Chapter 17

Managing Quality and Safety

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc.
 Objectives
 Define quality assurance and explain its role in
continuous quality improvement.
 Discuss at least two general and two specific
approaches to quality improvement and examine
ways to use them in practice.
 Plan a model quality assurance program.
 Identify the purposes for the types of records
kept in public health agencies.
 Evaluate a method for documentation of client
care in a community setting.

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 2
 Introduction
 Quality control is the tool used to ensure
effectiveness and efficiency.
 Quality of care in the U.S.
 Variety of definitions
 Difficulty getting comparable data
 Consumers rallying for quality health care
 Want higher quality and lower cost
 Total quality management

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 3
 Quality Improvement
Goals/Outcomes
 Improving safety of care saves lives
 Costs reduction by using effective interventions
 Increases in client confidence in health care
delivery regardless of setting

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 4
 Performance Information for the
Public
 Report Cards
 Health Plan Employer Data and Information Set
(HEDIS)
• National Committee for Quality Assurance
 Community health report card
 Community health profiles, needs assessments,
scorecards, quality of life indicators, health status
reports, progress reports

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 5
 Historical Developments
 F. Nightingale called for a uniform method for collecting and
presenting hospital statistics to improve treatment (1860).
 American Nurses Association (ANA) created the Divisions on
Practice (1966).
 Congress for Nursing Practice developed standards for quality
assurance programs (1972).
 Professional Review Organizations (PROs)
 Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)
 National Health Quality Improvement Act of 1986
 Standards for Community Health Nursing Practice were
developed in 1993.
 Core Competencies of Public Health Nursing (2010)

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 6
 Quality and the Current Health
Care System
 Historically, it often was accepted that there
would be some problems or complications.
 Incentives in health care changed with the
prospective payment system.
 Quality became important to reduce number of
complications that resulted in longer hospital stays.

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 7
 Definitions and Goals
 Quality
 Defined by the client as the improvement in health
status
 Defined by the organizations and providers as
accurate intervention, the clinical context of care, and
the skill of the provider
 Quality Health Care
 The degree to which health services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 8
Quality Assurance and Total Quality
Management
 Quality Assurance
 Monitoring the activities of client care to determine the
degree of excellence attained in the implementation
of the activities
 Goals of QA:
• To continuously improve the timeliness, effectiveness, safety,
and responsiveness of programs
• To optimize internal resources to improve the health of the
community

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 9
Quality Assurance and Total Quality
Management
 Total Quality Management (TQM)
 An approach to managing quality of care through
appraisal of the nursing process after the client’s
discharge from the health care system
 Continuous Quality Improvement (CQI)
 An approach to managing quality that emphasizes
continual improvement in real time, empowering
employees to manage quality themselves, and
making changes in organizational systems to enable
workers to provide high-quality services

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 10
 Quality Assurance (QA) versus
Continuous Quality Improvement
(CQI)
QA CQI
 External determinants  Internal determinants
 Detects errors  Determines requirements
and deficiencies and
 Fixes blame and
expectations
responsibility
 Identifies process
 Post-event investigation
improvement opportunities
 QA department is  Prevention
responsible  All members in the
 Inspires fear organization are responsible
 Inspires hope

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 11
 Approaches to Quality
Improvement
 General Approaches  Specific Approaches
 Seek to protect the public  Total quality management/
by ensuring a level of continuous quality
competency among health improvement, traditional
care professionals quality assurance, staff
 Examples: Credentialing, review committees,
Licensure, Accreditation, utilization review, risk
Certification, Charter management
recognition, academic  Professional review
degrees organizations
 Evaluative studies

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 12
Model Quality Assurance Program
 Primary purpose of a quality assurance program
is to ensure that the results of an organized
activity are consistent with the expectations.
 Structure (philosophy and objectives)
 Process (specific appraisal)
 Outcome (evaluation of outcome standards)
 Evaluation, interpretation, and action

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 13
 Documentation
 Documentation is essential to the evaluation of
quality care in any organization.
 Records
 Community health agency records
 Healthy People 2020 and quality health care

All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. 14