By Christina Lauderman RN, BSN, CEN
The learner will be able to..
 Define Quality Care
 Identify Standards of Care/Benchmarks
 Identify drivers of quality and their roles
in the continuous quality improvement
(CQI) process.
 Describe How Total Quality and
Continuous Quality Management, Six
Sigma, and Lean Six Sigma Addresses
Quality.
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Identify when an Incident report
needs filed.
Perform a Chart Review on Given
Stroke Charts
Develop a continuous quality
improvement project on a nursing
unit.
What Is Quality?
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Right Care at the Right time to the
Right Patient.
Compassionate/Empathetic
Competent
No Harm
Meets Standards
No Complications
Nondiscriminatory/Fair
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Involves the pursuit of excellence in
the delivery of care and ongoing
prevention of potential errors
The degree to which patient care
services increase the probability of
desired patient outcomes and reduce
the probability of undesired
outcomes given the current state of
knowledge (JCAHO, 2009)
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Florence Nightingale
Jean Watson- Theory of Caring
Dorothea Orem-Self care Deficit
June Larabee-Quality Theories
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Medicare and Medicaid
The Joint Commission (JCAHO)
State regulators
Payers
Professional groups
Patients
Why Is Poor Care
Sometimes Given?
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Under Or Inexperienced Staff
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Human Error
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Time, Money, and Space Constraints
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Attitude
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Ineffective Communication
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Complications
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Inability To Meet Patient’s Expectations.
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System Error
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Care Deemed Appropriate Based on
Scientific Evidence and Expertise of
Expert Professionals in that Area of
Care.
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Come From JCAHO, DOH, ANA, NLN,
NIH, AHA, ATA, ABA, UPMC
Standards, Medicare/Medicaid,
Insurance Companies etc.
First learn standards in Nursing
School.
 Learn Policies and Procedures of
Facility employed by.
 As you incorporate Evidence Based
Practice
 As you become involved in
Research.
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Structure Standards- Physical
Environment, Organization
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Process Standards-Delivery Of Care
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Outcome Standards-The End Results
Examples of
Standards
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After the Fact Identification
Prevention of Failed Standards and
Problems
Based on Data Collection and
Accountability
Uses Measurement Tools
Focus on “No Blame”
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4 Characteristics
 Customer/Client Focused
 Total Organizational Involvement
 Use of Quality Tools and Statistics
for Measurement
 Key Processes for Improvement
Identified
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Customer Client Focused
Internal Clients
Employees, lab, housekeeping
External Clients
Patients, Visitors, Physicians
Insurance Companies
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Total Organizational Involvement
 Team Approach
 Empowerment of Employees
 Management-Team
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Use of Quality Tools and Statistics for
Measurement
 Tools such as Graphs, charts
 Statistic tools such as percentages,
Probability
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Key Processes for Improvement
Identified
Systems Related
Clinical
Managerial
 Plan, Do, Check, Act Cycle
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TQM Philosophy CQI Process
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Never Ending Process
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Involves Evaluation, Actions, and a
Mind Set to Constantly Strive for
Excellence
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4 Key Players
Resource Group
Coordinator
Team Leader
Team
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Comprehensive Quality Management
Plan
 Multidisciplinary
 Standards
 Benchmarking
 Critical Paths
 Indicators
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Performance Appraisals
Intra/Interdisciplinary Assessments and
Improvements
Audits
 Retrospective
 Concurrent
Peer Reviews
Utilization Reviews
Outcomes Management
Six Sigma
Uses Quantitative Data
As a Measure
As a Goal
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As a Management System
Customer focus
Data Driven
Process Emphasis
Proactive Management
Boundary-less Collaboration
Aim for Perfection, Tolerate Failure
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Institute of Medicine- To Err Is Human:
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JCAHO- Patient Safety Goals
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Institute of Healthcare Improvement
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Right Patient, Right Medication, Right
Dose, Right Route, Right Time
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Patients Involved In Own Care
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Educate Patients About Medications
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Errors Need Reported
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Problem Focused Identify
 Analyze
 Evaluate Risks
 Develop Plan
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Education Based
Monitors Laws and Codes Related To
Patient Safety.
Collects Data In Legal Complaints
Provides Reports to Administration,
Medical Staff, and Board of Directors.
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Incident
Actual or Potential Risk.
Document in Chart and in Incident
Report.
Be Factual, Non Disciplinary, Honest
Case Followed Up by Risk Management
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Medication Errors
Falls
Complications from diagnostic or
treatment procedures
Patient/Family dissatisfaction with care
Refusal of Treatment or to sign consent
Skin Breakdown
Iv Infiltrations
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Encourage Staff To Report Incidents
No Blame or Disciplinary Action Unless
Absolutely Necessary
No Finger Pointing
Encourage a Culture of Safety and
Quality
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Clear Communication
Maintain Professional Caring
Attitude
Listen to Complaints
Determine Expectations of Patient or
Family
Quick Follow Up and Action
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Personal Contact-Utilize Charge
Nurse, Nurse Manager, Nursing
Supervisor.
Maintain Safety For Yourself and
For the Patient.
Make Restitution/Meet Expectations
When Applicable.
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Meeting Standards Helps to Provide
Quality
TCM- Philosophy Uses Plan, Do,
Check, Act
CQM-Never Ending, Strive for
Excellence.
Six Sigma- Reduce Waste Increase
Productivity
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Risk Management Role in Quality
Increase Patient Safety
Incident Reporting
Handling Complaints
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Textbook- Effective Leadership and
Management in Nursing by Pearson
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