Class 8 - Health Care Quality Flashcards
Define health care quality
Goal
degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Scope of health care quality includes:
- resource efficient
- patient centered
- patient care outcomes
- patient satisfaction
- safe
- evidence-based
What are the attributes of health care quality
- safe: practice w/in standard of care
- timely: reduce wait time for services
- effective: EBP
- efficient: avoiding waste of resources (time, cost, suppliers, tx)
- equitable: doesnt vary in quality regardless of gender, ethnicity, geographic location, and socioecon. status
- patient-centred care
What are the results of poor health care quality
- poor patient outcomes
- lost income
- disability
- health care costs
how do we evaluate health care quality in the context of nursing
Process
- how health care is provided
- how the system works
Outcomes
- health status
- did the process make a difference
How do we reduce error in health care
identify errors, risks, and causes
What does the CNA Code of ethics say about errors
- question and intervene to address unsafe practice
- admit to mistakes + be accountable
- support a climate of trust that supports openness
What are the types of errors
- Near miss event
- adverse event
- sentinel event
What is a near miss event
- error occurred or almost occurred
- did not cause harm because it was caught or mitigated
What is an adverse event
failure to give care or inappropriate care caused unintended harm
What is a sentinel event
- event causes death or serious injury
- so serious it requires immediate investigation
define quality management
Philosophy
a philosophy of health care culture that emphasizes customer satisfaction, innovation, and employee involvement
Define quality improvement
Process
an ongoing process of innovation, prevention of error, and staff development that is used by institutions that adopt the quality management philosophy
What are the principles of quality management
- operates most effectively w/in a flat, democratic, organization structure
- managers and workers must be committed to quality improvement
- goal is to improve systems and processes, not to assign blame
- patient define quality
- quality improvement process focuses on outcomes
- decisions must be based on data
What are the benefits of quality management
- greater efficiency and proactive planning
- increases patient safety and quality care
- enhanced job satisfaction
What are the quality management/improvement responsibilities of a senior nurse leader
- provide resources and removes barriers
- provides education
- implement QI systems
- defines procedures for immediate response to errors in care
- lead culture of safety
How does a senior nurse leader create a culture of health care safety
- goal is to improve the system
- educate all employees about QI strategies
- free flow of communication
- embracing non-punitive error reporting
- encouraging vigilance in identifying potential risks
- creating partnerships w/ patients to promote communication about safety issues
What are the quality management/improvement responsibilities of a nurse manager
- accountable for quality performance
- provides times for staff to participate in QI
- provide guidance to staff
- uses data to measure effectiveness of improvement
What are the quality management/improvement responsibilities of a nurse/follower
- follow policy/procedure
- keep current: EBP
- reports quality and safety issues to manager
- participates actively in QI
What are examples of models for health care quality
- Donabedian Model
- lean management system
- six sigma
- Magnet hospital designation
Describe the Donabedian model
- defined outcomes used to validate the quality and effectiveness of care
- involves structure, process, and outcomes
Donabedian model, describe structure
- characteristics of settings in which care is delivered
- Affects both processes and outcomes of care
Donabedian model, examples of structure of care
- infrastructure
- demographics
- tech
- education
- facilities
- setting
- health care workers
Donabedian model, describe process
- the health care provided as well as support functions
- Includes the services offered, the technical quality of the services, the quality of interpersonal interactions, and the adequacy of patient education, access, safety, and promotion of continuity of care provided as well as support functions
Donabedian model, example of process of care
- diagnosis
- tx
- appropriateness
- process of care
- resources requirements
- assessment
- provider/client interactions
Donabedian model, describe outcomes
- measured
- the end result of an encounter with the healthcare system
- impacted by both processes of care and structures of care
Donabedian model, example of outcomes of care
- mortality
- morbidity
- cost
- factors creating cost
- quality of life
- clinical outcomes
- functional status
- pt experience
what is a root cause analysis
systemic approach aimed to discovering the causes of those calls and adverse events for the purpose of identifying preventative measures
Describe the root cause analysis process
- uses a team of 5-6 people
- work to isolate primary cause of event from incidental factors that may not have contributed
- aim is to re-design system to eliminate root cause or mitigate impact
Examples of barriers to accessing the health care system in Canada
- availability of services
- financial barriers
- non-financial barriers to presentation of health care needs
- barriers to equitable treatment
What are the steps of a root cause analysis process
- identify adverse event
- assemble the team
- develop initial flow diagram of processes leading to event
- interview all people involved & review documentation
- develop cause & effect diagram
- identify contributing factors
- develop system redesign
- measure outcomes
Root cause analysis process, what should be included in the “develop cause & effect diagram”
- actions & conditions that causes event
- includes communication problems, policy, procedure & human error leading to event
Define risk management
- systemic identification, assessment & prioritization of risks
- development & implementation of strategies to reduce adverse events
What is included in the risk management framework
- identify
- assess
- manage
- report
What is included in a risk assessment
Understanding the potential consequences if errors occur (risk were to be realized):
- physical or psychological harm
- disengaged staff or physicians
- financial loss
Errors could result in:
- reputational loss
- service/business interruption
- failed strategic initiatives
What is the goal of Manitoba Institute for Patient Safety (MIPS)?
committed to helping HCOs and healthcare providers learn about leading practices to improve patient safety
What does the Manitoba Institute for Patient Safety do?
- develops, shares, and promotes patient safety resources
- hosts and sponsors patient safety education
- advises on patient safety related policy and legislation
- raise awareness about patient safety issues and our organization
