CITY UNIVERSITY

Faculty of Public Health

Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 6

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 6: Continuous Quality Improvement (CQI)
- Basics of Continuous Quality Improvement.

- Plan-Do-Study-Act (PDSA) Cycle.

- Implementing CQI Projects in Nursing Units.

- Integration with Performance Metrics and Root Cause

Analysis

- Group Discussion: What are the CQI Initiative in your hospital ?

And what do you suggest ?
 Continuous Quality Improvement (CQI)

Definition of Continuous Quality Improvement (CQI):

Continuous Quality Improvement (CQI) refers to an

ongoing process of identifying, analyzing, and
implementing improvements in healthcare delivery
systems and nursing management practices to enhance
patient outcomes, safety, and satisfaction.

Continuous Quality Improvement (CQI) is a progressive

incremental improvement of processes, safety, and
patient care. The goal of CQI may include improvement of
operations, outcomes, systems processes, improved work
environment, or regulatory compliance.
(NIH National Library of Medicine)
 Continuous Quality Improvement (CQI)

Importance: CQI is crucial in healthcare and nursing

management as it promotes the delivery of high-
quality, patient-centered care, ensures adherence to
evidence-based practices, enhances efficiency,
reduces medical errors, and fosters a culture of
learning and innovation.

. Practical Examples:
1. Conducting regular clinical audits to identify areas for
improvement in patient care processes.
2. Engaging frontline staff in quality improvement
initiatives through training, empowerment, and
recognition programs.
 Continuous Quality Improvement (CQI)
Primary Models for CQI in Healthcare

A number of established models can help organizations perform

effective continuous quality improvement. Many of those models
originated and are still used in other industries. But they can apply to
healthcare organizations. CQI models include the following:

1. Lean: This model originated with Toyota, a Japanese carmaker. It

defines value based on what the customer (or patient) wants, then
flows from there. In healthcare, the model focuses on reducing
activities that don’t add value, making tasks more mistake-proof, and
constantly cutting down on waste to improve the delivery of
healthcare.

2. Six Sigma: This model originated in the U.S. manufacturing

industry. It works to improve efficiency by minimizing variability in a
process, then finding and correcting errors. As errors decrease, so
does variability.
 Continuous Quality Improvement (CQI)

3. Plan Do Study Act (PDSA): This model begins by determining

the specifics and scope of the problem, determining the changes
that should happen, planning for those changes, and figuring out
what an organization will measure to determine whether change
under way. Then you establish whether any of the changes are
positive, adjust if needed, and start the process again. Learn more
about PDSA in “A Business Guide to Effective Quality Improvement
in Healthcare: Principles, Strategies, Templates, and Metrics.”

4. Root Cause Analysis: This method is used most often after an

event, usually adverse, to understand the underlying cause. It’s
based on the presumption that many human errors occur due to
an underlying systemic problem.

5. Deming Plan Do Check Act Cycle: This is another term for the
PDSA model that includes the name of William Edwards Deming, a
pioneer of quality improvement processes.
 Applying CQI to Healthcare Clinical Practice
CQI academic researchers have pointed out that applying CQI to clinical
practice usually involves three broad categories of problems:

1.Overuse: This refers to the use of healthcare services or procedures when the
risks outweigh the benefits. “The services that tend to be overused are the
prescription of tranquilizers and sedatives and the performance of carotid
endarterectomies, hysterectomies, and upper GI endoscopies,” wrote the
authors of “Assessing the Impact of Continuous Quality Improvement on
Clinical Practice.”

1.Underuse: This refers to the failure to provide healthcare services or

procedures when the benefits outweigh the risks. “In the underused category
are immunization, anticoagulation therapy, assessment for depression, prenatal
care, and mammography,” wrote the “Assessing the Impact” authors.

1.Misuse: This refers to when an appropriate healthcare service is used

improperly. “Common examples of misuse are medication errors and
complications or injuries to the patient that are caused by the provider,” the
paper’s authors wrote.
 Plan-Do-Study-Act (PDSA) Cycle.
The Plan-Do-Study-Act (PDSA) Cycle is a four-step iterative
problem-solving model used in CQI to test and implement
changes systematically. It involves planning a change,
implementing it on a small scale, studying the results, and
acting on what was learned to make further improvements.

Also Called: Rapid cycle improvement PDSA, or Plan-Do-Study-

Act, is an iterative, four-stage problem-solving model used for
improving a process or carrying out change.

Importance: The PDSA Cycle provides a structured approach

for healthcare professionals and nursing managers to
implement and evaluate changes effectively, minimize risks,
and continuously refine processes to achieve desired
outcomes.
 Plan-Do-Study-Act (PDSA) Cycle.

What Does PDSA Cover?

The PDSA framework covers four phases. It allows organizations

to plan to test a change in a process (plan), to carry out that
test by making changes in that process (do), to observe and
analyze, through measurements, the effects of that change
(study), and then to decide how to react to that first test (act).

Sometimes, the last phase includes the implementation of a

change; more often, it includes further modification of that
change and then the repetition of another PDSA process. An
older term for the same process is plan, do, check, act, or
PDCA.
The First Questions You Should Ask as You Embark on PDSA Work

The PDSA Model for Improvement was developed by a quality

improvement organization called Associates in Process
Improvement. Associates in Process Improvement was founded
by William Edwards Deming, a pioneer of quality improvement
processes who worked with the Japanese manufacturing
industry after World War II.
The Model of Improvement asks the following three
foundational questions in conjunction with the plan, do, study,
act cycle:
•What are we trying to accomplish?
•How will we know that change is an improvement?
•What change can we make that will result in improvement?
The First Questions You Should Ask as You Embark on PDSA Work

•Plan: Describe what you want to accomplish in an aim

statement or a project charter, or both.
•Describe the current process, the issues with that process, and
the overall context.
•Recruit PDSA team members who fully understand the process
you’re modifying.
•Identify possible causes of the problem.
•Identify possible changes or alternatives that might fix the
problem or improve the process.
•Make predictions about what will happen with proposed
changes and why.
•Plan the test of the change, including a plan for what data you
will collect and how you will collect it.
•Implement SMART goals (specific, measurable, attainable,
relevant, and timely) for the test.
The First Questions You Should Ask as You Embark on PDSA Work

•Do: Describe in writing what happens when you run the test.
Collect data that you identified during the planning stage. Your
team might find it helpful to use a check sheet, flowchart or run
chart to capture data/occurrences as they happen over time.

•Study:
• Compare the data you’ve collected to the data you
acquired prior to the change. Then, compare your most
recent data to your predictions.
• Determine if the change resulted in the expected
outcome.
• Decide on any lessons learned regarding how you
implemented or how you could improve the change.
• Summarize in writing what you learned, including
unexpected results, successes, and failures.
The First Questions You Should Ask as You Embark on PDSA Work

•Act: Based on what you learned from the test, your

organization should do the following:
• Adapt: Modify the changes and repeat the PDSA cycle,
including preparing a plan for the next test.
• Adopt: Implement the changes in the small-scale area
where you first tested and then consider expanding to
other departments.
• Abandon: Change your approach entirely and repeat
the PDSA cycle.
 - Implementing CQI Projects in Nursing Units.
Nursing Quality Improvement Project Ideas and guide factsheets offer
project ideas for quality improvement in nursing, including the
following:

•Improving healthcare-related communication about individual

patients during shift changes of nurses or other healthcare
professionals
•Improving nursing teamwork.
•Improving patient safety by improving the nursing workload
•Preventing falls and injuries in patients within healthcare facilities
•Preventing pneumonia that can come from airway ventilators used on
patients — called ventilator-associated pneumonia
•Preventing pressure ulcers (bedsores) in patients within healthcare
facilities
•Reducing medication errors
•Reducing nurse fatigue and stress
•Reducing staff turnover among nurses
 - Implementing CQI Projects in Nursing Units.
Strategies for Quality Improvement in Critical Care Nursing recommend the following:

•Choose the right healthcare metric to measure. The metric needs to be a relevant gauge
for true health benefits. An example of a good metric is the rate of catheter-related urinary
tract infections, which have been a problem throughout the U.S. healthcare system.

•Collect the best and most relevant data. The development of electronic health records for
all patients helps here, compared to decades ago when data was handwritten on paper
within patient charts. But there is still information outside of electronic health records that
can be helpful for understanding how to improve a healthcare process.

