self evaluation , peer evaluation, utilization review ppt

1. SELF EVALUATION, PEER REVIEW, PATIENT
SATISFACTION, UTILIZATION REVIEW
PRESENTED By:
Ritika Rana
M.Sc. Nsg
Neurosciences

2. INTRODUCTION
 The realization of goals and objectives is based on the accuracy of the
judgements and inferences made by decision-makers at every stage.
 To arrive at a good decision the test, measurements and evaluation are
being used in all situations.
 Thus, evaluation has become a part and parcel of every system to
determine the achievement of goals in a given period.

3. TERMS USED
 Evaluation: Evaluation is an act or process that allows one to make a
judgement about the desirability or value of a measure.
 Self-evaluation: Self-evaluation is an evaluation of one's own abilities
and failings

4. CONT…..
 Peer evaluation: Peer evaluation is a process by which one's colleagues
assess his quality and accuracy.
 Patient satisfaction: Patient satisfaction is defined as the extent of the
resemblance between the expected quality of care and the actual
received care.

6. MEANING OF EVALUATION
 The term evaluation is derived from the word valoir which means “to
be worth”.
 Thus, evaluation is the process of judging the value or worth of an
individual’s achievements or characteristics.

7. DEFINITION
 Self-evaluation is defined as looking at progress, development and
learning to determine what has improved and what areas still need
improvement. Usually involves comparing a "before" situation with a
current situation. -Riley guide
 Self -evaluation is an evaluation of one's own abilities and failings -
Reverse dictionary

8. CONT…..
• Self-evaluation is defined as judging the quality of one’s work, based
on evidence and explicit criteria, for the purpose of doing better work in
the future.

9. PURPOSES
 To encourage continuing self- evaluation and reflection.
 To promote an ongoing, innovative approach.
 To encourage individual professional growth in areas of
employee interest.
 To improve morale and motivation.

10. CONT…..
 To encourage collegiality and discussion about practices among
peers in an organization.
 To support employees as they experiment with approaches that
will move them to higher levels of performance.

11. TOOLS FOR EVALUATION
 Staff annual professional review procedures
 Peer support
 Coaching
 Joint preparation of materials

12. CONT……
 Planning
 Team building
 Observation
 Checklist

13. ADVANTAGES
 Increased confidence in their own learning, in trying out new ideas, in
changing their practice and in their power to make a difference.
 Enthusiasm for collaborative working, despite initial anxieties about
being observed and receiving feedback.

14. CONT……
 Improved team-work and greater flexibility in their use of their skills.
 Increased awareness of new techniques and greater insight into
thinking.
 Enhanced planning skills to ensure more effective task management.

15. DISADVANTAGES
 Reluctant to fill the self-appraisal forms.
 Self-assessment not always accurate.
 Conflict between the employee’s ratings and their supervisor’s rating.

17. INTRODUCTION
• In response to the public agitation for improved care quality, some
nursing organizations instituted peer review as one method for
increasing nurses accountability for effective decision- making and
interventions.

18. DEFINITION
 Peer review is a process by which employees of the same rank,
profession, and setting evaluate one another’s job performance against
accepted standards.
- O‟ Loughlin and Kaulbach
 An organized effort whereby practicing professionals review the
quality and appropriateness of services ordered or performed by their
professional peers.
-American Nurses Association

19. CONT……
• Peer evaluation is a process by which one's colleagues assess his quality
and accuracy.

20. METHODS OF PEER-EVALUATION
• Direct Observation.
• Videotaping.
• Evaluation Of Course Material.
• Formative Assessment.
• Summative Assessment.

21. PROCESS
 Establish a policy requiring peer reviews
 Establish criteria for peer evaluations
 Procedure for conducting peer evaluations
• Faculty chosen to conduct peer evaluations.

22. CONT…….
 A written report shall be prepared and signed by the evaluator
 Department shall archive the written evaluations .
 One copy of the peer evaluation shall be placed in the permanent
personnel file of the person being evaluated
 All reports of peer evaluations shall be included in the tenure file.

23. ADVANTAGES
 Improves team work.
 Encourage group members involvement and responsibilities
 Encourage peers to reflects on their role and contribution to the
process of group work.

24. CONT…..
 Focuses on the development of judgement skills
 Provides more relevant feed back to the students
 Give opportunities for the hidden leaders to be selected.

