Quality Control in Creating a Culture of Patient Safety

management process steps

1. planning

2. organizing

3. staffing/directing

4. controlling

quality control

• final step of the management process

• activities that are used to evaluate, monitor, or regulate services rendered to consumers

• performance measured against predetermined standards

• action taken to correct discrepancies between these standards and actual performance

management controlling functions

• periodic evaluation of unit philosophy, mission, goals, and objectives

• measurement of individual and group performance against pre-established standards

• auditing of patient goals and outcomes

hallmarks of effective quality control programs

• support from top level administration

• commitment by org in fiscal and human resources

• quality goals reflect search for excellence rather than minimums

• process is continuous

3 steps of the quality control process

1. the criterion/standard is determined

2. information is collected to determine whether the standard has been met

3. educational/corrective action is taken if the criterion has not been met

steps in auditing quality control

1. establish control criteria

2. identify the informational relevant to the criteria

3. determine ways to collect the info

4. collect and analyze the information

5. compare collected info with the established criteria

6. make a judgement about quality

7. provide information and if necessary, take corrective action regarding findings

8. reevaluation

standards in quality control

• predetermined baseline condition/level of excellence that constitutes a model to be followed and practiced

• each org and profession must set standards and objectives to guide individual practitioners in performing safe and effective care

• ANA has played a key role in developing standards for the nursing profession

benchmarking

• process of measuring products, practices, or services against best-performing organizations

• orgs can determine how and why their org differs from these exemplars and then use the exemplars as role models for standard development and performance improvement

• comparing performance to best-performing orgs to identify gaps and adopt best practices

quality gap

• difference in performance between top-performing health care organizations and the national average

• quality gap is typically small in industries such as manufacturing, aviation, and banking

• variation is more common in health care

why is it important to determine the source of the error?

computer aided error analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not occur

clinical practice guidelines

• also called standardized clinical guidelines

• provide diagnosis based step-by-step interventions for providers to follow in an effort to promote quality care

• should reflect EBP; should be based on cutting edge research and best practices

audits frequently used in quality control

• structure audits

• process audits

• outcome audits

structure audits

monitor the structure/setting in which patient care occurs (takes into account the environment)

process audits

measures the process of care/how the care was carried out

outcome audits

determines what results, if any, followed from specific nursing interventions for patients

nursing sensitive outcomes

• growing recognition that it is possible to separate out the contribution of nursing to the patients outcomes

• this recognition of outcomes that are nursing sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession

• highlights direct contribution of nurses to patient safety

quality assurance

• retrospective, compliance-focused approach that verifies if established standards are met

• identifying and correcting problems after they occur

• QA models target currently existing quality

quality improvement

• proactive, system-focused approach that uses data and a continuous cycle, such as the Plan-Do-Check-Act (PDCA) model, to find opportunities for systematic change and prevent future issues from happening

• QI models target ongoing and continually improving quality

• QI is proactive and identifies gaps