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"Quality is never an accident; it is always the result of high intention, Sincere effort, intellegent direction and skillful execution; it represents the wise choice of many alternatives.

DEFINITION
Its a proactive approach with set of procedures developed and activities done before the product or service is manufactured or delivered to assure of good quality to the customers.

CQI is an ongoing quality improvement measure using management and scientific methods of quality assurance involving data collection, its analysis, and formulating ways to improve performance outcome according to proposed standards. -British Standards Institute

OBJECTIVES
Public accountability. Management improvement Facilitation of adoption of innovations

PURPOSES/ NEED
Rising expectations of consumer of services. Increasing pressure from national, international, government and other professional bodies . The increasing complexity of health care organizations. Improvement of job satisfaction. Highly informed consumer To prevent rising medical errors Rise in health insurance industry

1. Adopt the new philosophy. 2. Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place. 3. Minimize total cost. 4. Improve constantly 5. Institute training on the job. 6. Institute leadership. 7. Drive out fear, so that everyone may work effectively for the company

9. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. 10. Eliminate work standards (quotas) on the factory floor. Substitute leadership. 11. Eliminate management by numbers, numerical goals. Substitute to leadership.

 12. Remove barriers that rob the hourly worker of his right to pride of workmanship. 13. Institute a vigorous program of education and self-improvement. 14. Put everybody in the company to work to accomplish the transformation

APPROACHES
GENERAL APPROACH

SPECIFIC APPROACH

Credentialing

Licensure

Accreditation

Certification

Recognition Academic degree

Charter

Recognition

SPECIFIC APPROACH
Control committees Services

Steps in Quality Assurance Process

Define the Objectives Understanding Customer Needs Designing the Product Product Pilot Testing Process Development Start Manufacturing Life Cycle Management

QUALITY ASSURANCE V/S QUALITY CONTROL

Quality assurance
A failure prevention system that predicts almost everything about product safety, quality standards and legality that could possibly go wrong and then takes steps to control and prevent flawed products or services from reaching the advanced stages of the supply chain. Process based approach.

Quality control
A failure detection system that uses a testing technique to identify errors or flaws in products and tests the end products at specified intervals

Product-based approach

assurance of quality is done before starting a The quality control begins once the product has been manufactured. project assurance of quality is a proactive or Quality control is a corrective process to identify the defects in order to correct them. preventive process to avoid defects

Performed customers, auditors.

by and

managers, Performed third party customers, auditors.

by and

managers, third party

Engineers, inspectors, and Engineers, inspectors, and supervisors on the shop floor supervisors on the shop floor perform quality control activities. perform quality control activities. The quality assurance relies mostly The quality control department the guidelines and on the feedback provided by the follows standards established by assurance quality control department. of quality department to check whether deliverables meet the quality requirements or not. Third party quality monitoring Experts who are directly involved companies or corporate with the design, research or administrators. manufacture of a product.

PRINCIPLE OF JCAHO
written plan

Annual reassessment of program

problemfocused approach

Measurable improvement

STANDARDS

 Check Sheet Cause-and-Effect Diagram Cause-and-Effect Diagram Pareto Chart Scatter Diagram Probability Plot

 Histogram

Control Charts

Brainstorming

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE

Lack of Resources

Personnel problems Improper maintenance

Absence of well informed population

Lack of incident review procedures Lack of good and hospital information system Unreasonable Patients and Attendants

Absence of patient satisfaction surveys Lack of nursing care records Absence of accreditatio n laws Miscellaneous factors

BARRIERS IN CQI
Shewart, Walter A., Economic Control of Quality of Manufactured Product, Princeton, NJ: Van Nostrand Reinhold Co.

1. Poor Planning -- The absence of a sound strategy has often contributed to ineffective quality improvement. deficiencies in the original planning cause a process to run at a high level of chronic waste.

2. Lack of management commitment -- A quality implementation program will succeed only if top management is fully committed beyond public announcements.

Success requires devotion and highly visible and articulate champions.

3. Resistance of the workforce -- A workforce is often unwilling to embrace TQM for a variety of reasons. A TQM project must be supported by employee trust, acceptance and understanding of management's objectives. employees will not work to their fullest potential when management defines its goals in terms of numbers. In this case, the focus shifts to level of production instead of to quality of production output. aging workers as well as workers who suffer from illiteracy or language barriers, may resist the implementation of new ideas and alien concepts

4. Lack of proper training -- There is evidence that lack of understanding and proper training exists at all levels of an organization, and that it is a large contributor to worker resistance.

5. Teamwork complacency -- Most TQM programs place substantial emphasis on teamwork and problem-solving groups. Problems arise when teams feel they have no authority, when they lack direction and purpose and when their large number causes status confusion. Newall and Dale found that teams are seldom fully used, and their individual members are often complacent.

6. Lack of resources provided many quality departments were over-worked and understaffed. although the return on investment for a quality improvement project is very high, many companies fail to provide the resources necessary to achieve significant results.
7. Lack of effective measurement of quality improvement -- TQM is centered around monitoring employees and processes, and establishing objectives that anticipate the customer's needs so that he is surprised and delighted. This has posed a considerable challenge to many companies.

Solutions for Quality Improvements

Individual Problem Solving Rapid Team Problem Solving Systematic Team Problem Solving

STANDARDS

DEFINITION
Standards are written formal statements to describe how an organization or professional should deliver health service.

Organizations
AHRQ Agency for Healthcare Research and Quality IHI Institute for Healthcare Improvement JCAHO Joint Commission on Accreditation of Healthcare Organizations NAHQ National Association for Healthcare Quality IOM Institute of Medicine NCQA National Committee for Quality Assurance

Characteristics of Standard
broad enough realistic, acceptable, and attainable. must be developed by members of the nursing profession. Phrased in positive terms must express what desirable optional level understandable and stated in unambiguous terms. based on current knowledge and scientific practice. must be reviewed and revised periodically.

Purposes of standards
Give direction and provide guidelines for performance of nursing staff. Provide a baseline for evaluating quality of nursing care Help improve quality of nursing care Improve documentation Determine the degree to which standards of nursing care maintained Help supervisors to guide nursing staff to improve performance. Improve basis for decision-making Help justify demands for resources association. Clarify nurses area of accountability.

Standards of Professional Conduct

The Profession of History Shared Values Scholarship Plagiarism Teaching History in the Public Realm Employment Reputation and Trust

Classification of Nursing Standards

Normative and Empirical Standards Process Standard Outcome standard

LEGAL SIGNIFICANCE OF STANDARDS

a patient-nurse relationship existed such that the nurse owed to the patient a duty of due care, the nurse deviated from the appropriate standard of care, the patient suffered damages, The patient's damages resulted from the nurses deviations from the standard of care

 ...What to change?, What to change to?, and how to cause the change?.... If a manager doesn't know how to answer those three questions is he or she entitled to be called a manager? Albert einstein

REFERENCE
Ward MJ, Price SA .Issues in nursing administration. St.Louis: Mosby; 1991. Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis; 1996. Basavanthappa BT. Nursing Administration. 1st edn. New Delhi: Jaypee Brothers; 2000 Johnson M and Closkey J.C. The Delivery of Quality Health Care Series on Nursing Administration. London: Mosby 1992 Koch M.W And Fairly T.M. Integrated Quality Management: The Key To Improving Nursing Care Quality. Marquis B.L. Leadership roles and management functions in nursing Theory and application. 5th ed. Philadelphia: Morrison M. Professional skills for leadership. Mosby: US; 1993.

Ho ! Ho! Ho!