•Disseminate the data. The medical teams involved must understand what the current data
shows about a healthcare process and recognize how that data is changing as the process
shifts. You can better engage everyone involved by using charts and graphics to show the
data.

•Empower nurses. There are more nurses than any other group of healthcare workers, and
their jobs put them in positions to understand problems and make change. They are often
motivated to bring about change, and quality improvement systems need to take advantage
of that, along with their experience and abilities.
 Root Cause Analysis (RCA) in Healthcare

•Definition of Root Cause Analysis

(RCA) in Healthcare:

Root Cause Analysis (RCA) in healthcare

is a systematic process used to identify
the underlying causes or contributing
factors of adverse events, errors, or near
misses that occur within healthcare
systems. It aims to delve beyond
surface-level symptoms to uncover the
fundamental reasons why an incident
occurred, with the ultimate goal of
implementing preventive measures to
mitigate future occurrences.
 Root Cause Analysis (RCA) in Healthcare
Root Cause Analysis is crucial in healthcare for several reasons:

1.Preventative Approach: RCA allows healthcare organizations to take a

proactive approach to patient safety by identifying and addressing
underlying issues before they lead to harm.
2.Continuous Improvement: By uncovering root causes of adverse events,
RCA facilitates continuous learning and improvement within healthcare
systems, fostering a culture of safety and quality.
3.Risk Reduction: Understanding the root causes of errors or incidents
enables healthcare providers to implement targeted interventions to reduce
risks and enhance patient safety.
4.Legal and Regulatory Compliance: Many healthcare regulatory bodies
require healthcare organizations to conduct RCA as part of their quality
improvement efforts to ensure compliance with standards and regulations.
5.Enhanced Patient Trust: By demonstrating a commitment to
transparency, accountability, and continuous improvement through RCA,
healthcare organizations can enhance patient trust and confidence in their
services.
 Root Cause Analysis (RCA) in Healthcare

A near miss in healthcare refers to an incident or event that

had the potential to cause harm to a patient, staff member, or
visitor but did not result in any injury or damage. It is a
situation where an error, mishap, or unsafe condition occurred
but was detected and corrected before any adverse
consequences occurred. Near misses are valuable
opportunities for learning and improvement in healthcare
systems as they provide insights into potential risks and
vulnerabilities that can be addressed to prevent future adverse
events.
 Root Cause Analysis (RCA) in Healthcare

Root Cause Analysis (RCA) Example: Medication Error

Scenario: Patient receives incorrect medication dosage.
Immediate Actions: Medication administration halted, patient
assessed, incident reported.
RCA Steps:
1.Gather Information: Review records, interview staff.
2.Identify Factors: Labeling issues, workload, staff training.
3.Determine Root Causes: Inadequate labeling standards,
staffing, training.
4.Preventive Measures: Standardize labeling, adjust staffing,
provide training.
5.Implement Changes: Update policies, adjust schedules,
conduct training.
 Root Cause Analysis (RCA) in Healthcare

Near Miss Example: Operating Room Equipment Malfunction

Scenario: Equipment failure during surgery, quickly replaced
with no harm.
Immediate Actions: Surgery paused, backup equipment used,
incident documented.
RCA Steps:
1.Gather Information: Review reports, interview team.
2.Identify Factors: Maintenance, training, environment.
3.Determine Root Causes: Lack of maintenance, backup
protocols, environmental conditions.
4.Preventive Measures: Increase maintenance, enhance
training, monitor environment.
5.Implement Changes: Revise maintenance schedules, conduct
training, install monitoring systems.
Session 6: Continuous Quality Improvement (CQI)

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 7

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 7: Patient-Centered Care and Experience

- Elements of Patient-Centered Care

- Case Study: Patient-Centered Care in
Doctor’s Office
- Measuring Patient Experience and
Satisfaction
- Strategies for Enhancing Patient-
Centeredness
 Patient-Centered Care Definition
Definition: Patient-centered care is an approach to healthcare
that prioritizes the needs, preferences, and values of patients.
It involves collaboration and communication between
healthcare providers, patients, and families, with a focus on
respecting patient autonomy and involving them in decision-
making. This approach ensures comprehensive, coordinated
services and aims to create a supportive and compassionate
care environment that addresses both physical and emotional
well-being. Ultimately, patient-centered care aims to enhance
patient satisfaction, improve health outcomes, and provide a
positive care experience aligned with individual patient goals
and values.

Definition: In patient-centered care, an individual’s specific

health needs and desired health outcomes are the driving force
behind all health care decisions and quality measurements.
Patients are partners with their health care providers, and
providers treat patients not only from a clinical perspective, but
also from an emotional, mental, spiritual, social, and financial
perspective.
Elements of Patient-Centered Care
 Elements of Patient-Centered Care

1.Mission and Value Aligned with Patient

Goals: Healthcare providers and organizations
align their mission and values with the goals
and priorities of the patients they serve. This
means placing patient well-being and
preferences at the forefront of decision-making
and care delivery.
Example: A hospital's mission statement
emphasizes patient-centered care and values
patient input in decision-making processes,
aligning organizational goals with improving
patient outcomes and experiences.
 Elements of Patient-Centered Care
2. Care is Collaborative, Coordinated,
Accessible: Patient-centered care involves
collaboration among healthcare providers from
different disciplines to ensure coordinated and
accessible care. This includes effective
communication among providers and with
patients to optimize treatment plans and
outcomes.
•Example: A primary care physician collaborates with
specialists, nurses, and other healthcare providers to
develop a comprehensive care plan for a patient with a
chronic condition. They ensure that the patient has easy
access to necessary services and appointments.
 Elements of Patient-Centered Care
3. Physical Comfort and Emotional Well-being
are Top Priorities: Patient-centered care
prioritizes not only addressing physical health
needs but also ensuring patients' emotional
well-being. Creating a comfortable and
supportive care environment contributes to
overall patient satisfaction and recovery.

•Example: A hospital provides private rooms with

comfortable beds, creative decor, and access to natural
light to promote physical comfort and emotional well-
being for patients during their stay.
 Elements of Patient-Centered Care

4. Patient and Family Viewpoints Respected

and Valued: Healthcare providers actively seek
and respect the viewpoints and preferences of
patients and their families regarding their care.
This involves open communication, listening
attentively, and incorporating patient
preferences into decision-making.
•Example: During rounds, medical staff actively listen to a
patient's concerns and involve their family members in
discussions about treatment options and care decisions,
respecting their viewpoints and preferences.
 Elements of Patient-Centered Care
5. Patient and Family Always Included in
Decisions: Patients and their families are
actively involved in decisions related to
treatment options, care plans, and goals.
Providers engage patients in shared decision-
making to ensure their preferences and values
guide the care process.

•Example: A healthcare team discusses treatment

options with a patient diagnosed with cancer, ensuring
that the patient and their family are involved in decision-
making processes and empowered to choose the most
suitable course of action based on their values and
preferences.
 Elements of Patient-Centered Care
6. Family Welcome in Care Setting: Patient-
centered care recognizes the importance of
involving and supporting patients' families in
the care setting. Families are welcomed and
encouraged to participate in discussions,
support patient recovery, and provide
emotional assistance.
•Example: A pediatric hospital allows parents to stay
overnight with their hospitalized child and encourages
family involvement in care routines, such as feeding,
bathing, and comforting the child, to create a supportive
and family-friendly environment.
 Elements of Patient-Centered Care
7. Full Transparency and Fast Delivery of
Information: Patient-centered care emphasizes
transparency in communication, ensuring that
patients receive timely and accurate
information about their health condition,
treatment options, and care plan. This
promotes patient understanding,
empowerment, and informed decision-making.
•Example: A healthcare provider explains a diagnosis and
treatment plan clearly to a patient, using simple
language and visual aids to ensure understanding. They
promptly share test results and updates with the patient
and address any questions or concerns in a timely
manner.
Case Study:
Patient-
Centered
Care in
Doctor’s
Office
 Under patient-centered care, care focuses more on the patient’s problem
than on his or her diagnosis. Patients have trusted, personal

Patient- relationships with their doctors in patient-focused care models.

