BUE ID: 111338 QMU ID: 09007674

Unseen code:

Module Title: Management of Health Care Services

Assignment Title: The effect of leadership on improving the nursing quality

care through the quality control process

Module code: N4260

By: Ahmed Khaled Tolba BUE ID: 111338 QMU ID: 09007674

Submission Date: 22/01/2013

Number of Words Used: 2,166

4th Year

BUE ID: 111338 QMU ID: 09007674

Outlines:

Introduction.

Identification and rational for the selection of a given area.

Description of the situation.

Identification of the problem.

Analysis of the factors influencing the situation.

Proposal for solution.

Conclusion.

BUE ID: 111338 QMU ID: 09007674

Introduction:

Management considers one of the main corner stone in any health care

organization, through proper management the health care system can reach

to the desired goals and be able to provide excellent health care for patients

in a professional manner. [Cherie, A and Gebrekidan, A. 2005]

Quality control is one of the controlling functions during the controlling phase

which is the fifth and final phase in the management process.

Management process

The IOM defines quality as “the degree to which health services for

individuals and populations increase the likelihood of desired health outcomes

and are consistent with current and professional knowledge”. [IOM, 2001]

Quality control is a type of controlling, which refers to activities that are used

to evaluate, monitor, or regulate services rendered to consumers, to help

ensure accurate patient results. [Marquis, B and Huston, C. 2009]

Organization

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According to the Institute of Medicine (IOM) 6 aims have been identified to

improve quality health care:

Safe: providing safe care through avoid injuries or any harm to patients.

Effective: providing nursing care that based on a scientific knowledge to

the patients.

Patient-centered.

Timely: reducing waits and harmful delays.

Efficient: avoiding waste of time, supplies, ideas and energy.

Equitable care for all patient without differ in quality due to personal

characteristics such as ethnicity, gender, socioeconomic status and

geographic location

(IOM, 2001)

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Identification and rational for the selected area:

I was training at one of the private hospital in the surgical care unit (SCU) that

located in the fourth floor of the hospital. The unit contain 20 beds spread over

5 rooms; in contrast there are 5 nurses and 1 nursing assistant this means

that, every nurse responsible to provide post-operative care for each room

(which contain approximately 4 patients). Nursing staff in the surgical care unit

are experts in caring for post-operative patients, such as surgical wound care,

burn care management, trauma care and stoma care ... etc.

The rational for selecting that unit is due to its importance as it plays a vital

role to prevent any post- operative complications and improve the patient

condition after the surgery, and because this unit is where the situation

happened as it will be descript at the following paragraph.

Description of the situation:

During my training I was assigned to provide nursing care for three patients at

the surgical care unit (two patients with inguinal hernia and one with burn), in

the same room there is another patient who was post-operative from

laparoscopic cholecystectomy and with past history of stoma “entered with it”.

the nurse started to do stoma care for the patient, and during the procedure I

noticed that she didn’t change her gloves that was contaminated with stool

due to removing the old bag and continued the procedure until the end with

the same contaminated gloves, and also she didn’t dry the area around

stoma after cleaning, that make the area at risk for infection, and also she

didn’t Prepare the proper equipment before starting the procedures, Moreover

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after she finishing the procedure and remove her gloves she washed her hand

by water only and didn’t use antimicrobial soap. Through my conversation

with the nurse later, I noticed that she know about her mistakes, she know

how to do the procedure well but it just was neglect from her. Also I noticed

that there is no clearly published standard “I didn’t see any posters of the

steps of hand hygiene or for waste management”.

After that I asked the head nurse that responsible for the surgical care unit

about the nursing performance how the nurses are evaluated and if there are

continuous and regular nursing learning sessions or conferences to improve

the nursing performance or to inform them if there are any update for example

any new modification for the infection control standards, she stated that “there

is no system for evaluating the nurses or a publish criteria that the evaluation

will based on it, but the nurses of the department are evaluated by me,

because I’ am the most experienced and about the learning sessions or

conferences it’s rarely and there is no specific and regularly time for it”

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Identification of the problem:

As its mentioned in the previous situation, there is a massive and serious

problem presents in lack of clear strategy to measure, monitor and improve

the nursing care quality and also absence of clearly publish standards,

moreover there is no any encouragement or control by leaders or managers

who are responsible for improve nursing performance, and almost there is no

continuous and regular nursing learning sessions or conferences to improve

the nursing performance.

Thus definitely lead nurses to neglect to follow the standards as principals of

infection control causing to poorly nursing performance and negligence during

provide the nursing care to the patients which not due to workload.

Analysis of the factors influencing the situation:

There is a major factor that led to aggravation all of these problems

eventually, which is absence of a clear quality control program to control

and improve the nursing care quality which is one of the main leadership roles

in collaboration with the quality control department.

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Analysis of factors influencing the situation by using SWOT analysis

tool:

Strength Weakness opportunity Threatening There is

enough

numbers of

nurses in the

surgical care

unit.

No establish

control criteria

like polices or

standards.

Absence of

effective

quality control

program.

No evaluation

process for

nursing

performance.

Connective

action to

establish

quality control

department

to collect data,

analyse the

information

and put

corrective

actions for

finding.

Determine

ways to

collect the

information.

Make a

judgment

about quality.

Train leaders

about

appraisal

High cost effect

to improve the

quality of care.

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evaluate

system and

how to

improve staff.

How to build

teamwork.

Continuous

and regular

nursing

learning

sessions and

conferences.

