Quality management

COTINUOUS
QUALITY
IMPROVEMENT

Quality and Patient Safety

Top priorities
Quality

and Patient Safety.

Commitment to provide exceptional patient
care and customer service throughout all our
facilities.
To ensure expert medical care in the safest
environment possible, in both an inpatient and
outpatient setting.

Quality Management

Quality : Degree to which a set of inherent

characteristic fulfills requirements.
Quality : the perception of the degree to
which the product or service meets the
customer's expectations.
Quality Management: Managing the
continuous improvement of service
delivery processes and outcomes through
data-driven strategies and empowered
staff to exceed customer expectations.

Quality management
Quality

management is a method for ensuring

that all the activities necessary to design,
develop and implement a product or service
are effective and efficient with respect to the
system and its performance.

The heart of analysis is customer needs.

Quality is not the absence of errors as
defined by the supplier, but the presence of
value as defined by the customer.

Customer satisfaction is when customer

needs and expectations are met or exceeded.

Basics : Strategize For Customer Loyalty!

Power Up Your Organization for Maximum
Retention

Handling Customer Complaints: Best Practices in

Resolving Customer Complaints
Consumers expect value for their money and count
on the existence of services when needed.

patients are demanding to be

informed partners in decisions
regarding their health
patients now complain, demand,
report and sue and have realized
that the quality of nursing care is an
important factor in patient
outcomes.

Responding to Angry
Customers:Understanding Hostile Customers .Give
An Angry Customer Even More Than They Asked For.

Measuring Customer Satisfaction: Using

satisfaction surveys to achieve a competitive advantage
When Should Changes Be Made to a Customer
Satisfaction Tracking Questionnaire

Continuous Quality
Improvement
Continuous Quality Improvement (CQI): is an
organizational process in which staff identify,
plan, and implement ongoing
improvements in service delivery.

CQI provides a vital way to assess and

monitor the delivery of services to ensure
that they are consistent with an
organizations best practice clinical
principles.

 The

primary goal of the Quality Improvement

program is the ongoing improvement of the
delivery, quality, efficiency, and outcome of
patient care and services.

 Quality

Management System (QMS) can be

defined as a set of policies, processes and
procedures required for planning and execution
(production / development / service) in the core
business area of an organization.

Continuous Improvement
Methods
Widely

used methods of continuous

improvement such as, Six Sigma and
Total Quality Management .They
emphasize employee involvement and
teamwork; measuring and systematizing
processes; and reducing variation,
defects and cycle times.

Total Quality Management (TQM) is a management

strategy aimed at embedding awareness of quality in
all organizational processes. TQM has been widely
used in manufacturing, education, government, and
service industries, as well as NASA space and science
programs.
Total Quality provides an umbrella under which
everyone in the organization can strive and create
customer satisfaction at continually lower real costs.

Total Quality Management (TQM )

TQM

is composed of three paradigms:

Total: Involving the entire organization, supply
chain, and/or product life cycle
Quality: With its usual Definitions, with all its
complexities
Management: The system of managing with
steps like Plan, Organize, Control, Lead, Staff,

 Six

Sigma is a set of practices originally

developed by Motorola to systematically
improve processes by eliminating defects.A
defect is defined as nonconformity of a product
or service to its specifications.

 The

term "Six Sigma" refers to the ability of

highly capable processes to produce output
within specification. In particular, processes
that operate with six sigma quality produce at
defect levels below 3.4
defects per (one) million opportunities (DPMO).
Six Sigma's implicit goal is to improve all
processes to that level of quality or better.

Quality Improvement Heroes:

W.

Edwards Deming is best known for his

management philosophy establishing
quality, productivity, and competitive
position. He has formulated 14 points of
attention for managers, some of these
points are more appropriate for
service management .

Break down barriers between departments;

Management should learn their responsibilities,
and take on leadership
Improve constantly
Institute a program of education and selfimprovement.
The following diagram is the (PDCA) cycle for
quality improvements, made popular by Deming.

 FOCUS

on a particular issue.
Find a process to improve
Organize to improve a process
Clarify what is known
Understand variation
Select a process improvement

 The

philosophy is to keep improving the quality of an

organization. It is defined by four keys:
Plan: Design or revise business process components to
improve results
Do: Implement the plan and measure its performance
Check: Assess the measurements and report the results
to decision makers
Act: Decide on changes needed to improve the process

Quality Standards
The International Organization for Standardization (ISO
) created the Quality Management System (QMS)
standards in 1987. These were the series of standards
comprising ISO 9001:1987, ISO 9002:1987 and ISO
9003:1987; which were applicable in different types of
industries, based on the type of activity: designing,
production or service delivery.

History

the concern for high quality health care dates back

to the 5th Century BC, when Hippocrates
established a code of medical ethics, obliging future
doctors to swear "never to do harm to anyone".
The history of quality assurance activities in nursing
can be traced back to Florence Nightingale's
attempts to improve the conditions of care Her
standards to assess the care of the soldiers has
been established as one of the first documented
efforts of quality improvement work as a priority for
nurses throughout the world (Kahn, 987: 21).

Improving Quality through Nursing

the

role of nursing in providing quality health

care.
the impending gap between the need for
nurses and the supply ,the various ways that
hospitals and other health organizations are
reducing nurse staffing and increasing nurse
workloads.

