Quality

‫‪DEFINITIONs OF QUALITY‬‬

‫❑‪Freedom from deficiencies‬‬

‫) ‪(Fitness for use‬‬

‫يعني عدم وجود أي خطأ يمكن تجنبه‬

‫أو خطوة غير ضرورية في التدخل‬
‫المطلوب لتحقيق نتائج مماثلة‬

‫‪Juran in 1989‬‬
 DEFINITIONs OF QUALITY
Quality is doing the •
right things right,
first time and every
time.

‫الجودة هي األداء الصحيح من‬

‫أول مرة وفي كل مرة‬
Brown 2001
 DEFINITIONs OF QUALITY
– What are the right things?

– How are the right things done right?

Compliance with ❖
Standards

‫❖التطابق مع المعايير‬
Brown 2001
 DEFINITIONs OF QUALITY
➢Quality is working according specifications
‫اجلودة هي العمل طبقا ملواصفات حمددة‬

➢Quality is providing effective services with

a minimum of unnecessary use of resources
‫اجلودة هو توفري خدمات فعالة مع احلد األدىن من االستخدام غري‬
‫الضروري للموارد‬

➢Quality is to satisfy customers

‫اجلودة هي رضاء العمالء‬
• Definition of Quality:
The Joint Commission (1993) defined
quality as ‘ the degree to which patient care
services increases the probability of desired
outcomes and reduces the probability of
undesired outcomes given the current state of
knowledge’.
• Standard: is a descriptive professional statement
of desired or agreed level of performance
against which the quality of care (structure,
process and outcome) can be judged. It must be
observable, achievable and measurable.
A clinical indicator: is a quantitative measure
that can be used as a guide to monitor and
evaluate the quality of important patient care
activities
• The goals of quality assurance:-

- Ensure that excellence is inherent in every

component of the process.

-Helps determine whether the steps used to

provide the product or services are appropriate
for the time and conditions.
Principles underlying quality assurance efforts:
1-All health care professionals should collaborate
in efforts to measure and improve care.
2-In planning a comprehensive quality assurance
program for a health institution, coordination is
needed to ensure that objectives and activities of
each health profession enhance rather than cancel
those of other professions.
3-Care should be taken to ensure that resource
expenditure for quality assurance activities is
appropriate in amount.
• 4-In order to ensure that resources expended
for quality yield significant finding or results,
investigators should focus their attention on
monitoring only critical performance factors.
• 5-The key to ensure quality in patient care is
accurate evaluation of care, and the key to
successful auditing of care is adequate
documentation of care.
Benefits of quality assurance:
• 1-Provide an appropriate mechanism for the
nursing staff to fulfill its mission.
• 2-Provide nursing staff members with
information as to where they are going.
• 3- Identify where nursing stands and what must
be done to improve nursing care for consumers.
• 4-Upgrades standards of nursing care and skills
of nursing personnel.
 Benefits of quality assurance:
• 5-Identify weak areas in the structure process and
outcomes of nursing that must be changed or
strengthened.
• 7-Promote cost containment.
• 8-Provide valuable documentation in case of any
litigation.
• 9-Provide interdisciplinary opportunities to achieve
the broad health care goal of quality assurance.
• 10-Integrate self-satisfaction to those delivering
nursing care and ensure the consumer optimal
service and satisfaction.
Quality control (QC) is defined as the process by
which actual performance is measured the
performance is compared with the goals, and
the difference is acted upon.
• Characteristics of quality control:-
• The QC process must be ongoing to ensure that
remedial efforts, if required, have produced
satisfactory results and to immediately detect
recurrences or new instances of trouble.

• Essentially, quality control involves the

examination of a product, service, or process for
certain minimum levels of quality.
Usually, it is not the job of a quality control team
or professional to correct quality issues. Typically,
other individuals are involved in the process of
discovering the cause of quality issues and fixing
them. Once such problems are overcome, the
product, service, or process continues production
or implementation as usual.
• Quality control and quality assurance
differentiation:

• Quality control is confused with quality

assurance. Though the two are very similar,
there are some basic differences. Quality control
is concerned with the product, while quality
assurance is process–oriented.
• Definitions of quality improvement
• Is any action taken to increase value of the
customer or other stakeholders by improving
effectiveness and efficiency of process and
activities throughout the organization.
• Quality Improvement is a formal approach to the
analysis of performance and systematic efforts to
improve it.
• The process of attaining a new level of
performance or quality that is superior to any
level of quality.
• Concept of quality improvement:

• Customer identification and satisfaction.

• Measurement and reduction of variation.

• Continuous process and improvement.

• Active employee participation.

• Measurement of quality care:
• There are several instruments to measure
quality of care standards:
• Observational instrument.
• Quality evaluation system.
• Monitor.
• Audit.
• National Association of Theater Nurses Quality
Assurance.
• Nursing quality measurement scale.
Nursing audit:

Definition of nursing audit:

• It is a method for evaluating the quality of

nursing care through appraisal of the nursing
process or outcome of care, as it is reflected in
the patient care records.
• The purpose of a nursing audit:
– Examine nursing care those has been given to clients
and verify that acceptable standards are being met.

– Auditing a patient’s charts not only indicates what

ought to be included, but also that the care given is
documented.

– Improve the quality of care and the need to prove

that quality care was delivered.

– Demonstrating the value and benefits of nursing

services.
• Types of nursing audit
• a. Concurrent audit:
• Evaluate care conducted during patient
hospitalization, examine the care being given by
reviewing what record is and supplemented by
observation, using:
– Open chart audit: This is the review of the patient’s
charts and records against present criteria. As the
patient is still receiving care, this process gives staff
immediate feedback.
– Patient interview or observation: which involves
talking to the patient about certain aspects of care,
conducting a bedside audit or observing the patient’s
behavior to present criteria.

– Peer review: occurs when practicing nurses

determine the standards and criteria that indicate
the quality and evaluate performance against it.
(Nurses evaluate each other).
– Staff interview or observation: which involves
talking to and observing nursing behaviors related
to present criteria.

– Group conference: This involves the patient and

family to joint discussion with staff about the care
being received. This leads to problems being
discussed and improved plans being agreed upon.
• b. Retrospective audit:
• Closed chart audit (nursing audit).
• Post care patient interview:
• Post care patient questionnaire:
• Post care staff conference:
 Concurrent audit Retrospective audit

• Purpose: is to assess the past - Assess care that has already

and present care given to been received by clients.
a client.
• Advantages & - The care of clients whose
disadvantages: charts are audited is not
- Can provide information influenced by the outcome of
to care givers that may the retrospective audit.
alter a particular client’s However, other clients may be
care plan. helped.
- Help in providing
immediate corrective
action.
 Concurrent audit Retrospective audit
- Is more costly, but provides faster - Less costly than concurrent
information and enables improvement audit and usually required less
of care for the specific patient whom time to complete.
the changes of care are indicated.
- Uses patient records in the review, but -Uses records review, post care
in addition, they often include questionnaire, patient's
interviews with clients and health team interviews.
members and observation of care given. - When the record is
unclear, the retrospective
audit must assume that
the criteria have not been
met.
- Is most useful to those directly involved - Is most useful to the
in client care? organization to give an overall
picture of care given to clients.