2. OUT LINES
* Introduction.
* Definition of Quality Improvement.
• Definition of Continuous Quality Improvement.
• General Principles of Quality Improvement.
• Purpose of Quality improvement.
• Steps of Quality Improvement Process.
• PDCA.
• Continuious Quality Improvement Tools.
* Comparison of Traditional Quality Assurance and Quality Improvement
Processes .
* Nursing Roles and Responsibilities of Quality Improvement.
* Barriers to Successful Quality Improvement.
3. * Introduction :
Health care organization is: providing high quality,
safe care to those who seek help ,whether they are
patient ,resident ,client or recipients of care.
4. Definition of QI:-
Is the commitment and approach used to the continuously
improve every process in every part in the organization , with the
intent of meeting and exceeding customer expectation and
outcome .
* Quality improvement is describe as both a science and art
* of improvement is the development of new ideas The science ,the
testing of those ideas and implementation of change
5. * Total Quality improvement referred to as Quality
improvement and performance improvement
* Definition of continuous quality improvement
* Part of the management of all system and process Achieving the
highest of performance
* The process of continues improvement must contain regular
cycles of planning, execution and evolution
6. Purposes of quality improvement :
The Purposes of quality improvement are:-
Improvement of performance based on objective and quality
information.
To improve systems and processes , not to assign blame.
To improve direct patient care.
To improve patient care outcomes by focusing on the processes
in producing patient outcomes..
7. It involves continual analysis and evaluation of
products and services to prevent errors and to
achieve customer satisfaction.
To improve the efficiency and effectiveness of
services .
To evaluate specific aspects of care to improve care
quality for all.
Cont……………
8. * General principles of Quality improvement
* Decisions to change or improve a system or process Based on
Scientific data
* Improvement of the quality of service is a continuous process.
* Quality improvement is achieved through the participation of
everyone in the organization
* Improvement opportunities are developed by focusing on the
work process.
* The priority is to benefit pts and all other internal and external
customers .
9. Steps of quality improvement process
1) Identify an issue
2) Build a team to address it
3) Define the problem
4) Choose a target
5) Test the change
6) Reconsider or extend the improvement efforts
10. 1-Identify an issue :
A process that causing concern or a possible opportunity
for a positive change.
2-Build a team to address it
Representation from groups involved this step is critical.
* Design staff knows the job the best and can…
* Address frustration
* Bottlenecks
* Bureaucracy
* Simplify processes
* Increase teamwork
11. * Make a list of who you would have on your design process
redesign team
Getting people onboard is critical
Change is hard for some teams.
* Honor the past
* Highlight past successes
* Highlight people’s contributions
* Highlight the attitudes that help
* Show appreciation for everyone’s hard work
12. 3-Define the problem
* Identify and carefully describe what it is you really want to improve; the source
of the problem you are confronting, etc.
4-Choose a target
Introduce and evaluate interventions, using quality improvement tools and skills
5-Test the change
Data measures to determine when a process change over time is likely to be due
to chance and when it is not
6-Reconsider or extend the improvement efforts
* Reconsider, sustain, and/or extend process improvements
14. Plan :
Identify one s customer groups
Define their unique needs and the characteristics of quality they hold
Develop the product and services to met these needs
Do :
Deliver your product or services
C) Check:
Contentiously measure and analyses key aspect of quality Contrast these data to
customer needs and expectations .
D) Act :
Refine , improve product or services
15. Continuous Quality Improvement Tools:-
1. Flow chart
2. Run ( tend) charts
3. Statistical process control charts (SPCC).
4. Pie chart
5. Bar chart
6. Pareto chart
7. cause and effect diagrams ( fishbone diagram).
8. scatter diagram(scattergrams)
16. Flow charts:- are pictorial representation of the steps of process .
Flow charts take complicated routines, jobs, and events and display them so that
they can e analyzed by individuals inside and outside that area of expertise
There are two types :-
A high level flow chart: provide a general overview of all steps of the process
but doesn't include detailed.
A low level flow chart: is more detailed and includes more steps.
