Quality Improvement Flashcards
Describe the philosophy of quality improvement
A patient (customer) focus
Identification of key processes to improve quality
Use of quality tools and statistics to support improvements
Involvement of the HCT in problem solving
Committed leadership
Long term commitment
Pt focus: address the needs of patients and staff. Employees and department such as lab, admitting offices etc. External would include patients, visitors, physicians etc.
Key Processes – all activities in an organization have to be described in terms of processes. They can be complex and invovle multidisciplinary or interdepartmental actions. They must be investigated by members from each department in the activity to seek opportunities to reduce waste and inefficiencies to improve performance or positive outcomes.
Identification of Tools requires tools and statistics for measurement
Define quality care and quality improvement
Quality Care
- exceeding patient requirement
- it is the continuum to excellence
- quality represents the wise choices of alternative
Quality Improvement
This is a type of activity to improve patient care
“It is a process of continuously improving a system by gathering data on performance and suing multidisciplinary teams to analyze the system, collect measurements and propose changes (Huber, 1996, p. 483)
It should pervade the entire organization.
Refers to activities that are used to evaluate, monitor, or regulate services rendered to patients and a never ending cycle.
QI should pervade the entire organization to allow a circular appraisal and goal setting for improvement. The Canadian Government is also very involved with these programs and outcomes at a federal level.
It emphasizes doing the right thing and the end result is to satisfy patients.
Outline the structure, process, and outcomes for measuring quality care
- The criteria or standard must be determined
Information is collected to see if the standard has been met
Action must be taken if the criterion is unmet
This is development of a standard. the practice that is occurring is compared to the standard using the measurement tool. Managers must see that all staff know and understand the standards. Each employee must be aware that their performance will be measured in terms of their ability to meet the established standard (ie postop care)
- Information: what information is needed in order to measure the critiera? The data produced must be analyzed and interpreted and any deficiencies must be identified and then corrected
Action: Nurses need and want to improve care and create a better future. Action can include development of knowledge that is supportive of improvement efforts, cultivating a shared sense of purpose and focus, develop new knowledge and apply it.
IMPLICATION FOR PATIENT CARE
Must be measured by the value of care
Value is a function of cost and quality outcomes together (Kelly, p. 331)
Outcomes according to Kelly include a patients clinical or functional outcomes
Cost includes direct and indirect patient care needs.
Outcomes include - did the pt live, can the pt go back to work. They can be measured by pt satisfaction.
Cost: direct cost is the cost of care of the client ie cost of meds, OR equipment, direct pt caregiver salaries
Indirect costs – costs of other care activities including utility costs such as electricity, admitting clerks salaries and human resource staff.
IN most QI efforts as the quality improves by standardizing the care delivery processes and applying evidence based principles, the cost of care decreases.
BENCHMARKING
Is the tool for identifying desired standards of organizational performance (Marquis & Huston)
Kelly states that “it is the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers” (Kelly, p. 335)
- Structure (Audits) - Measures or Standards – focuses on internal characteristics of an organization and personnel.
- Process (Audits) -Measures or Standards – focuses on whether the activities are being conducted appropriately.
- Outcome (Audits)- Measures or Standards – Refers to whether the services provided make a difference
Identify measures to implement when quality improvement standards are not met
For nurses a key element in leadership is what decisions and actions to take when there is a sudden realization that something has gone wrong. Since the goal is to protect the patient, reporting and re-mediation must occur as quickly as possible
The reporting mechanisms set up in the system need to be followed
An incident report needs to be filled out and documentation and evidence of discharge of duty in a timely and thorough manner. No mention of an incident report should go into the patient chart.
Describe the role of the CRNBC and CNA in establishing and maintaining standards of practice for registered nurses
CRNBA developed professional standards for the BC nurses
CNA ?
