Chapter 25 The Role of Quality Management in Accountability Fundamentals of Nursing: Standards & Practices, 2E

 Copyright 2002 by Delmar, a division of Thomson Learning 25-2 The Quality Movement In Health Care  The American College of Surgeons, established in 1913, was the first organized effort to develop quality standards in health care.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-3 Role of the JCAHO  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  Founded in 1951, it has become the largest accrediting organization in health care.  Quality assurance was introduced into the accreditation standards in the 1980s.  The current approach is continuous quality improvement.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-4 Defining Quality  Quality is defined as meeting or exceeding requirements of the customer/client.  A customer is anyone who uses the products, services, or processes of an organization.  Quality is measured in terms of customer perspective.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-5 Factors Influencing the Quality Movement in Health Care  Consumer demand  Financial viability  Professional accountability  Regulatory requirements  Progress in quality improvement techniques  Changes in health care delivery

 Copyright 2002 by Delmar, a division of Thomson Learning 25-6 Legal Implications  Laws and regulations create the external structure for quality management.  Failure to provide quality health care can result in lawsuits.  Institutions can face liability for action taken against a practitioner if objective measures are not applied to performance, and due process is not provided.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-7 Ethical Implications  Laws establish standards of acceptable conduct but they often represent only a minimum acceptable standard.  Nurses have an ethical responsibility to deliver the highest quality of health care.  Laws provide guidelines and ethics provide a sense of obligation.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-8 Quality and Cost  Delivery of poor quality care has a negative financial impact on health care organizations.  Today it is believed that efficiency can be improved without compromising quality.  The primary cost-containment measure in health care delivery has been the proliferation of managed care systems.

 Copyright 2002 by Delmar, a division of Thomson Learning 25-9 Quality Improvement  Quality assurance (QA)  Continuous quality improvement (CQI)  Total quality management (TQM)

 Copyright 2002 by Delmar, a division of Thomson Learning Customer Perspective  A customer’s dissatisfaction with one facet of service can be generalized to all related delivery systems.  Another effect of customer dissatisfaction is a tarnished community image.  Satisfaction is subjective, therefore, health care providers must listen to the customer constantly.

 Copyright 2002 by Delmar, a division of Thomson Learning Organizational Structure for Quality Management  Organizational culture  Work force diversity  Empowerment  Leadership  Teamwork

 Copyright 2002 by Delmar, a division of Thomson Learning Process Improvement  Each person’s action in an organization is a performance step that is connected to the action of others; this series of steps is known as a process.  Organizations must effectively use resources by focusing on high-priority systems that affect client outcome.

 Copyright 2002 by Delmar, a division of Thomson Learning  A scientific approach to performance improvement must be undertaken as it results in the following Minimal use of intuition and opinion More effective problem identification Understanding root causes of variation Better evaluation of alternative solutions Statistical measurements of improvement

 Copyright 2002 by Delmar, a division of Thomson Learning  Tools to evaluate organizational performance Audit Peer review Benchmarking Clinical pathways

 Copyright 2002 by Delmar, a division of Thomson Learning Nursing’s Role in Quality Management  Nurses function as clinicians, team members, and managers.  Each role has specific responsibilities for quality performance and requires certain skills to achieve the expected level of performance.

 Copyright 2002 by Delmar, a division of Thomson Learning Characteristics of Quality Nursing Care  Maintenance of a current knowledge base and competencies  Interpersonal skills  Caring and compassion  Mutual decision-making with client and nurse  Individualized treatment