Quality Control and Improvement: An Organizational Perspective

Quality control is a very important part of an organizations goals. This process provides a connection between knowledge and a process where outcomes help improve the quality between the patient and organization. The purpose of this paper is to describe my organizations quality programs goals and objectives, the structure of our quality control management, and describe how quality improvement (QI) projects are selected, managed, and monitored. I will discuss our in-service program, tools used to implement QI and whether they are effective. I will then describe how our QI processes are communicated to the staff and if this communication is effective. Lastly, I will describe how the organization evaluates QI activities and provide two examples

within my organization.
a. What are the organization’s quality program goals and objectives? Examples
A QI program is an effective way of integrating an organizations mission, values, and goals to promote an exemplary quality of care to the patients. A QI plan provides a guide to staff members to help improve performance, provide safe care, and increase the satisfaction of the customers who receives services from our company. One of our goals is to provide a safe and clean environment for our patients to reduce falls. The staff is trained on providing a safe environment, teaching our patients about safety, interventions, and reporting procedures. This helps reduce injuries and readmission rates. Another example is an influenza immunization program that helps promote the benefits of receiving a yearly immunization. According to the Centers for Disease Control and Prevention (2016), up to 710,000 hospitalizations have occurred and up to 56,000 people have died, since 2010, due to influenza. By offering these immunizations to the staff and their patients, we help deter against possible hospitalizations and spreading disease in the community.
b. What is the organization’s quality management structure? If there is not a formal structure, who is responsible for quality management in the organization?
According to Huber (2014), it is important to have structure standards to regulate the environmental and organizational characteristics and provide effective care. My organization is a very small company with only two people that work at the office, excluding the owner. Therefore, we do not have a formal QI structure. However, our director of nursing promotes QI during our in-service meetings. Studies have shown that a quality manager is an important factor, within an organization, to lead, teach, and review QI in order to improve performance and gain an edge on competitors (Kim, V. Kumar, & U. Kumar, 2012). These managers plan, establish goals, uses available resources, and monitors the performance of their staff toward goal attainment to gain knowledge to improve their services.
c. How are quality improvement projects selected, managed and monitored? Does nursing staff have any input?
Quality improvement projects are selected by our director of nursing. These decisions are based from previous research regarding the individual patients of the staff. For instance, when a patient falls, the nurse must fill out an incident report that is received by the office staff and forwarded to the primary care physician. If the patients of the nurses are having increased falls, the director of nursing determines that this would make a good topic for QI at the next quarterly meeting. The director of nursing can monitor these patients and use data to support if additional teaching and improvement is needed. Although the nurses do not have any input on the subject in a direct manor, the communication of the incident report does indirectly give the nurses input.
d. State if quality improvement inservice programs are available for staff in your facility and describe a brief overview of the content.
There are several ways to teach employees about QI. Some examples are lectures with discussions, hands-on training using skills, and computerized training. Studies have shown that adult learning styles improve when a curriculum of group lectures and participation is used over the course of a single encounter to multiple encounters (Wong, Levinson, & Shojania, 2012) This study also showed that when employees became engaged in the QI improvement project, significant improvements occurred. My organization has mandatory quarterly meetings and QI information is presented to us during this time. These meetings usually consist of reading material handed out with a quiz at the end of the meeting. Once everyone is finished, the director of nursing will then go over the answers and an open discussion will begin.
e. What quality methodology and quality tools/techniques are utilized? Are they effective? Why or why not? Provide rationale.
A tool used to measure the performance of an organization is to use a performance measurement system, such as a survey (Huber, 2014). By collecting data, having ongoing training with the staff, and continuing education, the director of nursing can measure the outcome of the teachings. Surveys are sent out to the patients of our organization with about 80 percent of these surveys being returned to the office. The director of nursing can then determine how our patients feel we are doing in certain areas and where we might need improvement. I believe this is an effective way to determine how our patients feel about their care. Al-Abri and Al-Balushi (2013) states that using patient satisfaction surveys are a strategic way to determine the strengths and weakness of a company. It provides the framework to creating a plan to increase patient satisfaction.
f. How are QI activities and processes communicated to staff? Is the communication effective? How could it be improved?
Quality improvement is communicated to our staff during quarterly meetings. The topic is determined by the director of nursing and educational handouts are given to us to increase our knowledge. After completing a quiz on the material distributed, an open discussion between the leader and the nurses then takes place. We are given an opportunity to ask for clarification or bring up issues that we feel need to be discussed further. Improvement could be made by presenting evidence-based practice results to give a better understanding that these methods do work and the reasons behind it. I also believe that it would be beneficial to the staff to feel praised for the items on the survey that were stated as positive areas that we have done well. Harrison (2013), states that every employee wants to feel recognized for a job well done. When the staff is given a praise for a job well done, this raises morale and productivity. When devising a QI plan to correct an action and improve the quality of care for our patients, we also need to hear about the good we have done as well.
g. How does the organization evaluate QI activities for effectiveness? What is the process when the QI activity is not effective?
To determine if the methods and tools that are used for the QI goal are successful, research on patient outcomes and responses by the patient and their family are measurable ways to tell.

