Nursing leader driving quality care.

1. NURSING LEADER DRIVING QUALITY CARE
Manjunathan C,
RN RPN., M.Sc.(N)., M.Sc.,(CP)
Deputy Nursing Superintendent,
Apollo CBCC Cancer Care,
Apollo Hospitals International Ltd.

2. Introduction to Quality
 Quality of care plays an important role in describing the intricate relationships
between quality, cost, and accessibility of health care within a community.
 Carrying out interventions correctly according to pre-established standards and
procedures, with an aim of satisfying the customers of the health system and
maximizing results without generating health risks or unnecessary costs.
“A process for making strategic choices in health systems”

3. Define: Quality
National Association of Quality Assurance Professionals described quality as “the
level of excellence produced and documented in the process of patient care, based on
the best knowledge available and achievable at a particular facility.”
The Community Health Accreditation Program defined quality as “the degree to
which consumers progress toward a desired outcome”

4. Leadership in Quality
 Leadership- the process of influencing others
 Leaders inspire thru personal trustworthiness & self-confidence
 Leaders communicate a vision of quality that turns self-interest into commitment
to the job

5. Difference: Boss / Leader Drive Quality
• A boss manages their employees, while a leader inspires them to innovate, think
creatively, and strive for perfection. Every team has a boss, but what people need is
a leader who will help them achieve greatness of quality in health care.

6. Nurse Drive Change in Patient safety
• Nurse Relates to providing care processes and
achieving outcomes as supported by scientific evidence.
Effectiveness
• Nurse Relates to maximizing the quality of a
comparable unit of health care delivered or unit of
health benefit achieved for a given unit of health care
resources used
Efficiency
• Nurse Relates to providing health care of equal quality
to those who may differ in personal characteristics
other than their clinical condition or preferences for
care.
Equity
• Relates to meeting patients' needs and preferences and
providing education and support.
Patient centered
• Relates to actual or potential bodily harm.
Safety
• Relates to obtaining needed care while minimizing
delays.
Timeliness

7. Cont…
Unit Based Clinical Leadership Model
The Healthcare Leadership Model is made up of nine behavioural dimensions:
• Inspiring shared purpose
• Leading with care
• Evaluating information
• Connecting our service
• Sharing the vision
• Engaging the team
• Holding to account
• Developing capability
• Influencing for results

8. Role of Nurse in Hospital Quality
Improvement
Nurses Pivotal to Hospital Quality Initiatives:
Hospitals face increasing demands to participates in a wide range of quality improvement
activities.
The nurses are reliant on nurses to help address these demands. Nurses faces challenges
and can provide important insight about how hospitals can optimize resources to
improve patient care quality.
1.Key quality improvement areas are,
a. Maintaining ALOS
 Prevention and controlling of Infection
 Prevention of fall
 Effective Assessment, Plan of Care, Documentation and Hands Off (SBAR) as well Pain
assessment.
b. Specific area quality improvement
 Extravasations
 TAT for Immunosuppressant's
 TAT for Critical test
 TAT for Critical values
 Accidental removal of tubing's
 MET Criteria-Code Orange (Rapid Response team)
 Code Blue
Data collection on quality indicator(Nursing, Infection Control and Specific) Gap
analysis and sustaining on basis of PDCA etc.

9. Quality Improvement Program /
Demands Increasing
Hospital have had quality improvement department. It It is not new for the hospital,
What is new however the demands increasing due to,
• Uplifting of policies SOPs, Manuals and Protocols ,
1. EXTERNAL PROGRAMES
• Accreditation (JCI, NABH, Bureau VERITAS and ISO 500001), regulatory bodies,
quality improvement, Medical speciality societies, State hospital associations and
health plans. In addition to these external programmes.