Empathy, two-way communication, and eye-to-eye contact are crucial, as

Centered is the ability of the doctor to see beyond a patient’s immediate symptoms
or pain. This broader look at the needs of the whole patient requires
providers to offer services or referral to services such as peer support
Care in programs, social workers, financial counselors, mental and emotional
health providers, transportation and daily living assistance, and in some

Doctor’s communities, language and literacy education. While human interaction

takes a primary role in patient-centered care, physician practices may also
employ a variety of technology-based tools to help patients take
Office ownership of their health care outside of the doctor’s office. Tools range
from 24/7 online portals that let patients schedule appointments, get
information about their condition and care instructions, review lab results
and doctor’s notes, and pay bills at their convenience, to wearable
technology and apps that let patients track their “important numbers” such
as weight, blood pressure, glucose levels, and cholesterol.
 1. Identify the key components of patient-centered care as
described in the example.

2. How does patient-centered care emphasize the relationship

between patients and their doctors?

3. What role does empathy play in patient-centered care, and

Questions: why is it important?

Patient-Centered 4. Explain the concept of looking beyond a patient’s immediate

symptoms or pain in patient-centered care.
Care in Doctor’s 5. List the types of support services mentioned in patient-
Office centered care.
Why are these services important in this model?

6. What role does technology play in patient-centered care

according to the example?

7. What are the potential benefits of patient-centered care for

both patients and healthcare providers?
 Benefits of Patient-Centered Care
The primary goal and benefit of patient-centered care is to
improve individual health outcomes, not
just population health outcomes, although population
outcomes may also improve, through:

• Improved satisfaction scores among patients and their

families.
• Enhanced reputation of providers among health care
consumers.
• Better morale and productivity among clinicians and
ancillary staff.
• Improved resource allocation.
• Reduced expenses and increased financial margins
throughout the continuum of care.
 Measuring Patient Experience and Satisfaction
Measuring patient experience and satisfaction
is essential for healthcare providers to
enhance care quality and patient-
.
centeredness. Various methods are used to
gather feedback and insights from patients.

1.Patient Surveys: Standardized surveys like CAHPS (Consumer

Assessment of Healthcare Providers and Systems) or
customized tools are deployed to evaluate care quality,
communication, and overall experience.

2. Real-Time Feedback: Instant feedback tools such as tablet-

based surveys in waiting areas allow for immediate impressions
and concerns to be captured.
 Measuring Patient Experience and Satisfaction
3. Online Reviews: Monitoring platforms like Google Reviews and
healthcare-specific sites helps analyze patient testimonials and sentiments.

.4. Complaint Tracking: Keeping records of patient complaints and

compliments aids in identifying recurring issues and successes.

5. Healthcare App Data: Analyzing usage patterns from patient-facing apps

provides insights into engagement and preferences.

6. Follow-Up Surveys: Post-appointment surveys are conducted to assess

satisfaction levels and identify areas for improvement.

7. Staff Engagement: Involving healthcare staff in feedback collection offers

valuable insights into patient interactions and perceptions.

8. Benchmarking: Comparing patient experience metrics against industry

standards and peer organizations helps identify best practices and areas for
improvement.
 Strategies for Enhancing Patient-Centeredness
Enhancing patient-centeredness in healthcare is
essential for delivering quality care that meets
. patients' needs. By adopting specific strategies,
healthcare providers can foster a more patient-
centered approach that improves patient satisfaction
and outcomes, here ‘s below some effective strategies:

1. Effective Communication Strategy:

•Encourage active listening to understand patients' concerns,
preferences, and values.
•Use clear, jargon-free language to explain diagnoses,
treatments, and procedures.
•Invite and address questions and encourage patients to
participate in decisions about their care.
 Strategies for Enhancing Patient-Centeredness
2. Respect for Patient Preferences Strategy:
•Recognize and accommodate individual patient preferences and
values.
•Offer choices whenever possible in treatment options,
medications, and care plans.
3. Empowering Patients Strategy:
•Provide education and resources to empower patients to
participate in their own care.
•Support shared decision-making by discussing risks, benefits,
and alternatives.
4. Cultural Competence Strategy:
•Respect and integrate cultural beliefs and practices into care
plans.
•Use interpreters and cultural mediators when necessary to
bridge language and cultural gaps.
 Strategies for Enhancing Patient-Centeredness
5. Holistic Approach Strategy:
•Consider the patient's physical, emotional, social, and spiritual
needs.
.•Collaborate with other healthcare professionals to address all
aspects of a patient's well-being.
6. Personalized Care Plans Strategy:
•Tailor treatment plans based on individual patient needs and
circumstances.
•Involve patients in setting achievable goals for their health and
well-being.
7. Access and Continuity Strategy:
•Ensure easy access to care and continuity of care across different
healthcare settings.
•Facilitate seamless transitions between primary care, specialty
care, and other services.
Session 7: Patient-Centered Care and Experience

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 8

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 8: Benchmarking, Best Practices, and Standards

- (Revision in Session 7): Patient Centered Care

(Benefits, Measuring, Strategies)
- Benchmarking in Healthcare (Definition,
Importance, Examples)
- Identifying Best Practices in Nursing
- Adopting National and International Standards
- Case Discussion: Benchmarking Exercise
 Benefits of Patient-Centered Care
The primary goal and benefit of patient-centered care is to
improve individual health outcomes, not
just population health outcomes, although population
outcomes may also improve, through:

• Improved satisfaction scores among patients and their

families.
• Enhanced reputation of providers among health care
consumers.
• Better morale and productivity among clinicians and
ancillary staff.
• Improved resource allocation.
• Reduced expenses and increased financial margins
throughout the continuum of care.
 Measuring Patient Experience and Satisfaction
Measuring patient experience and satisfaction
is essential for healthcare providers to
enhance care quality and patient-
.
centeredness. Various methods are used to
gather feedback and insights from patients.

1.Patient Surveys: Standardized surveys like CAHPS (Consumer

Assessment of Healthcare Providers and Systems) or
customized tools are deployed to evaluate care quality,
communication, and overall experience.

2. Real-Time Feedback: Instant feedback tools such as tablet-

based surveys in waiting areas allow for immediate impressions
and concerns to be captured.
 Measuring Patient Experience and Satisfaction
3. Online Reviews: Monitoring platforms like Google Reviews and
healthcare-specific sites helps analyze patient testimonials and sentiments.

.4. Complaint Tracking: Keeping records of patient complaints and

compliments aids in identifying recurring issues and successes.

5. Healthcare App Data: Analyzing usage patterns from patient-facing apps

provides insights into engagement and preferences.

6. Follow-Up Surveys: Post-appointment surveys are conducted to assess

satisfaction levels and identify areas for improvement.

7. Staff Engagement: Involving healthcare staff in feedback collection offers

valuable insights into patient interactions and perceptions.

8. Benchmarking: Comparing patient experience metrics against industry

standards and peer organizations helps identify best practices and areas for
improvement.
 Strategies for Enhancing Patient-Centeredness
Enhancing patient-centeredness in healthcare is
essential for delivering quality care that meets
. patients' needs. By adopting specific strategies,
healthcare providers can foster a more patient-
centered approach that improves patient satisfaction
and outcomes, here ‘s below some effective strategies:

