QUALITY

ASSURANCE
by: Jesah Maria S. Palmes

DEFINITION
Assurance-

means achieving a
sense of accomplishment and
implies a guarantee of
excellence.

Quality-

is the degree of
excellence and assurance
means formal guarantee of a
degree of excellence.

 Quality

of Care- is the degree to

which health services for
individuals and population increase
the likelihood of desired health
outcomes and are consistent with
the current professional
knowledge.

Quality

Assurance- is a process of
evaluation that is applied to the
health care system and the
provision of health care services by
health workers.

 Quality

Improvement Programis the umbrella program that

extends the many areas for the
purpose of accountability to
the consumer and the payor.

Indicators-

are valid and

reliable quantitative measures
of structure, process and
outcome that are related to
one or more dimensions of

 Sentinel

Event Indicatorsmeasures a low-volume but

serious, undesirable and often
avoidable process or outcome
such as falls and medication
errors.

Benchmarking-

is a tool to assist
in quality of care decision
making. It is a continuous
process of measuring what
exists against the best in search
for industry best practices.

 Best

Practice- is a service, function

or process that has been finetuned, improved and implemented
to produce superior outcomes.

Total

Quality Management (TQM)is a way to ensure customer

satisfaction by involving all
employees in the improvement of
the quality of every product or
service.

 Continuous

Quality
Improvement (CQI)- is a
process of continuously
improving a system by
gathering data or
performance and using multidisciplinary team to analyze
the system, collect
measurements, and propose
changes.

PRINCIPLES
UNDERLYING QUALITY
ASSURANCE EFFORTS

 All

health professionals should

collaborate in the effort to
measure and improve care.

Coordination

is essential in
planning a comprehensive
quality assurance program.

Resource

expenditure for
quality assurance activities is
appropriate.

 There

should be focus on critical

factors such as functions and
activities that promise to yield the
greatest health and financial benefit
to reveal significant findings.

Quality

patient care is accurately

evaluated through adequate
documentation.

The

ability to achieve nursing

objectives depends upon the optimal
functioning of the entire nursing
process and its effective monitoring.

 Feedback

to practitioners is essential
to improve practice. It perpetuates
good performance and replaces
unsatisfactory interventions with
more effective methods.

Peer

pressure provides the impetus

or effect prescribed changes based
on results of assessment and needed
improvements on quality of care.

 Reorganization

in the formal
organizational structure may
be required if assessment
reveals the need for a different
pattern of health care.

Collection

and analysis of data

should be utilized to motivate
remedial action.

QUALITY ASSURANCE
AND PERFORMANCE
EVALUATION

Performance evaluation
focuses on the worker. It asks
questions about how the
worker satisfies the
requirements of his or her job
within the organization.
On the other hand, quality
assurance focuses on the care
and service the patient
receives than how well the
professional performs the

QUALITY
ASSURANACE
METHODS

Several methods used are:

Concurrent

and retrospective
patient care audits

Patient
Peer

care profile analysis

review

Quality

circles

DEVELOPING
QUALITY ASSURANCE
CRITERIA

 Structure

Approach- includes
physical setting,
instrumentalities and
conditions through which
nursing care is given such as
the philosophy and
objectives, the building,
organizational structure,
financial resources, and
equipment.

Process

Approach- includes

 Outcome

Approach- identifies
desirable changes in the
patients health status as
modification of symptoms,
signs, knowledge, attitudes,
satisfaction, skill level, and
compliance with the
treatment regimen.

NURSING AUDIT
COMMITTEE

This is composed of a
representative from all levels
of the nursing staff, a member
of the Training Staff,
Supervising Nurse, Head/
Senior Nurse, and a Staff
Nurse. The composition may
vary in other hospitals. In
smaller hospitals, the Chief
Nurse or her Assistant may be
a member of this committee.

The audit team usually designates a

day within the week to be the audit
day. However, the nurses do not know
which unit will be audited. The audit
team utilizes the developed process
or outcome criteria to evaluate
nursing care.
The Staff Nurse or Senior Nurse
participates during the audit and are
shown the findings- both strong and
weak points. They sign the audit form
to confirm the authenticity of the
findings of the audit team.

PATIENT
CARE AUDITS

Concurrent Audit- is one in which

patient care is observed and
evaluated. It is given through;
A

review of the patients charts

while the patients are still confined
in the hospital
Observation of the staff as patient
care is given
Inspection of patients and/ or
observation of the effects of patient
care where the focus is on the
patient.

Retrospective Audit- is one in

which which patient care is
evaluated through;
A

review of discharged
patients charts

Questionnaires

sent or
interviews conducted on
discharged patients.

PEER REVIEW
Patient care audits may be
done by peers (employees of
the same profession, rank and
setting) evaluating anothers
job performance against
accepted standards.

QUALITTY CIRCLES
The quality circle may be defined
as a group of workers doing a
similar work who meet regularly,
voluntarily, on normal working
time, under the leadership of
their supervisor, to identify ,
analyze, and solve work-related
problems and recommended
solutions to management.

UTILIZATION OF
RESULTS

The Nursing staff in the unit is

given a feedback on the results on
the quality assurance study. Positive
feedback reinforces desirable
performance. Consistent positive
findings deserve a commendation
from the nursing service.
Negative feedbacks should tactfully
conveyed in a face-to-face situation
so that assessment result may easily
clarified. Negative findings have
implications for review of existing
standards in the unit regarding

CONTROL OF
RESOURCES

 Part

of the control process is

the periodic review of the
utilization of materials and
supplies in the various
nursing units.

Requisitions

of and/or
stocking a large number of
supplies and materials should
be avoided to prevent
pilferage, misuse, or spoilage.

high turnover inventory is

desired.

An

equipment utilization
report should be made
including frequency
breakdown.

Preventive

maintenance
requires the regular
inspection of equipment to

 Likewise,

end-users of
supplies, materials and
equipment should be given
the opportunity to evaluate
their quality.

Absences

due to leaves,
whether scheduled or not,
should be analyzed as these
may have implications for
staffing.

DISCIPLINE

Part of controlling process in

management is discipline. In the
past, discipline meant rigid
obedience to rules and regulations,
the violation of which resulted in
punitive actions.
Today, discipline is regarded as a
constructive and effective means by
which employees take personal
responsibility for their own
performance and behavior. This is
termed as self-discipline.

SOME FACTORSTHAT
INFLUENCE SELFDISCIPLINE
ARE:

strong commitment to the

vision, philosophy, goals and
objectives of the institution.

Laws

that govern the practice

of all professionals and their
Codes of Conduct.

 Understanding

the rules and

regulations of the agency.

An

atmosphere of mutual
trust and confidence.

Reference:
Lydia

M. Venzon 2006.
Nursing Management Towards
Quality Care. 3rd edition
Bessie L. marquis 2000.
Leadership and Management
Functions in Nursing. Theory
and Application. 3rd edition