10. Cont…
2. INTERNAL PROGRAMES
The hospitals engaging in variety of internal quality improvement activities based on
patient and employees feedback.
• Lean six Sigma Project
• Internal Clinical Audit
• AIDET
• SHHh
• Ward as a Unit Programmes
• Weekly process
• Apollo Way
• Apollo Clinical Excellence
• Uniflow system
• SUD tracking
• IPSG & HIRA
• 360 degree audits
• Cross functional audits
• Open and Closed audits
• Case and data presentation audits
• Competencies, Annual Appraisal and trainings like Mandate, Induction and
preceptors etc.
• Others Like MOM, HICP,ESP,PFE.

11. How can QI Division Support You for quality
improvement programe

12. Fish Bone Technique for Finding fit falls

13. QI MODEL FOR IMPROVEMENT
• Model consists of:
– three questions (aim, measure,
change) to form context for
improvement
– Plan-Do-Study-Act (PDSA) Cycle to
structure tests

14. Various Pressure Drive Hospital
Participation Decision
The hospital itself require a quality accreditation certification to tie up with corporate
patients, TPA (Med sav, Apollo Munich, Max health), ONGC, CGHS, Maa Yojana, ECHS
(Cashless and Reimbursement).
To stand as a competitors in market, It is bound to show the important on quality
progress.
The pressure from Local Bodies, National Bodies and International Bodies.
More than above all,
Liabilities, Consumer act, rights and Responsibilities of patients, Patient rights and
education, These are the highly pressured area to have accreditation
The pressure drives for reimbursement, This created strong financial incentives for
hospitals.

15. Demands Increase, So Does the role of
Nurses
Respondents described how vital nurses are to hospitals, that nursing care is a major
reason why people need to come to a hospital,
‘The nurses are heart and Soul’ of the hospitals. Nurses spend most of the time at the
patient bedside.
‘Nurses are the safety net’, They are right there, Real time, catching medication errors,
catching patient falls etc.,,

16. Cultures sets for Quality Improvement
• The supportive hospital culture is the key to make important advances in quality
improvement. The several strategies are
• Supportive hospital leadership
• Setting expectations for all staff
• Holding staff accountable for individual roles
• Inspiring and using physician and nurses championship efforts
• Providing ongoing, Visible and useful feedback to engage effectively.
• IMPORTANT is no blaming and fault finding culture has to made.
• Self reporting Culture

17. Challenges specific to Nurses
Involvement in Quality Improvement
The challenges are,
 Budget
 New divisions-focus vs integration
 Fire fighting(Comfortable) vs Process, Practice and care improvement
 Limited measurement of quality
 Having adequate Nursing Staff
 Facing growing demands to participate in more, Often duplicative, quality
improvement activities.
 Dealing with high administrative burden associated with these activities.
 Confronting traditional nursing education that does not always adequately
prepare nurses for evolving role in today’s contemporary setting.

18. Engaging All Nurses Not Just Nursing
Leadership
Involving Nurses in Quality Improvement activities , Preparing policies, SOP’s and
other legal documents such as MRD records, Statutory documents etc,
More over making them as a speciality nurses such as Stem Cell Transplant nurse,
Infusion Nurse, Tissue viability Nurse, Medication Management Nurse, Critical
Care Nurse, Chemotherapy Nurse, Radiation Nurse, Operation Theatre and
Dialysis Nurse,

19. Quality led by Staff
Staff experience – seek and value feedback and ideas for improvement
Quality and safety Walk-rounds
Enable people to do a better job
‘Walk in my shoes’
Do reinvent the wheel

20. Nursing Role in New Health Care
Arena
• Focusing on wellness
• Patient and Family cantered care
• Care coordination
• Data analysis focus on outcomes and improvement.

21. Implications
• Improving health care quality and patient safety is epic in health care system.
• Hospital will have to become more adept and sophisticated in discerning and
pursuing activities that substantively contribute to the achievement of their quality,
patient safety other performance goals.
• Quality improvement is not solely the domain of nurses, They are integral to these
activities because of their day to day patient care responsibilities.
• Hospitals will need to guard against diminishing the involvement of nurses in quality
improvement activities where they are likely to have the greatest influence and
impact.

23. “We have two jobs: Our job and
the job of improving our job”.
THANK YOU