17. b) Run ( trend) charts:- is a basic line graph that displays similar data
over a period of time.
Primary function of this graph: monitors processes or occurrences in order
to identify trends.
It is consist of two axis:
Vertical axis : display the variable that is being measured
Horizontal axis: display the time units.
This graph used to ;-
Increase understanding of problems
Identify gaps between current and desirable situations
Identify opportunities to improve
analysis process.
18. c) Pie charts:- primary function is to display the percentage that the category
contributes to the total of all categories.
It used to :-
Increase understanding of problems
Identify gaps between current and desirable situation
Identify variables affected process
Identify opportunities to improve.
19. d)Bar charts:- its primary function is to compare data at one point in time.
It is used to : increase understanding of problems
- Identify variables affecting process
- Identify opportunities to improve
e) Pareto charts:- its primary function is to determine the most frequent causes of the
problem.
It consist of a serious of bars that are displayed from tallest ( most important) to smallest
( least important).
20. Pareto chart used to :-
Increase understanding of problems
Identify and list problems
Indicate reasons likely to yield the most improvement
Identify variables affecting process
Analyze process
Evaluate tasks
21. f) Cause- and-effect diagram:- primary function is to displays multiple causes of a
problem ,and to explore all of the factors that influence a process or situation.
- Advantages of cause-and-effect diagram:-
it helps focus the discussions irrelevant discussion and complains are reduced.
It is an active process with a goal to uncover the root cause of the problem
Data usually collected with this tool .this increase objectively and reduces personal
opinion.
It can be used for a large variety of problems
It demonstrates the level of the staff's understanding of the process
22. It used for:-
• Increase understanding of the problems
• Identify and list problem
• Identify root causes
• Identify variables affecting process
• Identify opportunities to improve
• Analyze process
• Plan for changes
23. Scatter Diagram ( Scattergrams).
The primary function is to display the relationship or correlation between two
variables. They are useful because the display all of data as a whole rather than
individually.
Interpretation of scatter diagrams in general:-
Positive correlation: improving one variables will likely improve the other
variable.
Negative correlation:- increasing one variable will likely decrease the other.
No correlation :- there is no definite relationship between the two variables.
24. It used to:-
increase understanding of problems
identify opportunities to improve
analyze process
plan for change.
Evaluate tasks.
26. Goal To improve quality To improve quality
Focus Discovery and correction
of errors
Prevention of errors
Major tasks Inspection of nursing
activities
Review nursing
activities, Innovation
and Staff development
Quality
Team
QA personnel or
department personnel
Multidisciplinary team
27. Implications for pt care :
The implication of quality improvement for pt care
can measured by the overall value of care
value═qality of out comes÷cost
28. Nursing Roles and Responsibilities of Quality Improvement
AS A CLINICIAN:
* Maintain ethical standards of practice.
* Seek self development by continuing education.
* Be self directed.
* Serve as change agent.
* Practice efficient time management.
* Achieve customer satisfaction.
* Be committed to reducing cost and improving performance
29. AS A TEAM LEADER:
* Be knowledgeable about group dynamics.
* Support collogues.
* Promote mutual trust and respect.
* Practice active listening.
* Praise coworkers.
30. AS A MANAGER:
* Develop leadership skills.
* Be knowledgeable about statistical analysis.
* Provide clear and direct communication.
* Obligate to and empower staff.
* Leads by example
31. **BARRIERS TO SUCCESSFUL QUALITY IMPROVEMENT :
In a recent study of clinical engagement in quality
improvement,25 healthcare professionals identified the following
barriers to quality improvement:
* Lack of time
* Lack of resources
* High workload, inadequate managerial support and inadequate
skills to access and implement evidence (cited by therapists)
32. * staff shortages, their own lack of authority and the
need for active consultant support, and difficulties
reconciling research evidence with what happens in
practice (cited by nurses)
* a wide range of barriers including incompatible
computer systems, not enough secretarial time, and
their own fear of being undermined by assessment and
criticism (cited by doctors
Cont………..
