controlling in nursing management

1. -QUALITY
-STANDARDS
-AUDIT
PRESENTED BY
T.MAGLIN ANUSHA M.SC (N)

2. INTRODUCTION:
Controlling is an essential function of management
in every organization, the management process is
incomplete and sometimes useless without the control
function. The planning, organizing ,leading and
controlling of human and other resources to achieve
organizational goals effectively and efficiently.

3. DEFINITION:
Controlling is defined as verifying whether everything occurs is
conformity with the plan adopted ,the instructions
issued and the principles established.
-HENRY FOYAL.
Quality assurance is a judgement concerning the process
of care based on the extent to which that care contributes to valued
outcomes.
-DONABEDIAN .
Quality management is not necessarily a replacement for existing
quality assurance activities ,but rather and approache that
broadens the perspectives on quality.
-KOCH.

4. CONTROLLING AS A MANGEMENT FUNCTIONS:
•A process of monitoring performance and taking action to ensure
desired results.
•It sees to it that the right things happens, in the right ways ,and at the
right time.
•It ensure that the overall directions of individuals and groups are
consistent with short and long range plans of the organization.
•It helps ensure that objectives and accomplishments are consistent with
one another .
•It helps to maintain compliance with essential organizational rules and
policies.

5. Quality assurance Quality improvement
 Inspection oriented
(detection)
 Planning oriented
(prevention)
 Reaction  Proactive
 Correction of special
causes
 Correction of common
causes
 Responsiblities of few
people
 Responsiblities of all
people involved with the
work
 Narrow focus  Cross-functional
 Leadership may not be
vested
 Leadership actively leading
 Problem solving by
authority
 Problem solving by
employees at all levels.
QUALITY ASSURANCE VS QUALITY IMPROVEMENT

6. To successfully achieve
sustained improvement in
health care ,
To design processes well
and systematically monitor
,analyze
A designed system should
include standardized
predictable process
Set incremental goals as
needed.
Public accountability.
Management
improvement.
OBJECTIVES:

7. PURPOSES:
Rising
expectations of
consumer of
services
Increasing
pressure from
national
,international
,government and
other professional
bodies to
demonstrate that
the allocation of
funds
produces
satisfactory results
in terms of patient
care
The increasing
complexity of
health care
organizations.
Improvement of
job satisfactions

8. APPROACHES:
GENERAL
APPROACHES
SPECIFIC
APPROACHES

9. ELEMENTS AND COMPONENTS:
Structure
element
Process
element
Outcome
element
Physical ,financial and organisational
Resources provided for health care.
Activities of a health system or health care
Personnel in the provision of care
A change in the patients current of future
Health that results from nursing intervention

10. STANDARDS;
Standards are written formal statements to describe how
an organization or professional should deliver health
services and are guidelines against which services can
be assessed.
Provide direction
Reach agreement on expectations
Monitor and evaluate results
Guide organizations, people and patients to obtain
optimal results.
Standards are directed as structural .process and
outcome issues and guide the review of systems
function, staff performance and client care.
STANDARDS ARE NEEDED TO:

11. AREAS OF
QUALITY
ASSURANCE:
Outpatient
department
Emergency
medical
services
In-patient
services
Training
Speciality
services

12. MODELS:
Structural elements
characteristics of ;
community Institution,
Provider, patient
Eg: Nurse –patient
relationship
Outcomes :
Death, adverse events, readmissions to
hospitals,resource use (costs, stay in
hospital),Patient satisfaction with care
,quality of life.
Process elements:
Treatment process, Stages of
treatment ,Appropriateness Services
process
Eg: Use of diagnostic tests,use of
procedures ,treatment delays
DONABEDIAN
MODEL

13. ANA MODEL:
Take action Identify values
Select action
Identification
Identify
criterias
Secure
management
Interpretation

14. SYSTEM(individ
ual,group/organi
sati-on)
CLIENT(individual,fa
mi-ly &community)
INTERVENTIO
N OUTCOMES
QUALITY HEALTH OUTCOME MODEL:

15. Plan
Do
Study
Act
PLAN is developed to test
One of the improvement changes
During the DO phase
the change is made and
data are collected to
evaluate the results.
STUDY involves analysis of
the data collected in the
previous step.
Act step involves
taking actions

16. 5.SIX SIGMA:
•It refers to six standards deviations from the mean and is generally
used in quality improvement to define the number of acceptable defects or
errors produced by a process.
•It consists of 5 steps :
•Define
•Measure
•Analyze
•Improve
•Control.

17. QUALITY IMPROVEMENT PROCESS –STEPS
•Identify needs most important to the consumer of health
care services
•Assemble a multidisciplinary team to review the identified
consumer needs and services
•Collect data to measure the current status of these services
•Establish measurable outcomes and quality indicators
•Select and implement a plan to meet the outcomes

18. 1.plan
2.Set standards
Communicate
standards
monitor
Identify & prioritize
Define
problem
Identify who
work on problem
Analyze &study
problem
Choose &design
solution
Implement solution
QUALITY
ASSURANCE
CYCLE

19. INDICATORS FOR QUALITY ASSURANCE:
 Waiting time for different services in the hospital
 Medical errors in judgement ,diagnosis ,laboratory
Reporting ,medical treatment or surgical procedures.etc
 Hospital infections including hospitals acquired
Infections ,cross infections
 Quality of services in key areas blood bank ,laboratorie
X-ray department ,central sterilization sevices ,pharmacy
and nursing.

20. NURSING AUDIT:
Nursing audit refers to the assessment of the
Quality of clinical nursing.
CHARACTERISTICS:
 It improves the quality of nursing care.
 It compares actual practice with agreed
standards of practice.
 It is formal and systematic.
 It involves peer review
It requires the identification of variations
between practice and standards followed by the
analysis of causes of such variations
 It provides feedback for those whose records
are audited

21. OBJECTIVES:
To evaluate the quality of
nursing care given
To achieve the desired and
feasible quality of care
To provide a way for better
records
To focus on care provided
and care provider

22. Retrospective view-
It refers to the detail quality care assessment after
the patient has been discharged.
Concurrent view-
• It is achieved by reviewing patient care during the
time of hospital stay by the patient .
METHODS OF AUDIT:

23. Set
standards
Observe
practice
change
Compare
with
standards
Implement
change
AUDIT
CYCLE

24. ADVANTAGES
•Patient is assured of good services
•Better planning of quality improvement can be done
•It develops openness to change
•It provides assurance, By meeting evidence based practices
It increases understanding of clients expectations
DISADVENTAGES
•It may be considered as a punishment to professional group
•Medico-legal importance .They feel that they will be used in court of
laws as any document can be called for in a court law
•Time consuming
•It requires a team of trained auditors

25. NURSES ROLE:
•Nurses are the active participants of interdisciplinary
quality improvement team
•Develop mechanism for continually monitoring the
effectiveness of nursing
care both a collaborative and an individual professional
activity.
•Contribute innovations and improvement of patient care.
•Participating in improvement projects and patient safety
initiatives
•Identify any area of needed improvement in delivery of
care