, variation is more common in health care.
Quality Gap
What is an example?
hospital readmission rates.
According to recent data, top-performing hospitals may have readmission rates for conditions like heart failure around 15%, while the national average sits closer to 25%.
This 10% difference represents a quality gap, as top hospitals consistently achieve better outcomes due to higher care standards, more effective follow-up procedures, and comprehensive discharge planning.
Determining the Source of the Error
What is used?
Computer-aided error analysis and root cause analysis
Computer-aided error analysis and root cause analysis:
What is it?
help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur.
Clinical Practice Guidelines:
What do they provide?
Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care
Clinical Practice Guidelines:
What are they also called?
Also called standardized clinical guidelines
Clinical Practice Guidelines:
What should they reflect?
Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices
What is an audit?
An audit is a systematic and official examination of a record, process, structure, environment, or account to evaluate performance.
Auditing in healthcare organizations provides:
Auditing in healthcare organizations provides managers with a means of applying the control process to determine the quality of service rendered.
Audits Frequently Used in Quality Control:
Structure—
Process—
Outcome—
Audits Frequently Used in Quality Control:
Structure
—monitor the structure or setting in which patient care occurs
Audits Frequently Used in Quality Control:
Process—
measure the process of care or how the care was carried out
Audits Frequently Used in Quality Control:
Outcome—
determine what results, if any, followed from specific nursing interventions for patients
Nursing Sensitive Outcomes: There is growing recognition that what?
There is growing recognition that it is possible to separate out the contribution of nursing to the patient’s outcome;
Nursing Sensitive Outcomes:
There is growing recognition that it is possible to separate out the contribution of nursing to the patient’s outcome;
This recognition of outcomes that are nursing sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession.
Sample Standardized Nursing Languages and Measures
NANDA International (NANDA-I)
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
Clinical Care Classification System (CCC)
The Omaha System
Perioperative Nursing Data Set (PNDS)
International Classification for Nursing
Practice (ICNP)
Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)
Logical Observation Identifiers Names and Codes (LOINC)
Nursing Minimum Data Sets (NMDS)
Nursing Management Minimum Data Sets (NMMDS)
ABC Codes
Quality Assurance and Quality Improvement
How has healthcare system changed?
Over the past three decades, the American health care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI).
Quality Assurance and Quality Improvement
Over the past three decades, the American health care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI).
The difference between the two concepts is that QA models target currently existing quality; QI models target ongoing and continually improving quality.
Total Quality Management (TQM):
Also referred to as?
Also referred to as continuous quality improvement (CQI)
Total Quality Management (TQM):
What is it based on the premise of?
Based on the premise that the individual is the focal element on which production and service depend
Total Quality Management (TQM):
What is the focus on?
Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving.
Total Quality Management (TQM):
What is it?
TQM is based on the premise that the individual (i.e., customer/client/patient) is the focal element on which production and service depend and that the customer knows best.
Total Quality Management (TQM):
What is the focus on?
The primary focus is on quality and not cost.
Total Quality Management (TQM):
What is favored? What should be promoted?
In TQM, team efforts are favored over individual accomplishments–Promote teamwork rather than individual accomplishments.
Quality Measurement as an Organizational Mandate:
What is a major accrediting body for healthcare in the US?
The Joint Commission is the major accrediting body for health care organizations and programs in the United States.
Quality Measurement as an Organizational Mandate:
The Joint Commission is the major accrediting body for health care organizations and programs in the United States.
It also administers the ORYX initiative and collects data on core measures to better standardize data collection across acute care hospitals, and for National Patient Safety Goals (NPSG).
Quality Measurement as an Organizational Mandate
NPSG stands for what? What was it established by? Why?
NPSG stands for National Patient Safety Goals, which are established by The Joint Commission (TJC) to improve patient safety in healthcare settings.
Quality Measurement as an Organizational Mandate
NPSG stands for National Patient Safety Goals, which are established by The Joint Commission (TJC) to improve patient safety in healthcare settings. What do these goals aim to do?
These goals aim to reduce the risk of medical errors and enhance the quality of care provided to patients.
Quality Measurement as an Organizational Mandate
Joint commission = Standardizing clinical outcome data collection for :
ORYX
Core measures
National Patient Safety Goals
Sentinel Event
A sentinel event is defined by TJC as a patient safety event (an event, incident, or condition that could have resulted or did result in harm to a patient) that results in death, permanent harm, or severe temporary harm. ( TJC 2022a)
Sentinel Event:
Events are called sentinel because?
Such events are called “Sentinel” Because they signaled the need for immediate investigation and response.
Sentinel Event
(RCA) Root Cause Analysis with a Sentinel event is?
(RCA) Root Cause Analysis with a Sentinel event is a systematic approach used in healthcare to investigate and understand the underlying reasons for serious, unexpected event that leads to patient harm or near miss.
Sentinel Event
Signal for what?
Sentinel events are incidents that signal a need for immediate investigation, as they indicate a breakdown in processes that could result in severe outcomes like injury or death.
Centers for Medicare & Medicaid Services (CMS):
What role does it play?
CMS plays an active role in setting standards for and measuring quality in health care including pay for performance.
Medical Errors #1:
A plethora of studies across the past two decades suggests
A plethora of studies across the past two decades suggests that medical errors are rampant in the health care system.
Medical Errors #1:
What does not eliminate the underlying problem of medical errors?
Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems.
Medical Errors #2
What is a “just culture”?
A “just culture” deemphasizes blame for errors and focuses instead on addressing factors that lead to and cause near misses, medical errors, and adverse events.
Medical Errors #2
A “just culture” avoids what?
A just culture avoids focusing solely on blame and punishment while still promoting accountability.
Medical Errors #2
What kind of culture should organizations foster?
Organizations should foster a “just culture climate” where analysis of errors is not solely focused on blame.
Strategies to Prevent Medical Errors
Better reporting of the errors that do occur
The Leapfrog initiativesReform of the medical liability system
Other point-of-care strategies
Bar coding
Smart IV pumps
Medication reconciliation
Leapfrog Group Initiatives
What does it include?
Computerized physician–provider order entry
Evidence-based hospital referral
ICU physician staffing
The use of Leapfrog safe practices scores
