NCM 107

QUALITY CONTROL
Controlling is the function of management that involves,

setting standards, measuring performance against those
standards, reposting the results and taking action.
Quality control is a specific type of controlling, which refers
to activities that evaluate, monitor or regulate services
rendered to consumers .
Quality control has three basic steps:
 Criterion or standard is determined
 Information is collected to determine if the standard has
been met.
 Educational or corrective action is taken if the criterion
has not been met.
 Accountability ; is the obligation to provide a reasoning
for one’s actions to the persons who delegate authority
for that action.
 Nursing care outcome: is the end result of nursing
interventions ; a measurable change in the state of a
patient’s health that is occasioned by nursing action.
 A criterion is the value free name of a variable that is
known to be a reliable indicator of quality.
 A standard is the desired quality, quantity or level of
performance that is established as criterion against
which worker’s performance will be measured.
 Objective is a goal towards which effort is directed. To
be effective, it should be expressed in observable,
measurable terms and should include a target date for
fulfillment.
 Evaluation is a subjective judgement based on objective
measurement.
 Feedback is the information about system performance
that is reflected back into the system on a basis for
monitoring system operation.
 Continuous quality improvement : is the ongoing process
of monitoring structure, process and outcome indicators
in order to identify signal events, significant trends, and
opportunities for change that will guide health care
professionals in preventing patient care problems and
improving already satisfactory patient services.
 Peer review:is the evaluation by a group of practising
professional nurse peers of the quality of nursign care
implemented by another nurse.
Steps in quality control
 Establishment of control standards or criteria.
 Identify the information relevant to criteria.
 Determine ways to collect the information.
 Collect and analyse the information.
 Compare collected information with established
criteria.
 Make a judgment about quality.
 Provide information and if necessary, take
corrective action regarding findings of
appropriate sources.
 Determine ways to collect the information.
STANDARD AS A DEVICE FOR QUALTIY CONTROL
Types of standards the most organisation must establish
(Koont & Weitrich;1988):
 Physical standards: which include patient activity ratings
to establish nursing care hours per patient per day.
 Cost standards: which include the cost per patient per
day.
 Capital standards: include the review of monetary
investment or new programmes.
 Programme standards: which guide the development
and implementation of programmes to meet client needs.
 Intangible standards: which include staff development or
Personnel orientation costs.
 Goal standard: which outline qualitative goals in short
and long term planning.
 Strategies plan standard: which outline check points in
developing and implementing the organization’s strategic
plan.
AUDIT AS A TOOL FOR QUALITY CONTROL
An audit is a systematic and official examination of a
record, process or account to evaluate performance .
Types of Audit
 Outcome audit : end results of care. Eg: length of stay,
morbidity, mortality.
 Process audit : used to measure process of care or how
the care was carried out.
 Structure audit: monitors the structure or setting in which patient
care occurs, such as the finances, nursing services, medical records
and environment.
Nurse manager’s roles in quality control
 Encourage staff to be actively involved in the quality control
process.
 Clearly communicate standards of care to subordinates.
 Encourage the setting of high standards to maximize quality instead
of setting minimum safety standards.
 Implement quality control proactively instead reactively.
 Use control as a method of determining why goals were not met.
 Be positively active in communicating quality control findings.
 Act as a role model for followers in accepting responsibility and
accountability for nursing actions.
Functions of nurse manager in quality control.
 In union with other personnel in the organisation
establish clear cut , measurable standards of care and
determine the most appropriate method for measuring if
those standards have been met.
 Select and use process, outcome and structure audits
appropriately as quality control tools.
 Assesses appropriate sources of information in data
gathering for quality control.
 Determine descrepancies between care provided and
unit standards and seeks further information regarding
why standards were not met.
 Use quality control findings as a measure of employee
performance and reward, coach, counsel or discipline
employees accordingly.
 Keep abreast of current government and licensing
regulations that affect quality control.
TOTAL QUALITY MANAGEMENT

This is a philosophy developed by Dr. Edward Deming.
Principles
 Create a constancy of purpose for the improvement of
the products and service.
 Adopt a philosophy of continual improvement.
 Focus on improving processes, not on inspection of
products.
 End the practice of awarding business on price alone,
instead minimise total cost by working with a simple
supplier.
 Improve constantly every process of planning,
producting and service.
 Institute job training and retraining.
 Develop leadership in the organisation.
 Drive out fear by encouraging employees to participate
actively in the process.
 Foster inter-departmental cooperation, and breakdown
barriers between departments.
 Eliminate slogans, exhortations and targets for the
workforce.
 Focus on quality and not just quantity.
 Promote team work rather than individual
accomplishments .
 Educate employees to maximize personal development.
 Charge all employees with carrying out the total quality
management package.
NURSING AUDIT
Nursing audit is the assessment of the quality of nursing
care and uses records as an aid in evaluating the quality
of patient care. It is an evaluation of the nursing service.
Purposes:
 Evaluating nursing care given
 Achieves deserved and feasible quality of nursing care.
 Stimulant to better records
 Focuses on care provided and not on care provider.
 Contributes to research.
Methods of nursing audit
 Retrospective view:
 Concurrent review:
Advantages of nursing audit:

 Can be used as a method of measurement in all areas of
nursing.
 Scoring system is fairly simple.
 Results are easily understood.
 Assesses the work of all those involved in recording
care.
 May be a useful tool as part of a quality assurance
programme in areas where accurate records of care are
kept.
Disadvantages of nursing audit
 Appraises the outcomes of the nursing process, so it is
not so useful in areas where the nursing process has not
been implemented.
 Many of the components overlap making analysis
difficult.
 Is time consuming.
 Requires a team of trained auditors.
 Deals with a large amount of information.
 Only evaluates record keeping. It only serves to improve
documentation, not nursingz care.
NURSING CARE STANDARDS IN WARD MANAGEMENT

NCM 107

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QUALITY CONTROL

Controlling is the function of management that involves,

TOTAL QUALITY MANAGEMENT

Advantages of nursing audit:

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