Quality Indicator Nurses

The theory and the reality NEA Conference 2009 Dr Sue Armstrong

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A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or the level of quality achieved.

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Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of (health care) a product or service.

QAP

THE THEORY

Medicalwebends

THE REALITY

STANDARDS (Performance that is expected)

CRITERIA (Items or variables which enable

the achievement of a standard and the evaluation of whether it has been achieved or not.)

INDICATORS (Qualitative or quantitative

measures – see, feel, touch, hear)

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To improve the quality of the

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organization 

State what the ideal is and measure

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To comply to requirements to operate May be licensing, accreditation, certification “Voluntary” or required Organization has no say

development towards compliance

THE THEORY

THE REALITY

THE DECISION MAKERS:    

HEQC

UMALUSI SANC

PROVINCIAL GVT

1.

APPLICATION FOR ACCREDITATION OF A NURSING EDUCATION INSTITUTION  Conditions for application for accreditation as a nursing education institution  Requirements for accreditation as a nursing education institution  Requirements for the Institutional Portfolio  Standards for Approval as a Nursing education Institution

2. PROCESS OF ACCREDITATION OF INSTITUTIONS          

Pre-audit preparation The Audit visit The auditors The audit report The appeals process Types of accreditation Accreditation certificates Re-accreditation and the accreditation cycle Withdrawal of accreditation Application for extension of scope of accreditation

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The institutional mission and focus Governance framework for the institution Proof of financial viability Links between planning, resource allocation and quality management The education programmes to be offered Arrangements for ensuring quality theoretical and practical teaching and learning Arrangements for creating and applying knowledge Community engagement and service

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Structure Standards including human resources, material resources, financial resources, technology, theoretical and practical learning facilities Process standards including leadership and management of the institution, management of educational programmes, relationships and record keeping and reporting Outcomes standards including quality of graduates, organizational development, and community outreach.

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A panel of auditors is appointed, based on their knowledge, experience and skills in terms of nursing education and quality assessment They will need to be trained on the auditing process.

The audit team for a particular visit is selected on a rotational basis The size of the team of auditors will be determined by the complexity of the institution.

Each team is accompanied by at least one audit officer and an audit administrator from the accreditation body staff The chairperson of the audit team should have acknowledged credibility and authority who commands respect in the nursing education sector.

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Probationary accreditation which enables an nursing education institution applying for accreditation for the first time to offer nursing education for a period not exceeding three years whilst completing requirements for full accreditation.

Provisional accreditation which enables a nursing education institution which has previously been accredited but which complies with most but not all of the required standards to operate for a period not exceeding one year whilst it addresses the areas of concern.

Full accreditation which indicates that the institution complies with all the required standards and may operate for a period of five years before applying for re-accreditation.

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Failure to maintain the requirements Continuous failure to maintain standards after accreditation Evidence that the institution has contravened the Act and its regulations Evidence that submission for accreditation was made fraudulently or contained false or misleading information Failure to inform the Council, in the event of a move On request for voluntary de-accreditation from the head of the nursing education institution.

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The process of systematic

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internal audits

examination of a quality system by internal or

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audit as a requirement

Important part of

organization’s quality management system

THEORY

Reality is that most organizations only do a self-

external auditors 

True when referring to

preceding an external audit 

They are time consuming but very useful if done regularly

REALITY

Standards should reflect best practices benchmarked on the best in the industry  Should be chosen on high risk, high cost, high volume issues 

THEORY

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Reality is they usually reflect best equivalent provider standards Also reflect values of licensing body Licensing bodies have to be sure they will not shut down the entire industry!

REALITY

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The outputs of any programme are the most important aspect for assessing quality of education Tool should be developed so no assessor bias is possible

THEORY

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In reality they are the most difficult to assess and most audit tools have fewer standards & criteria on this aspect than any other

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Unless tools are extremely detailed assessors need to exercise some judgement

REALITY

AREA

INPUT

RELEVANT ASPECTS

•Programme design

•Student recruitment, admission & selection •Staffing •Teaching & learning strategy •Student assessment policies

•Infrastructure & library resources

•Programme administrative services •Postgraduate policies, regulations & procedures

AREA

PROCESS

RELEVANT ASPECTS

•Programme coordination

•Academic development for student success

•Teaching & learning interactions •Student assessment practices OUTPUT & IMPACT

•Coordination or work-based learning and throughput rates •Student retention of post-graduate programmes •Delivery •Programme impact

DOMAIN: PATIENT RIGHTS SUB-DOMAINS: 

1.1 Respect and dignity

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1.2 Information to patients

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1.3 Physical access

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1.4 Continuity of care

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1.5 Reducing delays in care

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1.6. Emergency care

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1.7 Access to a package of services

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1.8. Complaints management

SUB-DOMAIN: RESPECT & DIGNITY STANDARDS: 1. Patients

are treated in a way that shows respect and

maintains patient dignity

2. Results

of patient satisfaction surveys are used to

inform quality improvement in the establishment 3. Establishments

provide hotel services that meet the

patients’ expectations

STANDARD: Establishments provide hotel services that meet the patients’ expectations

CRITERIA: 

The cleanliness and hygiene of the facility contribute towards patient satisfaction.

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The linen services contribute to patient satisfaction.

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The food services contribute to patient satisfaction

CRITERIA: The food services contribute to patient satisfaction

MEASURES / INDICATORS: ď ˝

5 randomly selected patients in the ward

indicate they are satisfied with the temperature of the food served in the ward ď ˝

5 randomly selected patients in the ward

indicate they are satisfied with the quality and quantity of the food served in the ward

CRITERION: The food services

WEIGH

PLACE

TYPE

contribute to patient

T

ASSESSED ASSESS

satisfaction 5 randomly selected patients in the 15%

In-patient

MENT Patient

ward indicate they are satisfied

units

interviews

5 randomly selected patients in the 15%

In-patient

Patient

ward indicate they are satisfied

units

interviews

with the temperature of the food served in the ward

with the quality and quantity of the food served in the ward

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Patient interviews

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Staff Interviews

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Document reviews

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Document analysis

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Patient record reviews

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Patient record audits

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Observation with checklist

Pass Rate per subject Ratios 1 tutor to x students

Pass rate per subject

Difficulty index of exams

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Need to be accredited by both HEQC and SANC

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In theory SANC may be used as agent for HEQC

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Nurses needed to evaluate

nursing aspects especially clinical areas 

System of licensing health establishments coming – implications for NEI’s?

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Nothing to lose if we do internal quality audits meantime

“Aim at the sun, and you may not reach it; But your arrow will fly higher than if you aimed at an object on a level with yourself” J Howse

THE THEORY

THE REALITY