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Updated on March 29, 2012



INTRODUCTION:-Health care quality is in the eye of the beholder. In this, the primary goal is to secure the health care. It refers to the actual delivery of care from the point of patients first signaling a desire to be considered for potential treatment.


Quality assurance is a programme adopted by an institution that is designed to promte the best possible care. (Delaughery)

Qulity assurance is the process of achieving excellence in the service rendered to every client.


managers need to be committed to quality management.All employees must be involved in quality improvement.The qoal of quality management is to provide a system in which workers can function effectively.The focus quality management is on improving the system.Every agency has internal and external customers.Customers define quality.Decision must be based on facts.


Methods for measuring performance:

As nursing care is delivered within a frame work of independent relationships wth physicians and a multiplicity of other health care personnel. The most commonly used methods of nursing care are task analysis and quality control.

Measuring actual performance:

It is an ongoing repelitive process with the actual frequency dependant on the type of activity being measured. It is better to clarify the purpose of the measurement and to measure performance on a continuous basis.

Comparing results of performance wth standards and objectives and identifying strengths and areas for correction:

The standards and objectives and methods of measurement have been set ,if performance matches standards and objectives , managers may assume that things are under control if performance is a contrary to standards and objectives, action is necessary.

Acting to reinforce strengths or success and taking corrective action as necessary:

Positive aspects needed to be idebtified in order that they may e translated into encouragement and motivation for the nursing members involved in achieving them.


Lack of resources: Insufficient resources, infrastructure, equipment, money for recurring expenses and staff make it impossible for output of a certain quality.

Personnel problem : Lack of trained, skilled and motivated employees, staff in disciplne etc. affects the quality of care.

Unreasonable patients and attendants:

Illness, anxiety absence of immediate response to treatment, unreasonable and unco-operative attitude which in turn affects the quality care.

4 .Improper maintenance: Building equipment requires proper ,aintenance for efficient use.

5. Absence of well-informed populance:

To improve quality nursing care, it is necessary that the people become knowledgeable and assert their rights to quality care.

6. Absence of accreditation laws: There is no organization strictly empowered legislation to lay down standards for nursing & medical care so as to requlate the quality of care.

7. Inspect hospitals and ensure that basic requirements are met: Enquire into major incidence of negligence and take action against health professional involved in malpractices.

8. Lack of incident review procedures:

During a patient’s hospitalization several incidents may occur which have a bearing on the treatment and the patient’s final recovery.

9. Delayed attendance by physician/nurse:

Incorrect medication, burns arising out of faulty procedures, death in a corridor with no nurse/physician accompanying the patient care.

10. Lack of good hospital information system:

A good management information system is essential for the appraisal of quality care.

11 Absence of conducting patient satisfaction surveys: Surveys to be carried out through questionnaires, interviews etc. by social worker, hospital management trainees and consultant groups.

12. Lack of nursing care records:

Nurses should use the problem oriented record system or use nursing process while recording the care given.

13. Miscellaneous: Lack of good supervision absence of knowledge about the philosophy of nursing care, lack of policy & administrative manual lack of procedure manual, substandard education and trining, inadequate quality and number of professionals, lack of evaluation techniques, lack of co-ordination between and within departmens, lack of written job descriptions and job specifications, lack of in service and continuing educational programmes.



This programme is a carefully planned, phased process, or it may be implemented in one step as part of a fundamental organizational change.

Foster Commitment o Quality:

This process must continue throughout the life of a project and at all levels of the organization. Commitment can be done through awareness- raising seminars, special planning meetings, or one-to- one discussion with an organizations leader

Conduct a Preliminary Review of Quality- Related Activities:-

It is important to conduct an initial review of the organization and to develop a general description of the existing system.

Develop the Purpose and Vision for the Quality Assurance Effort:

Purpose is to build consensus between managers and to set boundaries for the quality assurance effort. The vision will help the staff to understand how their day-to day wok relates to quality improvement.