Improving Quality through Nursing

The quality of nursing is central to preventing errors in

hospitals and providing high-quality care.
It was have demonstrated an association between
nurses workload and the number of deaths in hospitals.
It was have also shown an association between nurses
education and the number of deaths.
highly dissatisfied nurses with their working conditions ,
lack of autonomy, turnover and burnout.Studies have
suggested that when nurses have more control over
their work, care improves and hospitals function better.

FACT
Hospitals

with low nurse staffing levels tend to

have higher rates of poor patient outcomes
such as pneumonia, shock, cardiac arrest, and
urinary tract infections, according to research
funded by the Agency for Healthcare Research
and Quality (AHRQ) and others.

Functions of the quality improvement

department to improve nursing quality

Develop mechanisms for using evidence-based

practice to improve quality of care
Support nursing staff involvement in collaborative
quality initiatives that improve organizational
performance and patient outcomes
Assist nursing staff to interpret and use data from
internal and external sources to improve care or
resolve identified problems
Promote safe practices by infusing a culture of safety
for both patients and staff.

Promote the use of an institutional set of core outcome

indicators to monitor and improve care
Facilitate performance improvement efforts of
department and interdisciplinary teams
Coordinate or conduct interdisciplinary performance
improvements that impact patient care delivery from
multiple services
Provide education and consultation to internal and
external constituents regarding quality and outcomes
management activities

 Promote

a scientific approach to problemsolving in management and delivery of patient

care services
Promote discussion and exchange of
information regarding status and progress of
evidence-based practice, and process
improvement projects.

scope
The

scope of patient care services provided by

the department includes:
Assessment of patients
Planning, implementing, evaluating the nursing
plan of care
Administration of medications
Administration of treatments and therapies
Patient and family education

Structure, Process and

Outcome

Structure is the evaluation of the organization of the

institution delivering care; the conditions under which
care is provided and its impact on quality, i.e. buildings,
budget and equipment.
Process concerns the evaluation of the performance of
health professionals in the management of patients
outcome is the evaluation of the end result,
observable changes in the health status of the patient.

Quality Tools

Cause Analysis Tools

Tips and tools for the first step to improvement
identifying the cause of a problem or situation.
Evaluation and Decision-Making Tools
Making informed decisions and choosing the best
options with a simple, objective rating system, and
determining the success of a project.
Process Analysis Tools
How to identify and eliminate unnecessary process
steps to increase efficiency, reduce timelines and cut
costs.

Quality Tools You Can Use

Flowcharting
Fishbone diagrams
Pareto charts
SMART goals
Brainstorming
Benchmarking
Interviews
Nominal group process
Force-field analysis
Multi-voting
Cost-benefit analysis

Observation
Written standards and
procedures
Rewards
Teamwork
Questionnaires
Charts/graphs
Time-run chart

 Seven

Basic Quality Tools

These seven tools get to the heart of
implementing quality principles.
These are the most fundamental quality
control (QC) tools. They were first
emphasized by Kaoru Ishikawa, professor
of engineering at Tokyo University and
the father of quality circles.

1.

Cause-and-effect
diagram (also called
Ishikawa or fishbone
chart): Identifies
many possible
causes for an effect
or problem and sorts
ideas into useful
categories.

Check sheet: A
structured, prepared
form for collecting
and analyzing data; a
generic tool that can
be adapted for a wide
variety of purposes.

Control charts: they

are also
called:
Control Chart: Out-of-Control
Signals
statistical process
control .
They are:Graphs used
to study how a
process changes over
time.

Histogram: The most

commonly used graph
for showing frequency
distributions, or how
often each different
value in a set of data
occurs.

Pareto chart: Shows

on a bar graph which
factors are more
significant.

Pareto chart is a bar that displays categories of data in

descending order of frequency from the left to the right.
When analyzing data about the frequency of
problems or causes in a process.
There are many problems or causes
Communicating with others about your data.

Scatter diagram: Graphs

pairs of numerical data,
one variable on each axis,
to look for a relationship.

Is there any relationship

between product purity
(percent purity) and the
amount of iron

Stratification: technique
that separates data
gathered from a
variety of sources so
that patterns can be
seen.

Risk management
Risk

management is the human activity which

integrates recognition of risk, risk assessment,
developing strategies to manage it, and
preventing of risk using managerial resources.
The strategies include transferring the risk to
another party, avoiding the risk, reducing the
negative effect of the risk, and accepting some
or all of the consequences of a particular risk

Steps in the risk management process

Identification

of risk in a selected domain of

interest
1. Planning the remainder of the process.
2. Mapping out the following: the social scope
of risk management, the identity and objectives
of stakeholders, and the basis upon which risks
will be evaluated, constraints.
.

 3.

Defining a framework for the activity and

an agenda for identification.
4. Developing an analysis of risks involved in
the process.
5. Mitigation of risks using available
technological, human and organizational
resources

Potential risk treatments

Avoidance (elimination) :Includes not performing an

activity that could carry risk
Reduction ( mitigation): Involves methods that reduce
the severity of the loss
Retention :Involves accepting the loss when it occurs.
Self insurance
Transfer ( buying insurance) :Means causing another
party to accept the risk, typically by contract