New surveys can be distributed, throughout the year as a follow-up, to see if any improvements were made. If not, another QI meeting to continue with additional education is needed. When planning a goal, the goal must be clear to the staff, achievable, and measurable. According to Wong, Cummings, and Ducharme (2013), a measurable goal can determine the outcome of a patient by assessing safety and fall outcomes, adverse events, hospitalizations, mortality, and also patient

satisfaction.
h. Provide 2 examples of a QI initiative that has been effective in your organization. Describe the QI process that occurred. What was the impact on patient outcomes? Did it result in a change in practice?
One example of a QI initiative my organization has implemented was to reduce incidences of falls.

Most of the patient’s we serve consist of elderly patient’s or patients with limited mobility. By using educational material involving signs to look for in the home and patient’s condition, the nurses can devise a care plan to include teaching to the patients, family members, and the home health aide staff. Although a majority of patients understand that by having a clear path can reduce falls, many do not understand the relationship between medication and side effects that could cause weakness and falls. I personally had a patient that had multiple falls on a weekly basis. By recording these falls on our incident report and making myself a tally sheet listed with the number of falls, location in the home where the fall occurred, and the time of day the fall usually happened, I could see a pattern of falls occurring when the patient had no one in the home with her. We were able to get her home health aide hours increased and on a rotating shift. She now has care from the time she gets up until the time her live-in son comes home from work. We have seen a reduction rate, of up to six falls per month, down to twice a

month.
Another example of a QI goal that was suggested was to implement a different way obtaining hand hygiene. So many of our patients were getting influenza and bronchitis, with hospital admissions over the last several months, that we decided to try something new between our nurses and patient’s. As a nurse, we always carry around hand sanitizer, although soap and water is always the preferred method, we do not always have access to these items. As a rule, we always sanitize ours hands upon arrival at a patient’s home. However, it was brought up about possibly having the patient also sanitize their hands with us at the time of service. Studies have shown that 71 percent of patients want to be involved in proper hand hygience (McGuckin & Govednik, 2013). These studies showed that patients were willing to take the initiative to clean their hands along with the staff to reduce illness and disease. I personally made a song and game with my patients and they accepted the change easily. Our measurable outcomes have not yet been determined as a whole for this winter, however, I have noticed that my patients have not had any hospital admissions or additional visits with their physicians, with influenza symptoms, since this QI goal was implemented. I am excited to see the outcome from the other nurses at our next meeting.
In conclusion, nurses are at the forefront of patient care. It is our job to protect the safety of our patients and devise goals to improve patient satisfaction. Organizations must have a quality improvement goal to increase the safety and satisfaction of our patients and it must be measurable. Although my organization lacks structure and an actual QI team, we come together during meetings to construct ways to work toward goals to improve knowledge, skills, and education to both our staff and our patients. We must continue to set goals for continued improvements to occur for the success of the company and safety of our patients.