1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 17 Quality Management

2. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Quality Management What is quality? Indicators of quality in health care

3. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 JCAHO Indicators of Quality of Care Appropriateness Availability Continuity Effectiveness Efficacy

4. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 JCAHO Indicators of Quality of Care Efficiency Respect Caring Safety Timeliness

5. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Quality Assurance Accountability of provider to deliver quality care

6. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Quality Improvement Process of attaining a higher level of performance

7. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Measuring Quality Identify key indicators Identify key processes Enhance key processes Determine outcome achievement

8. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Total Quality Management (TQM) Continuous Quality Improvement (CQI) Based on work of W. Edwards Deming Continual improvement Efficient systems

9. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Historical Development of Quality in Health Care Nightingale’s pioneering efforts Quality assurance emphasis Standards of care National Association for Healthcare Quality JCAHO quality control

10. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 International Organizations for Quality Health Care International Society for Quality in Health Care European Society for Quality Healthcare

11. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Why is quality important to community health nursing?

12. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Quality (According to Juran, 1988) Quality planning Quality control Quality improvement

13. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Quality (According to W. Edwards Deming, 1986) Key points  Continual improvement  Examine processes and systems  Create a trusting environment  Empower staff to make decisions

14. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Total Quality Management/Continuous Quality Improvement Management philosophy Process driven Teamwork Leadership

15. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Total Quality Management/Continuous Quality Improvement (cont.) Empowerment Individual responsibility Prevent outcomes Data-based collaborative approach Systematic, cyclical

16. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 How to Develop a Quality Assurance/Quality Improvement Program Performance knowledge Performance measurement Performance improvement

17. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Evaluative Models Donabedian’s model  Structure  Process  Outcome

18. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Purpose of Outcomes research in nursing Determine “best practice” Determine cost-effective interventions Demonstrate nursing’s contribution to health care delivery

19. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Applying QA/CQI in Community and Public Health Settings Structure Process Outcomes

20. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 17 Applying QA/CQI in Community and Public Health Settings (cont.) Evaluation  Identify strengths and weaknesses  Compare care standards and health care practice Communication  Communicate findings Action  Develop action plan