1. Effective Communication Strategy:

•Encourage active listening to understand patients' concerns,
preferences, and values.
•Use clear, jargon-free language to explain diagnoses,
treatments, and procedures.
•Invite and address questions and encourage patients to
participate in decisions about their care.
 Strategies for Enhancing Patient-Centeredness
2. Respect for Patient Preferences Strategy:
•Recognize and accommodate individual patient preferences and
values.
•Offer choices whenever possible in treatment options,
medications, and care plans.
3. Empowering Patients Strategy:
•Provide education and resources to empower patients to
participate in their own care.
•Support shared decision-making by discussing risks, benefits,
and alternatives.
4. Cultural Competence Strategy:
•Respect and integrate cultural beliefs and practices into care
plans.
•Use interpreters and cultural mediators when necessary to
bridge language and cultural gaps.
 Strategies for Enhancing Patient-Centeredness
5. Holistic Approach Strategy:
•Consider the patient's physical, emotional, social, and spiritual
needs.
.•Collaborate with other healthcare professionals to address all
aspects of a patient's well-being.
6. Personalized Care Plans Strategy:
•Tailor treatment plans based on individual patient needs and
circumstances.
•Involve patients in setting achievable goals for their health and
well-being.
7. Access and Continuity Strategy:
•Ensure easy access to care and continuity of care across different
healthcare settings.
•Facilitate seamless transitions between primary care, specialty
care, and other services.
 Benchmarking in Healthcare
•Title: What is Benchmarking in
Healthcare?
• Benchmarking in healthcare has been a
common practice since 1985. It involves
comparing an organization’s performance
metrics to a standard developed using data
from other similar organizations.
Benchmarking in healthcare is used as a tactic
to understand where an organization’s
performance stands in comparison with its
peers, and the scope for improvement.
• Objectives of Benchmarking in Healthcare:
Improve service delivery, increase patient
satisfaction, and optimize operational
efficiency.
Benchmarking in Healthcare
 Benchmarking in Healthcare
•Title: Why is Benchmarking Important in
Healthcare? Examples of Benchmarking
•Content:
• Importance of Benchmarking:
• Enhances quality of care
• Promotes competitive advantage
• Drives organizational changes and
improvements
• Examples:
• Comparing patient wait times
• Benchmarking surgery recovery rates
against leading healthcare facilities
• Patient outcome comparisons
 Benchmarking in Healthcare
Internal benchmarking involves comparing departments,
divisions, or locations within the same healthcare
organization to identify best practices and areas needing
improvement. For example, a hospital administrator
might analyze patient satisfaction ratings across different
facilities to enhance service quality uniformly.
Competitive benchmarking entails comparing an
organization's performance metrics with those of
competitors or industry peers. This type of benchmarking
is crucial in healthcare for organizations to evaluate how
they stand against others in the same or different
geographic regions, facilitating mutual learning and
process improvement.
 Benchmarking in Healthcare
Functional benchmarking in healthcare involves comparing an
organization’s operations to those in different industries with similar
processes or metrics, providing insights for potential improvements. For
example, a hospital might look at a manufacturing company’s supply chain
efficiency to enhance its own medical inventory management. This
approach allows healthcare providers to adopt best practices from sectors
outside of healthcare, enhancing operational efficiency.

Generic benchmarking goes beyond specific data sets to focus on broad

processes. This method encourages innovative thinking within healthcare
by comparing general practices with those in unrelated industries. For
example, analyzing a hospital’s patient admission process alongside a
hotel’s check-in procedure can reveal new ways to streamline operations,
even though these sectors are fundamentally different. This type of
benchmarking encourages significant process improvements by exploring
diverse industry strategies.
 Identifying Benchmarking Best Practices in Nursing
A quality manager can effectively report on benchmarking and performance
improvements in healthcare by following a structured approach. This helps communicate
insights and progress clearly and compellingly to stakeholders such as senior
management, department heads, and regulatory bodies. Here’s how they might
structure their reporting:

1. Executive Summary
•Purpose of the Report: Briefly describe the intent of the benchmarking efforts and the
main findings.
•Key Findings: Highlight major achievements, areas of concern, and general performance
compared to industry benchmarks.

2. Methodology
•Selection of KPIs: Detail the criteria for selecting specific KPIs and how they align with
organizational goals.
•Data Sources: Identify the sources of benchmarking data (e.g., government databases,
industry reports, private benchmarking firms) and the rationale for their selection.
•Benchmarking Process: Explain the process of comparing organizational performance
against industry standards, including any analytical tools or software used.
 Identifying Benchmarking Best Practices in Nursing
3. Performance Analysis
•Current Performance vs. Benchmarks: Present data showing the organization's
performance relative to industry standards. Use charts, graphs, and tables for clarity.
•Gap Analysis: Discuss any discrepancies between current performance and
benchmarks, pinpointing both strengths and weaknesses.
•Trend Analysis: Include historical data comparisons to show trends over time, which
helps in understanding progress or regression.
4. Improvement Initiatives
•Action Taken: Outline specific initiatives undertaken to address areas needing
improvement as identified through benchmarking.
•Results of Initiatives: Provide preliminary results or expected outcomes of the
improvement measures.
5. Recommendations and Next Steps
•Short-Term Actions: Suggest immediate steps to address any critical issues.
•Long-Term Strategies: Recommend strategies for sustained improvement and
continuous compliance with industry standards.
•Future Benchmarking Plans: Discuss plans for ongoing benchmarking activities,
including potential adjustments in KPIs or methodologies based on outcomes and
feedback.
 Identifying Benchmarking Best Practices in Nursing
Additional Enhancements to Reporting
•Regular Updates: Provide regular updates
during stakeholder meetings to keep all parties
informed about progress and any adjustments
in strategy.
•Feedback Integration: Incorporate feedback
from nursing staff and other departments to
refine practices and reporting over time.
•Technology Use: Leverage technology like
healthcare analytics platforms to gather real-
time data and generate insightful reports that
are dynamically updated.
 Adopting Benchmarking National and International
Standards – National and International Standards
Adopting benchmarking standards, both national
and international, is crucial for healthcare
organizations aiming to enhance their quality of
care, operational efficiency, and patient satisfaction.
Here’s an overview of how specific national and
international benchmarking standards play a role in
healthcare:
National Standards (Lebanese Ministry of Public
Health - MOH)
1.Lebanese Ministry of Public Health (MOH):
1. The MOH in Lebanon sets standards and
guidelines for healthcare facilities and
practitioners to ensure quality of care and patient
safety.
2. These standards cover various aspects of
healthcare delivery, including infrastructure,
staffing, clinical protocols, and patient rights.
 Adopting Benchmarking National and International
Standards – National and International Standards
International Standards
1.Joint Commission International (JCI):
1. JCI provides accreditation for healthcare organizations worldwide based
on rigorous standards of patient care, quality improvement, and patient
safety.
2. JCI standards are globally recognized and used by healthcare facilities to
benchmark their performance against best practices.
2.Canadian Accreditation:
1. Accreditation Canada offers standards and accreditation programs for
healthcare organizations in Canada and internationally.
2. Their standards focus on patient-centered care, leadership, governance,
and continuous quality improvement.
3.Australian Accreditation:
1. In Australia, accreditation is provided by organizations such as the
Australian Commission on Safety and Quality in Health Care (ACSQHC).
2. Australian standards emphasize safety, effectiveness, patient-
centeredness, timeliness, efficiency, and equity in healthcare delivery.
 Adopting Benchmarking National and International
Standards – National and International Standards
Benefits of Adopting These Standards
•Improved Quality of Care: Adherence to established standards
ensures consistent delivery of high-quality care and adherence to best
practices.
•Global Recognition: International accreditation enhances the
reputation of healthcare organizations and fosters trust among
patients and stakeholders.
•Enhanced Patient Safety: Standards promote patient safety by
identifying and mitigating risks within healthcare settings.
•Continuous Improvement: Benchmarking against international
standards encourages ongoing quality improvement and innovation in
healthcare delivery.
•Facilitated Collaboration: Common standards enable collaboration
and knowledge-sharing among healthcare providers globally.
Case Discussion - Conducting the Benchmarking Exercise
Objective: Request preparation of a comprehensive benchmark report to inform
strategic decisions and enhance hospital performance.
1.Select Key Performance Indicators (KPIs):
1. Choose critical metrics aligned with hospital objectives (e.g., patient
satisfaction, readmission rates, financial performance).
2.Data Collection and Analysis:
1. Gather internal data (e.g., EMR systems, quality improvement initiatives).
2. Obtain external benchmarking data from reputable sources (e.g., industry
reports, comparative studies).
3.Benchmarking Analysis:
1. Compare hospital performance against industry benchmarks.
2. Identify strengths and areas needing improvement.
4.Insights and Recommendations:
1. Summarize findings and insights from benchmarking.
2. Provide actionable recommendations for performance enhancement.
Session 8: Benchmarking, Best Practices, and Standards

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 9

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 9: Teamwork, Collaboration, and Interdisciplinary Care

- Importance of Teamwork in Quality

Care.
- Key Elements of Effective
Teamwork.
- Collaboration Among Healthcare
Professionals (as selected elements, Ex).
- Interdisciplinary Rounds and Care
Planning.
- Interdisciplinary Care Challenge:
Enhancing Teamwork in Patient-
Centered Care
 Importance of Teamwork in Quality Care
1.Introduction
1. Importance of teamwork in healthcare settings.
2. Definition of teamwork and its significance in providing
quality care.

2.Key Elements of Effective Teamwork

1. Communication: Clear and open communication among
team members.
2. Collaboration: Working together towards common goals.
3. Respect: Valuing each team member's expertise and
contribution.
4. Coordination: Efficient coordination of tasks and
responsibilities.
 Importance of Teamwork in Quality Care
1.Introduction
Importance of teamwork in healthcare settings/
Definition of teamwork and its significance in providing quality care.