*Determine level and scope of initial Quality Assurance Activities:

It depend on the resources available, the implementation time frame and the receptivity of managemet and program staff to the idea of quality assurance, The effort can be implemented at national, regional and district level or within a single health facility.

*Assign responsibility for Quality Assurance:

An Existing committee or management body will take on responsibility for quality assurance, integrating it into the general management structure.

*Allocate resources for quality assurance

Local resources must be allocated to quality assurance programme to become a permanent part of a health care organization. It may depend on outside technical and financial assistance.

*Develop a written quality Asurance plan

This plan is a written document that describes the programme objectives and scope, defines lines of responsibility and authority, and puts forth implementation strategies. The plan help the staffs to relate quality, goals and objectives to their routine activities.

*Critical Management System:

Quality assurance efforts will focus three critical management system: Supervision, training and management information systems.

*Disseminate Quality Assurance Experience:

Dissemination strategy should be devised to share experience inside and outside the organization. Conferences which conduct at local, regional, national & international level will reinforce success encourage dialogue and creativity.

*Manage Change:

A careful, phased approach to change is required and an open and trusting environment must be cultivated.


A nursing administrator has to develop a formalized quality programme.

1. Review organizational, personnel and environment.

2. Focus on standards of nursing care and methods of delivering nursing care.

3. Focus on the outcome of care


It focuses the production and service, ie; the environment must be customer responsive. It identifying and doing the right things, the right way, the first time and the prevention of problems.In this, customer needs and experiences with the end product are constantly evaluated.

The critical component in tota quality management is the empowerment of employees by providing positive feed back and reinforcing attitudes and behaviors that support quality and productivity. In total quality management, the employee to be knowledgeable, accountable and responsible and provides education and training for employees at all level.



(i)“Nursing audit refers to assessment of the quality of clinical nursing”-Elison.

(ii) “ Nursing audit is an exercise to find-out whether good nursing practices are followed.”- Goster welfer


Improve quality of health care.

Promote improved communication among nurses & other health team members.

Improve quality of nursing care.

Detect and analyze problems and errors

Ensure that nurses are accountable or answerable for the care.

Contribute to research

For the purpose of reimbursement.


*Selection of a topic

*Development of criteria

*Development of performance standards.

* Chart Preview

*Identification of variation

* Analysis of variation

* Development of solutions to correct poor performance.

* Implementation of corrective action

* Evaluation and reaudit


An audit can be retrospective or concurrent or prospective audit.


A retrospective nursing audit will identify the specific nurse who are responsible for patients care at various times during hospitalization and deficiencies in performance or charting will be reported back to the nurse.


It reviews and evaluates records while persons are receiving care. The advantage is providing opportunities for making changes in the ongoing care programme.


It identifies how future performance will be affected by current interventions.Most frequently used qualiy control are process audit, structure audit and outcome audit.

Prcess Audit: They are used to measure the process of care and how the care was carried out; and are task oriented and focus on whether or not standards of nursing practice are being met.

Structure Audit: These audits assume there is a relationship between setting, quality care, and appropriate structure.

Out Come Audits: They are end results of care. It determines what results occurred as a result of specific intervention by nurses for clients.


A biographical index of quality of nursing

A patient is assured of good services.

It will give a valuable and pertinent information for the staff.

It will lead to between co-operation and communication among the nurse & health team.

It will help each professional nurse for her self evaluation.

It helps the administration as better planning.

It will reduce the incidence of medical legal complication.

It will broaden and strengthen nursing service.


The concept of quality assurance refers to the accountability of the health professions to the society for the quality, quantity, appropriateness and costs of health services provided. In addition to the development of outcome indicators the agenda for change focus on continuous improvement. Total quality management may be one of the factors guaranteeing the survival of the fittest in the future. Fr the evaluation of care, an ongoing system of quality control was necessary in each hospital


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      4 years ago

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