25. DISADVANTAGES
 Threats to friendship bias
 Time consuming
 Artificially inflated.
 Peers feels ill equipped to undertake the assessment.
• Reluctance to make judgement regarding their peers

27. INTRODUCTION
 Consumers of health care services demand quality care.
 Patient satisfaction used as an indicator of quality services.
• Most important predictor of patient overall satisfaction with hospital
care is particularly related to their satisfaction with nursing care.

28. CONT…….
• In recent years, the focus on consumerism in a highly
competitive environment has led to increased interest in
measuring patient satisfaction with health care.

29. DEFINITION
 Patient satisfaction is defined as a health care recipients’ reaction to
salient aspects of the context, process, and result of their service
experience. - Pascoe (1983)
 Patient satisfaction is defined as the extent of the resemblance between
the expected quality of care and the actual received care. - Scarding
(1994)

30. NEED FOR EVALUATING PATIENT
SATISFACTION
 Data about patient satisfaction equip nurses with useful information
about the structure, process and outcome of nursing care.
 It is a requirement for therapeutic treatment and is equivalent to self -
therapy.

31. CONT……
 Satisfied patients help themselves get healed faster because
they are more willing to comply with treatment and adhere
to instructions of health care providers, and thus have a
shorter recovery time.

32. METHODS OF EVALUATING PATIENT
SATISFACTION
 Medical audit
 Quality assurance committee reviews
 Indices of nursing performances
 Judgemental method

33. COMPONENTS OF EVALUATION OF PATIENT
SATISFACTION
 Evaluation of the programs and activities of various departments
including outpatient care, inpatient care, overall health education
activities of the hospital
 Evaluation of the various resources available in the hospital for
effective health care

34. CONT…….
 Evaluation of effectiveness of hospital personnel including medical,
paramedical, nursing as well as non- medical employees of the
hospital.
 Services are relevant to the needs of the population it serves.

35. ADVANTAGES
 Cost effective.
 Specific segments can be easily targeted.
 Wider sample distribution possible.
 Encourages high response rate.
 Visuals may be used.

36. CONT…..
• Patient/client anonymity
 Respondents given time to complete.
 Can use validated survey instruments.
 Qualitative comments can be included.
 Can be administered by independent external agencies.

37. DISADVANTAGES
 Difficulties associated with procuring an accurate list of
client/patient details.
 No opportunity for explanation or follow up questions.
 Potential to excludes sections of the population.

38. CONT……
 Provides limited opportunities for large numbers of
community members to participate in the process.
 Does not allow for the exchange of ideas and discussion.
 Reliability dependent on timing.

40. INTRODUCTION
• The utilization review program includes determining appropriate
hospital length of stay and necessary treatments for various illnesses
and conditions and reviewing patient medical records on admission and
at intervals during hospitalization to ensure that the patient receives
appropriate care.

41. DEFINITION
 Utilization review is an assessment of the appropriateness and
economy of an admission to a health care facility or a continued
hospitalization. The length of the hospital stay also is compared
with the average length of stay for similar diagnoses.
- Mosby's Medical Dictionary, 8th ed.

42. AIMS & OBJECTIVES
 Main aim is to reduce the health care costs
 They work in liaison with a business organisation .
 Cost control to limit each patient’s diagnostic and treatment measures
to the fewest, least expensive procedures.

43. TYPES
• Prospective Review
• Concurrent Review
• Retrospective Review

44. UTILIZATION REVIEW NURSE
 A utilization review nurse is a registered nurse who reviews individual
medical cases to confirm that they are getting the most appropriate
care.
 These nursing professionals can work for insurance companies,
determining whether or not care should be approved in specific
situations.
 They can also work in hospitals.

45. MINIMUM QUALIFICATION OF UTLIZATION
NURSE
 A Bachelor’s Degree in Nursing; five (5) years of clinical care or
nursing experience. An equivalent combination of education and
experience.
 Two years’ experience of utilization review.
• Certification in Utilization Review or Utilization Management is
preferred.

46. ESSENTIAL FUNCTION OF UTILIZATION
NURSE
 Obtains and evaluates medical records for in-patient
 Obtains appropriate records as required.
• Conducts on-going reviews and discusses care changes with attending
physicians and others.

47. CONT…….
 Formulates and documents discharge plans.
 Provides on-going consultation and coordination appropriate referrals
 Coordinates with admitting office to avoid inappropriate admissions.

48. CONT……
 Coordinates with clinic areas in scheduling specialized tests with other
health care providers.
 Reviews and approves surgery schedule .
 Coordinates with correctional facilities to determine appropriate use of
elective procedures, durable medical goods and other services.