Effective teamwork, collaboration, and communication are not abstract

concepts but critical skills that directly impact patient outcomes and the
quality of care. As frontline caregivers, nurses depend on these abilities to
deliver optimal treatment and support to patients.
Nurses play a pivotal role in long-term care settings, often being the first
responders to changes in a patient's health status.

Their close observation and swift actions are instrumental in identifying

improvements or declines in patient conditions. Practical Nurses,
equipped with specialized knowledge gained from practical training
programs, function as integral members of multidisciplinary healthcare
teams. They play a key role in ensuring the coordination and delivery of
high-quality care by relaying vital patient information to physicians,
specialists, and other healthcare professionals.
 Key Elements of Effective Teamwork
1. Communication: Clear and open
communication among team members:

• Communication is fundamental for effective teamwork

in healthcare settings.
• Clear and open communication ensures that vital
information is shared accurately and promptly among
team members.
• It involves active listening, speaking clearly, and using
appropriate language to convey messages.
• Good communication helps prevent errors, promotes
transparency, and fosters a supportive team
environment.
 Key Elements of Effective Teamwork
2. Collaboration: Working Together towards
Common Goals:

•Collaboration entails healthcare professionals coming

together to achieve shared objectives related to patient care.
•It involves pooling individual expertise and resources
towards a common purpose.
•Collaborative teamwork ensures comprehensive care that
considers all aspects of a patient's well-being.
•By working collaboratively, team members can brainstorm
ideas, solve problems collectively, and innovate care
practices.
 Key Elements of Effective Teamwork
3. Respect: Valuing Each Team Member's Expertise
and Contribution

1. Respect is essential for building trust and mutual

understanding within a healthcare team.
2. It involves recognizing and appreciating the unique
skills, knowledge, and experiences that each team
member brings.
3. Respecting diversity of perspectives and opinions
encourages a culture of inclusivity and openness.
4. When team members feel respected, they are more
likely to actively engage and contribute effectively
to team goals.
 Key Elements of Effective Teamwork
4. Coordination: Efficient Coordination of Tasks and
Responsibilities

1. Coordination ensures that tasks and

responsibilities are allocated appropriately among
team members.
2. It involves organizing workflows, setting
priorities, and ensuring smooth transitions
between different aspects of care.
3. Effective coordination reduces duplication of
efforts and minimizes delays in patient care.
4. Through efficient coordination, healthcare teams
can optimize resources and deliver timely and
effective interventions for patients.
 Collaboration Among Healthcare Professionals

1.Barriers to Collaboration
1.Limited communication channels.
2.Hierarchical structures.
3.Role Confusion and Conflict

2.Strategies for Effective Collaboration

1.Interprofessional education and training.
2.Regular team meetings and case
conferences.
3.Utilization of technology for
communication and data sharing.
 1.Barriers to Collaboration
•Limited Communication Channels
• Challenges arise when there are insufficient or unclear
methods for team members to communicate with each other.
• This can lead to misunderstandings, missed information, and
difficulty in coordinating care effectively.
•Hierarchical Structures
• Formal or rigid organizational hierarchies can hinder open
communication and discourage input from all team
members.
• It may create barriers for lower-level staff to freely express
ideas or concerns.
•Role Confusion and Conflict
• Uncertainty about individual responsibilities and
overlapping roles can lead to confusion and conflict within
the team.
• When team members are unsure of their roles, it can create
friction and impede collaboration.
 2. Strategies for Effective Collaboration
•Interprofessional Education and Training
• Providing opportunities for healthcare professionals to learn
together and understand each other's roles and contributions.
• This promotes mutual respect and appreciation for diverse
expertise within the team.
•Regular Team Meetings and Discussions
• Holding frequent team meetings and case conferences to
facilitate open dialogue and information sharing.
• These sessions allow team members to align goals, address
challenges, and coordinate care plans.
•Utilization of Technology for Communication and Information
Sharing
• Leveraging digital tools such as secure messaging platforms,
electronic health records, and teleconferencing for efficient
communication.
• Technology enhances real-time collaboration and enables
seamless data sharing among team members.
 Interdisciplinary Rounds and Care Planning
1.Definition and Importance
1. Explanation of interdisciplinary rounds.
2. Importance in care planning and decision-
making.
2.Components of Interdisciplinary Rounds
1. Team composition: Who participates (e.g.,
nurses, physicians, therapists).
2. Patient-focused discussions: Reviewing care
plans and progress.
3. Collaborative problem-solving: Addressing
challenges and adjusting plans.
3.Benefits of Interdisciplinary Rounds
1. Enhanced care coordination.
2. Reduced medical errors.
3. Improved patient and family satisfaction.
 1. Definition and Importance
Definition: Interdisciplinary rounds refer to
structured meetings involving healthcare
professionals from different disciplines who come
together to discuss and coordinate patient care. The
primary purpose of interdisciplinary rounds is to
ensure comprehensive and holistic care planning
through collaborative decision-making.

Importance: Interdisciplinary rounds are crucial in

care planning as they facilitate: Comprehensive
Assessment, Holistic Approach, and Informed
Decision-Making.
 2.Components of Interdisciplinary Rounds
1.Team Composition
•Interdisciplinary teams typically include nurses, physicians,
therapists (physical, occupational, speech), social workers,
pharmacists, and other allied healthcare professionals.
•Each team member contributes unique insights and expertise to
the discussion.
2.Patient-Focused Discussions
•Interdisciplinary rounds involve detailed reviews of patients'
conditions, progress, and care plans.
•Discussions focus on evaluating treatment responses, identifying
needs, and setting goals based on patient outcomes.
3.Collaborative Problem-Solving
•Teams collaboratively address challenges encountered during
patient care.
•They collectively develop strategies to overcome barriers, adjust
treatment plans, and optimize outcomes.
 3. Benefits of Interdisciplinary Rounds
1.Enhanced Care Coordination
1. Interdisciplinary collaboration ensures seamless
coordination among healthcare providers.
2. Teams work together to synchronize efforts, prevent gaps in
care, and promote continuity for patients.
2.Reduced Medical Errors
1. By fostering open communication and shared decision-
making, interdisciplinary rounds minimize the risk of errors
and oversights.
2. Multiple perspectives help identify and mitigate potential
issues before they escalate.
3.Improved Patient and Family Satisfaction
1. Patients and families benefit from cohesive and coordinated
care delivery.
2. Involving families in interdisciplinary discussions fosters
transparency and encourages shared decision-making,
leading to greater satisfaction with the care provided.
 Scenario 1 & 2 Practical Example

Interdisciplinary
Care Challenge:
Enhancing
Teamwork in
Patient-Centered
Care
Session 9: Teamwork, Collaboration, and Interdisciplinary Care

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 10

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 10: Ethics, Legal Aspects, and liability in Nursing

- Introduction to Ethical Considerations

- The 9 Codes of Ethics for Nurses.
- The Ethical Rights of Patient.
- Introduction to Legal Aspects of
Nursing.
- Introduction to Legal Liability.
- Negligence with some Examples.
- Malpractice with some Examples.
 - Introduction to Ethical Considerations

Ethical considerations in nursing are crucial

for ensuring patient safety, respect, and
dignity throughout the care process.

1. Definition of Ethical Considerations

Ethical considerations refer to the principles
that guide nurses in making decisions that are
morally right and justifiable in the context of
patient care.
 - Introduction to Ethical Considerations

-Respect for Patient Autonomy:

Example: A patient decides to stop aggressive
treatments for their illness and choose palliative
care.‫الرعاية التلطيفية‬
The nurse supports their choice and gives them all the
information they need.
-Acting in the Patient's Best Interest:
Example: A nurse notices a patient is still in pain
despite medication. They speak up to get the
treatment adjusted and ease the patient's discomfort.
 - Introduction to Ethical Considerations
-Avoiding Harm to Patients:
Example: A nurse catches a medication error before it's
given to the patient. They stop it and fix the mistake to keep
the patient safe.
-Fair Treatment for All Patients:
Example: A nurse divides their time and attention equally
among patients, no matter their condition or background.
-Protecting Patient Privacy:
Example: A nurse reminds others to talk about patient
matters in private, respecting the patient's right to
confidentiality.
 - The Code of Ethics for Nurses.

