Presented by:-

Priya patel
Prutha patel
4th year b.sc nursing
. Introduction OUT LINE
. Defination
. objectives
. Types
. Factors influencing
. Principles
. Approaches
Quality assurance model.
. Goals
. Models
1) American nursing model
2) Wilson's model
 Introduction
 Qualityassurance refers to a system for
monitoring outcome of professional
intervention and departmental activities
compared with established standards.
 Nursingquality assurance is focused on
nursing care delivery structure, process and
outcome.
 Qualityassurance is a dynamic process,
through which nurse assume accountability
for quite of care they provide. It is guarantee
to the society that members of the
Definition

 “Quality assurance refers to making

sure that the services provided by the
hospital are the best passible in a
given existing resource and current
medical knowledge.”
-world health
organization
Objectives of Quality
Assurance
 Itlays the standards for quality in nursing
education and nursing care.
 To successfully achieve sustained
improvement in health care and meet nerds
of the patients
 Tobaseline process and systematically
monitor,analyze and improve the
performance to enhance patient outcome
Cont….

 Toinclude standardized predictable

processes based on based on best practices
 To set incremental goals as needed
 To
demonstrate public accountability of
nursing care
Types of Quality Assurance

 Two types of Quality assurance

{1} External quality assurance

{2} Internal quality assurance
Cont….
{1} External quality assurance
 Quality assurance is evaluated by
independent assessors or people from
outside the institution or hospital
{2} Internal quality assurance
 Quality assurance is evaluated by local
assessors or senior personnel from the same
instruction or hospital
 Factors influencing
quality assurance
 There are various factors which may
adversely influence Quality assurance in
health care they are as follows…
i) lack of resources
ii) Personnel related problems
iii) Miscellaneous factors
i) Lack of resources
 Lackof infrastructure, equipments and
supplies etc…
 Lack of good hospital information systems
 Lack of patien satisfaction surveys.

ii) Personnel related problems

 Lack
of trained,skill and motivated
employees may decrease the quality of care
 Unresponable expectations of patients and
their caregivers
 Actions of accrediation laws
iii) Miscellaneous factors

 Lackof good supervision,policy and

administrative manual, procedure manual,
evaluation tools and techniques, written job
descriptions, continuing education programs
etc…
 Principals of Quality Assurance

1. Quality assurance must be focused on the needs of the

clients. Clients include patients community and the
health teams
2. Quality assurance requires collaborative effort among all
health care professionals.
3. Collective analysis of quality assessment data should be
linked to decision making to foster effective quality
assurance
4. Employees should be involved in problem solving and
opportunity improvements in quality improvement
activities
 Approaches For quality
assurance program
Two major categories of approaches exist in quality
assurance.
These are :-
(1) General approach
(2) Specific approach
 (1) General Approach
Itexamines the ability of the agency to meet
criteria or standards.
The mechanism often used in the health care
system in credentiality which is defined as
the formal recognition of a person as
professional with technical competence or of
an agency that has met minimum standards
of performance .
The god of credentialing process are :-
To produce quality product
To give an unique identify (e.g. registered
 (2) Specific Approach
 There are methods used to evaluate providers and
client interaction.
 The goals are :-
 To identify problems between provider and client.
 To intervene in problem cases.
 Toprovide feedback regarding interaction between
client and provider.
 Toprovide documentation of interactions between
provider and client.
 These specific approaches often are implemented
voluntarily by agencies and providers groups
interested in the quality of interactions in their
settings.
 Quality Assurance Model
Goals of quality assurance model :-
 The goals of quality assurance model are as follows :-
(1)Developconfidence of the receivers that quality care is
being rendered as per assurance.
(2)Develop commitment of the management toward quality
care.
(3)Prevent errors in patient care.
(4)To increase job satisfaction among nursing personnel.
(5)Promote optimum utilization of resources in providing
cost-effectiveness nursing care.
 Models of quality assurance:-
 There are two models of quality assurance which
 (1)American
nurses
association model (ANA)

This is the first proposed and accepted

model of quality assurance for nursing
profession.
The model is open and circular
indicating the components in the
implementation process.
 1
8 Identify
Revaluation Values
2
Take Action Identify
Standard
7 Criteria

Choose
3
Appropriate Select
Action Measurem
ent
6
Identify
.

Make
Course Of Interpre 4
Action
tation
5
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(i) Identify Values

Standards and criteria must reflect

societal and professional values.
The standards and criteria must be
dynamic and subject to change in
the light of new knowledge and
experience
 (ii) Identify Structure,
Process, Outcome
Standards, And Criteria
Nurses planning a equality assurance
program must decide which type of
criteria they will use depending on the
purpose and target of the program.
The philosophy and objectives of an
agency define the structural standards.
These standards are defined by the
licensing or accrediting agency.
 (iii) Select measurement needed to
determine the degree of attainment of
criteria and standards
 There are many methods that can be used to measure the level of nursing practice according
to the established criteria are there :-

Types Of Standards Approach And

And Criteria Technique Used To
Evaluate
- Structural standards - Nursing audit, review of
agency document , self-
studies review of physical
- Process Standards facilities.
- Peer review, direct
observation , questionnaire,
- Outcome Standards interview, written audit,
videotapes.
- Research studies, surveys,
(iv) Make
Interpretation
The degree to which the pre-
determined criteria are met is the
basis for interpretation about the
strength and the weakness of the
program The rate of compliance is
compared against the expected
level of criteria.
(v) Identify Possible Course
Of Action

If the compliance levels is below the

expected level it is necessary to improve
the situation by identification of the cause
and by providing solutions to rectify the
problem.
It compliance level is above the expected
level it is important to provide positive
feedback and reinforcement.
(vi) Choose Appropriate
Action
Among the various alternatives which
are available to solve a problem it is
important to select the best choice.
This is done by carefully weighing the
pros and cons of each alternative
considering the environmental
context and availability of resources.
(vii) Take Action
The action selected in the
previous component is
implemented and
documented.
(viii) Revaluation

Revaluation is done to
determine wheter the course of
action resulted in rectifying the
deficiency.
 2.Wilson’s Model
 The donabedian model is operationalized into a tangible
and practical from by Wilson’s model (1987).
 He redefined it as input, methods or procedures and
outcomes.
 Inputs :- Inputs comprises of the people (personnel),
equipment, and environment (resources that are need to
attain an defined level of care).
 Methods :- This includes the procedures that are being
does as a part of everyday practice, It includes the
professional skills, technical skills, or expertise.
 Out Comes :- This refers to the targets of care or
services which are measured in terms of productivity,