Proposal for solution:

Since the major factor for exacerbating this problems is absence of effective

quality control program and the ineffective role of the quality control

department in the hospital specially the surgical care unit. So to overcome this

problem, hospital officials in collaboration with leader’s departments (head

nurses) and the quality control department must pay more attention to

develop a strategy aimed to improve and monitor the nursing performance by

following the quality control process.

Establish control criteria or standard is the first step in structuring any quality

control program; Standards not only provide trusted guidelines for nurses to

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follow it but also introduce a measurable tool for nursing care evaluating

quality (quality assurance) and thus provide safe and effectiveness nursing

care.

Measuring and monitoring the nursing performance will be impossible without

clearly established standards or hospital policy, the leader or managers (the

head nurse at the unit) must be sure that the standards are clearly understand

from the subordinates (nurses, assistant nurses or workers), and In contrast

the subordinates should be know and aware that their performance will be

measured based on their ability to achieve or not this established standard.

Nursing performance will be measuring and evaluated through information

which is collected and gathering from many appropriate sources as patient

chart and follow-sheet, monitoring nursing practice and also talking with

patient or nurse also may yield information … etc.

After collecting the appropriate information, the managers begin to analyzing

this information and compare this information with the established standards

to reach to a fair judgment about the quality of the nursing care.

If the nurse performance or practices are not enough to satisfy the established

standard, the manager starts to search and fined the real reason for failure to

achieve or met the standers, and trying to find the answer of the question

“why standards was not met?”.

To identify the real or root cause of the problem, the manager using process

as Root cause analysis (RCA) or critical event analysis (CEA) which are a

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process that through it the manager can not only know what or how an

problem happened, but also why it happened?, To be able to correct and

remedy the problem in order to ensure that a preventable negative outcome

does not recur.

[Marquis, B and Huston, C. 2009]

Continuous and regular nursing learning sessions and conferences are also

important to do knowledge refreshment for nurses and also to inform them by

updates or new modification on the standards.

There are some main important points the leader (nursing director or the

head nurse) must take it in account to achieve an effective quality

control program:

o The quality control program must be supported from top-level

administration (nursing director and hospital director).

o Commitment by the organization in terms of fiscal and human resources.

The leader must be realistic and take the economic state and the human

resources of the hospital into account during the implementation of the

quality control program, and works to achieve the difficult equation which

are the balance between quality and cost, So that limits cost as much as

the possibilities for hospital without violating professional obligations to

patients and subordinates.

o Quality control aims and reflect search for excellence rather than

minimums, and the desire to constantly improving for the better.

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o Everyone in the hospital should participate and involved in the quality

control program, because each individual is recipient of benefits, and the

benefit will return to the hospital as a whole.

o The integrated leader or manager in quality control must have the

characters that help to positively influence on the subordinates by

motivating and encouraging them and have the ability and challenge to

make a change to promote quality care for patients:

Vision is one of the main leadership skills that inherent in quality control.

The visionary leader looks at what is and determines what should be. This

character allows leaders to shape the unit goals proactively and improve

the quality of care.

[Marquis, B and Huston, C. 2009]

Leadership roles and management functions that related to quality

control:

In collaboration with other personnel and department (as quality control

department) in the hospital, to establish measurable and achievable

control criteria (standards - policy) of care.

Clearly communicates standards of care to subordinate.

Ensure that standards clarity and understanding from subordinates.

Encourage high standards setting to increase quality efficiency instead of

minimum safety standards, and thus will lead to quality improvement.

Determine the appropriate quality control tools as audits.

Encourage and motivate subordinates and to be actively involved in the

quality control process.

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Continually assesses the unit performance and gathering the necessary

information from appropriate sources for quality control.

Uses quality control results to make a judgment about quality.

Uses quality control as method to determined needs, weak point and

errors of each unit and work to find appropriate solutions, to improve

weaknesses and proactively reworks the processes that led to the errors.

Ensuring that patients receive desired acceptable levels of quality care.

Supports/actively participates in research efforts to identify and measure

nursing-sensitive patient outcomes.

Keeps abreast with current government regulations that affect quality

control. [Marquis, B and Huston, C. 2009]

Conclusion:

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Quality control provides for leader the opportunity to achieve the desired

acceptable levels of quality care and also forming a judgment about unit

quality performance through a systematic, scientific way, to do so, managers

must participate with other personal and hospital department to establish

measurable, achievable, clearly, understand standards that used as a guide

for subordinates, and also as a tool for measure quality care and then develop

and implement quality control programs that comparing the results against

those establish standards to reach to the fair judgment, this strategy help the

leader to determine unit problems, needs, and errors and improve it. The

subordinates can have a feedback from their leaders about their current

quality of care and how their performance can be improved. Because it’s

never-ending process, everyone in the hospital is subject to continuous

improvement efforts.

List of references:

BUE ID: 111338 QMU ID: 09007674

Marquis, B and Huston, C. 2009. Leadership roles and management

functions in nursing. 6th ed. China. Wolters Kluwer Lippincott Williams

& Wilkins.

Whitehead, D, Weliss, S and Tappen, R. 2010. Essential of nursing

leadership and management. 5th ed. U.S.A. F. A. Davis Company.

Institute of Medicine. Crossing the Quality Chasm: A New Health

System for the 21st Century. Washington, DC: National Academies

Press, 2001.

http://www.medscape.org/viewarticle/561651

Cherie, A and Gebrekidan, A. 2005. Nursing leadership and

management. Retrieved from:

http://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_

notes/nursing_students/LN_nsg_ldrshp_final.pdf