The Code of Ethics for Nurses is

divided into nine provisions to guide
the nurse. The following is a
summary of the American Nurses
Association Code of Ethics for
Nurses:
Nursing Ethical Considerations, National Library of Medicine
 The Code of Ethics for Nurses
Provision 1. The nurse practices with compassion
and respect for the inherent dignity, worth, and
unique attributes of every person.

The nurse must have a high level of respect for all

individuals, and allow dignity in regards to dealings
in care and communication. It's important that
patient's families are also treated with respect for
their relationship to the patient. Nurses must
understand the professional guidelines in
communications and work with colleagues and
patient families.
 The Code of Ethics for Nurses
Provision 2. The nurse’s primary commitment is to the
patient, whether an individual, family, group, community, or
population.
The patient should always be a first and primary concern. The
nurse must recognize the need for the patient to include their
individual thought into care practices.

Provision 3. The nurse promotes, advocates for, and

protects the rights, health, and safety of the patient.
It is important for the nurse to understand all privacy
guidelines with regards to patient care and patient
identifiers.
 The Code of Ethics for Nurses

Provision 4. The nurse has authority, accountability, and

responsibility for nursing practice; makes decisions; and
takes action consistent with the obligation to provide
optimal patient care. As a nurse, it's inherent that
accountability for all aspects of care aligns with
responsible decision making.
Provision 5. The nurse owes the same duties to self as to
others, including the responsibility to promote health and
safety, preserve wholeness of character and integrity,
maintain competence, and continue personal and
professional growth.A nurse must also demonstrate care
for self as well as others.
 The Code of Ethics for Nurses
Provision 6. The nurse, through individual and
collective effort, establishes, maintains, and improves
the ethical environment of the work setting and
conditions of employment that are conducive to safe,
quality health care.

Provision 7. The nurse, in all roles and settings,

advances the profession through research and
scholarly inquiry, professional standards
development, and the generation of both nursing and
health policy.
 The Code of Ethics for Nurses

Provision 8. The nurse collaborates with other

health professionals and the public to protect
human rights, promote health diplomacy, and
reduce health disparities.

Provision 9. The profession of nursing,

collectively through its professional organization,
must articulate nursing values, maintain the
integrity of the profession, and integrate principles
of social justice into nursing and health policy.
 Ethical Rights of Patient

Introduction: In healthcare,
patients have ethical rights that
are essential for ensuring
dignified, respectful, and
personalized care. These rights
empower patients to
participate in decision-making,
voice concerns, receive
individualized treatment, and
work towards independence.
 Ethical Rights of Patient
1.Right of Personal Dignity:
1. Patients have the right to be treated with respect and dignity,
ensuring their individual worth and humanity are honored
throughout their care journey.
2. Healthcare providers must uphold the patient's dignity by
maintaining confidentiality, providing privacy during
examinations, and communicating in a respectful and
compassionate manner.
2.Right to Complain and Obtain Changes in Care:
1. Patients have the right to voice their concerns and complaints
about their care experience, and healthcare facilities should
have processes in place to address and resolve these issues
promptly.
2. By listening attentively to patient feedback and actively
involving them in decisions about their care, healthcare
providers can ensure that necessary changes are made to
improve the quality and effectiveness of patient care.
 Ethical Rights of Patient
3. Right to Individualized Care:
1. Each patient has the right to receive care that is tailored to their
unique needs, preferences, and circumstances, acknowledging
their individuality and promoting personalized healing.
2. Healthcare providers should engage patients in shared decision-
making, consider their cultural beliefs and values, and collaborate
with interdisciplinary teams to develop individualized care plans
that optimize health outcomes and enhance patient satisfaction.

4. Right to Assistance Toward Independence:

1. Patients have the right to receive support and guidance aimed at
promoting their independence and autonomy, empowering them
to actively participate in their own care and decision-making
processes.
2. Healthcare providers should assess patients' abilities and
limitations, offer education and resources to enhance self-
management skills, and foster a supportive environment that
encourages patients to achieve their maximum level of
independence and self-care.
 Legal Aspects of Nursing

Definition: Legal aspects of nursing involve

the laws, regulations, and standards that
govern the practice of nursing. Nurses must
adhere to these legal requirements to ensure
patient safety and maintain professional
accountability. This includes understanding
the legal framework within which nurses
operate, such as scope of practice, licensure
requirements, documentation standards, and
healthcare laws. ‫الجوانب القانونية‬
 Legal Liability of Nursing

Definition: Legal liability in nursing refers to

the legal responsibility and accountability that
nurses have for their actions and decisions in
providing patient care. This liability can arise
from various sources, including negligence,
malpractice, breach of duty, and violation of
laws or regulations. Nurses may be held
legally liable for any harm or injury caused to
patients due to their actions ‫المسؤولية القانونية‬
 Negligence
Definition: Negligence in nursing refers to the
failure of a nurse to provide the standard level of
care expected, resulting in harm or injury to a
patient. It involves a breach of duty owed to the
patient, where the nurse fails to exercise the degree
of care that a reasonably prudent nurse would have
exercised in similar circumstances.
Examples:
•Administering the wrong medication or dosage to a patient.
•Failing to assess and monitor a patient's vital signs, leading to
a deterioration in their condition.
•Not properly securing a patient's bed rails, resulting in a fall
and injury.
 Malpractice
Definition: Malpractice, also known as
professional negligence, refers to the failure of a
healthcare professional, including nurses, to provide
care that meets the accepted standards of practice,
resulting in harm or injury to a patient. It involves
the deviation from the standard of care expected
from a reasonably competent healthcare professional
in the same field.
Examples:
•Misdiagnosing a patient's condition, leading to delayed
treatment and worsening of symptoms.
•Performing a medical procedure without obtaining
informed consent from the patient.
•Violating patient confidentiality by sharing sensitive
medical information without authorization.
Scenario 1 &
2 Practical
Example
Session 10: Ethics, Legal Aspects, and liability in Nursing

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 11

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 11: Communication Patient Safety, SBAR Technique, Quality Challenges and Capstone Intro

- Communication and Patient Safety

- Effective Communication Strategies
- Role of Communication in Preventing Errors
- SBAR (Situation-Background-Assessment-
Recommendation) Technique
- Efforts Undertaken by the Quality Teams
- Quality Challenges in Critical Care
- Quality Management in Long-Term Care
- Quality in Ambulatory and Home Care
- Capstone Introduction
 Communication and Patient Safety

•Definition: Communication in healthcare

refers to the exchange of information
between healthcare professionals,
patients, and their families to ensure the
provision of safe and effective care.

•Importance: Effective communication is

vital for patient safety as it facilitates
accurate diagnosis, treatment, and
coordination among healthcare team
members.
 Communication and Patient Safety
Examples of Communication in Ensuring Patient Safety:

1.Handoff Communication: Smooth transition of patient

care between shifts or departments to prevent errors and
ensure continuity of care. Example: Nurse providing detailed
information about a patient's condition during shift change
to the incoming nurse.

2. Patient Education: Clear and concise communication with

patients regarding their conditions, treatments, and
medications to prevent misunderstandings and adverse
events. Example: Pharmacist explaining medication
instructions to a patient before discharge from the hospital.
 Communication and Patient Safety
Examples of Communication in Ensuring Patient Safety:

3. Team Collaboration: Open and effective communication

among healthcare team members to share vital patient
information, coordinate care plans, and address concerns
promptly. Example: Interdisciplinary team meetings to
discuss treatment plans for complex cases and ensure all
perspectives are considered.

Conclusion: Communication plays a crucial role in patient

safety by facilitating information exchange, teamwork, and
patient engagement, ultimately reducing the risk of errors
and adverse events.
 Effective Communication Strategies
Introduction
•Effective communication strategies are essential in
healthcare to ensure clarity, understanding, and
collaboration among healthcare professionals, patients,
and their families.

•Examples of Effective Communication Strategies in

Hospitals

1. Standardized Communication Tools: Implementing

tools such as SBAR (Situation-Background-Assessment-
Recommendation) to structure and streamline
communication, particularly during critical situations.
•Example: Using SBAR to communicate patient status
and concerns during handoffs between nursing shifts
 Effective Communication Strategies
2. Active Listening: Encouraging healthcare professionals to
actively listen to patients' concerns, questions, and feedback to
enhance understanding and build rapport. Example: Physicians
attentively listen to patients' symptoms and concerns during
consultations to ensure accurate diagnosis and treatment.

