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1. System model
4 components:
Compared w/ present state of system
Developmental process
Finished product
Essential component of system because it maintains & nourishes growth of system
2. ANA Quality assurance model
a. Identify valuesPatient/client, philosophy, needs and rights from an economic, social, psychology and spiritual perspective and values, philosophy
of Health care organization and the providers of the nursing services.
b. Identify structure, process and outcome standards and criteria:
* Begins with writing of philosophy and objective of organization
*The philosophy & objectives of an agency serves to define the structural standards of agency.
*Standards of structure are defined by licensing/accrediting agency.
*Evaluation of standards of structure is done by a group internal/external to the agency.
*Evaluation of process standards is more specific appraisal of quality of care given by agency care providers
3. Select measurements needed to
Measurement- tools used to gather info. Or data, determined by the selection of
determine degree of attainment of
standards and criteria.
criterion and standards
I. Approaches and techniques to evaluate structural standards & criteria:
*Nsg audit
*Utilization reviews (2 types)
-Microutilization-pt still in the hospital
-Macroutilization- pt discharged in the hospital
*Review of agency documents
*Review of physical facilities
*Peer review
II. Approaches and techniques to evaluate process standards and criteria:
*Client satisfaction surveys
*Direct observations
*Written audits
*Research studies
III. Approaches and techniques to evaluate outcome standards and criteria:
*Client satisfaction surveys
*Client satisfaction
*Discharge & morbidity data
IV. Make interpretations
The degree to w/c the predetermined criteria are met is the basis for interpretation
V. Identify course of action:
*If compliance level is above expected level, the great value in conveying positive feedback and reinforcement.
*If compliance level is below the expected level, its essential to improve the situation.
Then its necessary to identify the cause of deficiency. Identify the various soln to probs.
VI. Choose action
Use various alternative course of action
*Consider always the environment context and availability of resources
VII. Take action
Firmly establish accountability for action to be taken
This concludes w/ actual implementation of proposed courses of action
VIII. Pre evaluate results of action
*Careful interpretation is essential to determine whether the course of action has
improves the deficiency
*Positive reinforcement is offered to those who participated and the decision is made
about when to again evaluate that aspect of care.
1. Establishment of standards/criteria
2. Identify the info relevant to the criteria
3. Determine ways to collect info
4. Collect and analyze the info
5. Compare collected info w/ established criteria
6. Make judgment about quality
7. Provide info * if necessary, take corrective action regarding findings of appropriate sources
*Info collection determined if standard
has been met
*Educational/corrective action taken if
criterion hasnt been met
1. Lack of resources
2. Personnel probs
3. Improper maintenance
4. Unreasonable pts and attendants
5. Absence of well-informed population
6. Absence of accreditation laws
7. Lack of incident review procedure
8. Lack of good and hospital info system
9. Absence of pt satisfaction surveys
10. Lack of nsg care records
11. Miscellaneous factors:
*Lack of good supervision
* Absence of knowledge about philosophy of nsg care
*Lack of policy and administrative marvels

*Substandard education and training

*Lack of evaluation technique
*Lack of written job description and specification
*Lack of in-service & continuing educational programs
1. Maxwell
Recognized that in a society where resources are limited, HA by health care providers
isnt satisfactory in demonstrating the efficiency of service.
*Access to service
Dimensions of quality:
*Relevance to need
*Social acceptance
*Efficiency and economy
2. Wilsons (1987)
4 components of QA Programme:
*Setting objectives
*Quality promotion
*Activity monitoring
*Performance assessment
3. Lang (1976)
*Identify and agree values
*Review literature, known QAP
*Analyze available programs
*Determine appropriate QAP
*Establish structure, plans, outcome criteria and standards
*Ratify standards and criteria
*Evaluate current levels of nursing practice against ratified
*Identify and analyze factors contributing to results
*Select appropriate actions to maintain/improve care
*Implement selected outcomes
*Evaluate QAP