Quality Improvement Report
Cynthia Leonard, BSN, RN
HCS/588
June 4, 2012
Darlene M. Cantu, RNC-NIC, C-EFM, MSN

Quality Improvement report Quality measures and quality improvements are the focus of most health care organization today. Quality has many meanings and consumers, health care organization, regulatory agencies, and professionals have different view of the meaning of quality. Quality has advanced from the ability to give good care to the need to ensure that patient’s expectations are met. Quality in health care encompasses professional quality requirements and patients expectations. This paper will highlight the concepts of QI, including definitions of quality, along with patients, and professional roles in quality improvement. The paper will mention why quality management is requirement in the health care industry and how to monitor quality. The paper will also highlight the roles of accrediting and regulatory organization along with identifying helpful resources for organizations that affect QI. Foundational Frameworks of QI Industrial models have influenced how health care organization approaches quality improvement. Leaders, such as Armand Feigenbaum, who was the originator of total quality control, offered health care organization with “…a system that integrates quality development, quality improvement, and quality maintenance” (Ransom, Joshi, Nash, & Ransom, 2008, p. 67). Kaoru Ishikawa contributed to the quality movement by the introduction of such techniques, like the fishbone tool and emphasizes that quality improvement is the responsibility of the entire organization. W. Edwards Deming is the father of quality and has developed a 14-Points approach to quality improvement. Deming also created the Plan, Do, Study, Act (PDSA) cycle of continual improvements, which is used in many organization’s today. Deming also emphasizes the importance of “…practicing continual improvement and thinking of manufacturing as a system” (Ransom, Joshi, Nash, & Ransom, 2008, p. 64). Joseph Juran wrote a handbook on quality control and is most noted for his trilogy, which includes three processes “…quality planning, quality control, and quality improvement” (Ransom, Joshi, Nash, & Ransom, 2008, p. 65). These are just a few prominent founders on quality improvement, who has laid the foundational framework for quality improvement in health care. Differences in Stakeholders Definitions of Quality Stakeholder’s viewpoint on quality differs in meaning. Health care organizations differ in their interpretations and consequently have defined quality in different ways. The Institute of Medicine in 1990 defines quality as “…the degree to which health services for individuals and populations increase the likelihood of desired health outcomes, are consistent with current professional knowledge” (Manjunath, 2008, p. 73). The definition should also include and meets the expectation of health care consumers. Patients define quality differently then health care professionals. To patient’s quality means “…how well a service was delivered not how technically superior the actual service or clinical component turned out” (Chilgren, 2008, p. 221). On the other hand, health care professions define quality according to technical aspects, such as accuracy, appropriateness, and the outcome of the care, whereas, payers view quality as how cost-effective was the care. Health care managers are concerned with the allocations of resources and appropriate use of resources. Societal views on quality are about efficiency, cost-effectiveness, access, and safety. Each group highlights a certain feature of care, which leads to expectations of quality. Roles of Patients and Various Clinicians in QI Patients today are aware of the need for improvements in health care. Patients play a vital role in designing improvements and monitoring if improvements are present because they are receiving the care. In today’s health care patients are more empowered to have control over the care they are receiving by “…partnering in their health care decisions, to get second opinions, and to learn the details of appropriate expectations through informed consent forms that describe the risks and benefits of procedures” (Dlugacz, 2006, p. 6). Nurses play a pivotal role in the efforts of organizations to improve quality. Hospitals are dependent on nurses to address the demands of quality because they spend the most time with the patient. Nurses are in excellent position to have a positive influence on patient satisfaction and outcomes. Leadership also has an important role in quality improvement and set the stage for quality improvements. Leadership is responsible for setting goals and objectives for all staff. The Need for Quality Management Quality management is a “…structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality care that meets or exceeds expectations” (McLaughlin & Kaluzny, 2006, p. 3). Quality management is about improving systems, not to assign blame. It uses performance measures and data to improve the delivery of care. Quality management encompasses continuous quality improvement activities and the management of systems that foster these activities. Areas to Monitor for Quality Monitoring quality is essential to improving quality in health care. Monitoring provides organizations with a method to identify what the organization is doing and to compare that with the initial targets to pinpoint opportunities for improvement. Donabedean outlined a theoretical framework for quality improvement, which consists of structure, process, and outcomes. Structure means “…the human, physical, and financial resources that are needed to provide care” (Emmett, 1999, p. 3). Process is about the care delivered and is a good source for appraising quality of care. Outcomes consist of achievement of goals and another area for evaluating and monitoring quality of care. Patient satisfaction is a positive indicator of high-quality and as a result a good area to monitor for quality. Roles of Various Accrediting and Regulatory Organizations Accrediting and regulatory agencies play important roles to ensure organizations are providing quality safe care. For example, the Joint Commission requires hospitals seeking accreditation to report core quality measures. The National Database of Nursing Quality Indicators is a database of the American Nurse Association. This database collects and evaluates unit-specific nurse-sensitive data from hospitals in the United States, which can be used for quality improvement purposes. Many agencies exist today whose purpose is to monitor and measure the quality of organizations.
Helpful Resources for Organization that Affect QI Leaders in health care have a number of resources available to them for quality improvement initiatives. Tools and techniques that organizations can use consist of data collection tools, which can help categorize data. Control charts that look for variations, the fishbone diagram, which illustrates cause, and effects to identify root causes. Flowcharts are the cornerstone of process improvement planning and analysis, which allows organizations to identify process improvement opportunities.
Conclusion
Quality is a top priority in health care. Many people define quality differently but the outcome is the same. Everyone has a role in quality and nurses play an integral role in influencing patient satisfaction and positive outcomes. Patients play an important role in quality and are more empowered to make decision about their care. Quality management guides organization in the process of improving quality. To improve quality organizations have to monitor aspects of care to see where improvements are needed. Accrediting and regulatory organizations safeguards the public by ensuring that hospital are providing quality care by publicly reporting quality measures. Many resources are available to help organization improve their quality. For organization to stay competitive and meet regulatory requirements quality improvement effort is an ongoing journey.

References
Chilgren, A. A. (2008, July/August). Managers and the New definition of quality. Journal of Healthcare Management, 53(4), 221-229.
Dlugacz, Y. D. (2006). Measuring health care: Using data for operational, financial, and Clinical improvement. San Francisco, CA: Jossey-Bass.
Emmett, M. (1999). An agenda for quality. Retrieved from http://www.hcawv.org/policyplan/shpbmat/shpqtyemmett.pdf
Manjunath, U. (2008, December). Core issues in defining healthcare quality. ICFAI University Journal of Services Marketing, VI (4), 73-78.
McLaughlin, C. P., & Kaluzny, A. D. (2006). Continuous quality improvement in health care: theory implementations and applications (3rd ed.). Sudbury, MA: Jones & Bartlett Publishers.
Ransom, E. R., Joshi, M. S., Nash, D. B., & Ransom, S. B. (eds.). (2008). The healthcare quality book: vision, strategy, and tools. (2nd ed.). Chicago, Il: Health Administration Press.