3. Clear Documentation Practices: Maintaining accurate and

concise documentation of patient information, assessments, and
care plans to facilitate communication and continuity of care.
Example: Nurses documenting vital signs, medications
administered, and patient responses accurately in electronic
health records.

Conclusion: By employing effective communication strategies

such as standardized tools, active listening, and clear
documentation, hospitals can enhance patient safety, improve
outcomes, and foster a culture of collaboration and trust among
healthcare professionals.
 Role of Communication in Preventing Errors
Introduction: Communication plays a pivotal role in preventing
errors in healthcare settings by facilitating accurate information
exchange, collaboration, and error detection.

Examples of Communication in Preventing Errors in Hospitals

1.Clarification of Orders: Healthcare professionals communicate

effectively to clarify medication orders, treatment plans, and
procedures to prevent errors due to misunderstandings.
Example: Nurse consulting with the physician to clarify dosage
instructions before administering medication to a patient.

2. Reporting Safety Concerns: Encouraging staff to communicate

safety concerns, near misses, and errors promptly to facilitate
root cause analysis and implementation of preventive measures.
Example: Nurse reporting a potential medication error to the
hospital's quality improvement team for investigation and
action.
 Role of Communication in Preventing Errors
3. Team Communication during Emergencies:
Effective communication among healthcare teams
during emergency situations to ensure timely
interventions, minimize errors, and optimize patient
outcomes. Example: Emergency department staff
communicating clearly and efficiently during a code
blue situation to coordinate resuscitation efforts and
provide critical care.
Conclusion: Communication is integral to error
prevention in healthcare, enabling healthcare
professionals to clarify orders, report safety concerns,
and collaborate effectively during emergencies,
ultimately enhancing patient safety and reducing
adverse events
Universal hospital codes are used to quickly and efficiently
communicate critical information in a variety of emergency
situations. Each code is assigned a unique color, and each color
represents a specific emergency or event that requires immediate
action. Below are some of the most common hospital codes:
•Code Blue: This is the most well-known code that signals a
medical emergency, such as cardiac arrest.
•Code Gray: This code is used to alert staff members of
combative or violent patient that requires immediate intervention
•Code Brown: This code is used in hospitals to indicate a
situation in which there is a hazardous spill
•Code Yellow: This code indicates a situation in which a patient
or visitor is missing or lost.
•Code Green: This code is called when an external disaster, such
as a tornado or hurricane, affects the hospital.
•Code Black: This code is called when there is a bomb threat or a
suspicious package in the hospital
 SBAR Technique (Situation-Background-Assessment-Recommendation)

Introduction
•SBAR (Situation-Background-Assessment-Recommendation)
is a structured communication tool commonly used in
healthcare to facilitate clear, concise, and organized
communication, particularly during handoffs, consultations,
and critical situations.

SBAR is an acronym for Situation, Background, Assessment,

and Recommendation, providing a standardized framework
for communicating essential information about a patient's
condition.

•Importance: SBAR promotes effective communication by

ensuring that relevant information is conveyed systematically,
reducing the risk of miscommunication and errors.
 SBAR Technique (Situation-Background-Assessment-Recommendation)
Key Components of SBAR
1.Situation: Describing the current situation or problem
concisely, including patient identification and the reason
for communication.
2.Background: Providing relevant background information,
such as medical history, recent events, and pertinent
clinical findings.
3.Assessment: Presenting the healthcare professional's
assessment of the situation, including vital signs,
symptoms, and clinical observations.
4.Recommendation: Offering recommendations or
requests for action based on the assessment, such as
orders for medications, interventions, or further
assessments.
 SBAR Technique (Situation-Background-Assessment-Recommendation)

Application of SBAR in Healthcare

•SBAR can be utilized during various communication scenarios,
including handoffs between shifts, consultations between
healthcare providers, and communication with ancillary
services.
•Example: Nurse using SBAR to communicate a change in a
patient's condition to the physician during rounds, providing a
structured overview of the situation, background, assessment,
and recommendations for further action.

•Conclusion: The SBAR technique serves as a valuable

communication tool in healthcare settings, promoting clarity,
consistency, and safety in information exchange, ultimately
enhancing patient care and reducing the risk of errors.
 Quality Teams Challenges in Critical Care

General Challenges

1.Resource Constraints: Critical care units often face

challenges related to limited resources, including staffing
shortages, equipment availability, and high patient acuity
levels, which can impact the quality of care delivered.
2.High Patient Turnover: Critical care units experience
frequent patient admissions, transfers, and discharges,
leading to challenges in care continuity, care coordination,
and communication among healthcare providers.
3.Complex Patient Needs: Critically ill patients often present
with complex medical conditions, comorbidities, and multiple
organ system involvement, requiring specialized expertise,
interdisciplinary collaboration, and intensive monitoring.
 Quality Management Challenges in Long-Term Care

General Challenges
1.Staffing and Training: Long-term care facilities encounter
challenges related to staffing shortages, high turnover rates, and
the need for ongoing staff training and education to maintain
quality standards and provide person-centered care.

2. Care Coordination: Long-term care involves coordination

among various healthcare professionals, including physicians,
nurses, therapists, and social workers, as well as family members
and community support services, which can pose challenges in
ensuring seamless transitions of care and continuity.

3. Regulatory Compliance: Long-term care facilities must adhere

to complex regulatory requirements, accreditation standards, and
quality indicators set forth by regulatory bodies, which can be
challenging to navigate and implement effectively while
maintaining resident safety and quality of life.
 Quality Challenges in Ambulatory and Home Care

General Challenges
1.Care Coordination: Ambulatory and home care settings involve
coordination among multiple providers, including primary care
physicians, specialists, home health agencies, and community
resources, which can pose challenges in information sharing, care
planning, and continuity of care.

2.Patient Engagement: Engaging patients in their care and

promoting adherence to treatment plans can be challenging in
ambulatory and home care settings due to factors such as limited
access to healthcare resources, health literacy barriers, and social
determinants of health.

3.Technology Integration: Implementing and integrating

technology solutions such as electronic health records (EHRs),
telehealth platforms, and remote monitoring devices in ambulatory
and home care settings can be complex and may present
challenges related to usability, interoperability, and data security.
 The Capstone
Capstone Definition: A capstone project in nursing education is
a comprehensive, culminating academic project that integrates
and applies the knowledge and skills gained throughout a
nursing program. It serves as a demonstration of a student's
ability to synthesize theory and practice in a real-world context.
Capstone Purpose: The purpose of a capstone project in
nursing is multifaceted:
1.Integration of Knowledge: It allows students to integrate the
knowledge and skills they have acquired across various courses
in their nursing program.
2.Application of Skills: Students apply theoretical concepts and
practical skills to address real-world healthcare issues or
challenges.
3.Professional Development: Capstone projects foster critical
thinking, problem-solving, communication, and collaboration
skills essential for professional nursing practice.
4.Contribution to the Field: Capstone projects often aim to
contribute to the body of knowledge in nursing or to address
specific healthcare needs within a community or healthcare
organization.
 Steps to Prepare a Capstone Project

1.Identify a Healthcare Quality Issue: Choose a specific

healthcare quality issue or challenge that interests the student.
This could include areas such as patient safety, infection
control, medication errors, or improving patient outcomes.

2. Define Objectives and Scope: Clearly define the objectives

of the capstone project and the scope of work. Identify the
specific problem to be addressed, the target population or
setting, and the desired outcomes.

3. Develop a Project Plan: Create a detailed project plan

outlining the timeline, tasks, resources needed, and
responsibilities. Set milestones to track progress and ensure
timely completion of the project.
 Steps to Prepare a Capstone Project

4. Implement Interventions or Solutions: Develop and

implement evidence-based interventions or solutions to
address the identified healthcare quality issue. This may
involve conducting quality improvement initiatives,
developing protocols or guidelines, or implementing best
practices.

5. Evaluate Outcomes and Communicate Findings:

Evaluate the effectiveness of the interventions or solutions
implemented. Assess whether they have achieved the
desired outcomes or improvements in healthcare quality.
Present the findings of the capstone project through written
reports, presentations, or other forms of dissemination.
 Steps to Prepare a Capstone Project

The capstone project in healthcare quality

involves identifying a specific issue, defining
objectives, and developing a project plan,
each section consisting of approximately 250-
300 words. Implementing interventions and
evaluating outcomes require around 500-600
words. The entire capstone project should be
no more than 1800-2000 words. All sections
should follow specified formatting guidelines
and include proper referencing with in-text
citations and a reference list at the end.
Session 11: Communication Patient Safety, SBAR Technique, Quality Challenges and Capstone Intro

Thank you
CITY UNIVERSITY
Faculty of Public Health
Department of Nursing

Quality
Management
in Nursing &
Healthcare
(NUR315)
OUSSAMA HUSSEIN AGHA
(BBA, MPH)
Session 12

Quality Management in Nursing & Healthcare (NUR315)- Oussama Hussein Agha

 Session 12: Healthcare Technology and Quality Management
- Capstone details.
- Technology in Quality Assurance
(Overview, Role)
- Telemedicine and Virtual Care Quality
- Digitalization of Healthcare Processes
- Electronic Health Records (EHRs) and
Patient Safety
- Interactive Demo (INTERPHASE): Digitalization
of Healthcare Processes, focusing specifically
on the hospital admission process for City
University Hospital. (KG01- 10:00 to 11:30)
 Steps to Prepare a Capstone Project
1.Identify a Healthcare Quality Issue: Choose a specific
healthcare quality issue or challenge that interests the student.
This could include areas such as patient safety, infection
control, medication errors, or improving patient outcomes.

2. Define Objectives and Scope: Clearly define the objectives

of the capstone project and the scope of work. Identify the
specific problem to be addressed, the target population or
setting, and the desired outcomes.

3. Develop a Project Plan: Create a detailed project plan

outlining the timeline, tasks, resources needed, and
responsibilities. Set milestones to track progress and ensure
timely completion of the project.
 Steps to Prepare a Capstone Project

4. Implement Interventions or Solutions: Develop and

implement evidence-based interventions or solutions to
address the identified healthcare quality issue. This may
involve conducting quality improvement initiatives,
developing protocols or guidelines, or implementing best
practices.

5. Evaluate Outcomes and Communicate Findings:

Evaluate the effectiveness of the interventions or solutions
implemented. Assess whether they have achieved the
desired outcomes or improvements in healthcare quality.
Present the findings of the capstone project through written
reports, presentations, or other forms of dissemination.
 Steps to Prepare a Capstone Project

The capstone project in healthcare quality

involves identifying a specific issue, defining
objectives, and developing a project plan,
each section consisting of approximately 250-
300 words. The entire capstone project should
be no more than 1000-1200 words. All
sections should follow specified formatting
guidelines and include proper referencing with
in-text citations and a reference list at the end.

Let’s discuss the Shared Example.

 Technology in Quality Assurance Overview
Technology plays a pivotal role in ensuring and maintaining high standards of quality in healthcare
delivery. It involves the integration of digital tools, data analytics, and automation to enhance
efficiency, accuracy, and safety in healthcare processes.
1. Digital Tools: Software applications and hardware devices designed
to streamline healthcare workflows and improve patient care. Example:
EHR Systems: Electronic platforms for storing, managing, and accessing
patient health information, enabling healthcare providers to make
informed decisions and coordinate care more effectively.

2. Data Analytics: Utilizing advanced analytics techniques to extract

insights from healthcare data, identify trends, predict outcomes, and
optimize decision-making processes. Examples include predictive
analytics models for patient readmission risk and population health
management dashboards.
Example: Predictive Analytics Tools: Software solutions that analyze
historical healthcare data to identify patterns and trends, allowing
providers to intervene early and prevent adverse events such as
hospital-acquired infections or medication errors.
 Technology in Quality Assurance Overview

3. Automation: Implementing automated processes to

reduce manual tasks, minimize errors, and improve
efficiency in healthcare operations. Examples include
automated medication dispensing systems, robotic
surgery platforms, and appointment scheduling
algorithms.

Example: Robotic Process Automation (RPA):

Automating repetitive administrative tasks such as
data entry, billing, and claims processing, freeing up
healthcare staff to focus on patient care and reducing
the likelihood of human error. An example of RPA is
robotic systems assisting in medication distribution in
hospitals, ensuring accurate and timely delivery while
minimizing errors.
 Role of Technology in Quality Assurance
1.Quality Monitoring Systems: Implementing software
solutions to continuously monitor and analyze healthcare
processes and outcomes to identify areas for improvement.
Example: Clinical Dashboards: Platforms that aggregate data
from various sources to provide real-time insights into key
performance indicators, such as patient wait times, infection
rates, and medication errors.

2. Decision Support Systems (DSS): Providing clinicians with

real-time data and evidence-based guidelines to aid in
clinical decision-making, thereby improving the quality of
care. Example: Computerized Physician Order Entry (CPOE):
Systems that enable healthcare providers to electronically
prescribe medications, reducing the risk of errors associated
with handwritten prescriptions.
 Telemedicine and Virtual Care Quality
Definition: Telemedicine and virtual care involve the
use of telecommunications technology to deliver
healthcare services remotely. Quality in telemedicine
refers to the effectiveness, safety, and patient
satisfaction with virtual care encounters.

1.Telehealth Platforms: Facilitating remote

consultations, monitoring, and follow-ups between
healthcare providers and patients. Example: Video
Consultations: Conducting virtual appointments
between patients and healthcare providers via secure
video conferencing platforms.
 Telemedicine and Virtual Care Quality

2. Remote Monitoring Devices: Utilizing

wearable sensors and devices to track
patients' vital signs and health status
from a distance. Example: Mobile Health
(mHealth) Apps: Offering applications
that allow patients to schedule
appointments, access medical records,
and receive educational resources from
their smartphones or tablets.
 Digitalization of Healthcare Processes
Definition: Digitalization in healthcare refers to the
transformation of analog processes and information into
digital formats, enabling easier access, storage, and
analysis of healthcare data.

Specific Roles:
1.Electronic Health Records (EHR): Digitizing patient
health records to facilitate secure storage, retrieval, and
sharing of medical information among healthcare providers.
Example: Integrated Clinical Systems: Implementing
electronic systems that connect various healthcare
stakeholders, including hospitals, clinics, pharmacies, and
laboratories, to streamline communication and care
coordination.
 Digitalization of Healthcare Processes
Data Analytics Platforms: Leveraging big data analytics
to identify patterns, trends, and insights from large
volumes of healthcare data, aiding in population health
management and personalized medicine.

For example, they can help doctors identify groups of

people at high risk of certain diseases, so they can take
action early. They also make medicine more
personalized by analyzing each person's data to
recommend treatments that fit them best. Overall,
these platforms help healthcare organizations use data
smartly to make better decisions and take better care
of patients.
 Electronic Medical Records and Electronic Health Records (EHRs)
Electronic Medical Records (EMR) and Electronic Health
Records (EHR) are both used to store patient information
digitally, but they serve different purposes. EMRs are like
digital versions of paper charts in a doctor's office, containing
medical history and treatment details for patients in one
practice. They are mainly used by the healthcare provider in
that single office and are not easily shared with other doctors.

EHRs, on the other hand, offer a complete view of a patient's

health and can be shared across different healthcare settings,
like hospitals, clinics, and specialists. This sharing helps doctors
coordinate care better and make more informed decisions.
EHRs also often include features that allow patients to access
their health information and communicate with their
healthcare providers, making it easier for patients to manage
their health.
 Top Healthcare Technology Trends in 2023-2024

The healthcare industry is undergoing a significant

transformation, moving beyond traditional
treatment methods to emphasize comprehensive
health and sustainable well-being.
This shift includes a growing focus on preventive
healthcare and value-based care, aiming to
maintain health rather than merely treating illness.
This evolution is driven by technological
advancements that enable more efficient, effective,
and personalized healthcare delivery. In 2023 and
beyond, several key trends are poised to shape the
future of healthcare, leveraging technology to
improve patient outcomes and operational
efficiency.
 Top Healthcare Technology Trends in 2023-2024

1.Artificial Intelligence (AI): AI involves technologies that

enable computers to mimic human cognition, learn, think, and
make decisions. These systems can analyze complex medical
data to provide insights and support decision-making.

Growth: Predicted Compound Annual Growth Rate (CAGR) of

45% from 2023-2033.
Benefits:
1. Early Disease Diagnosis: AI algorithms can analyze
imaging scans to detect diseases like cancer at an
early stage.
2. Personalized Treatment: AI can process patient
data to create customized treatment plans.
3. Operational Efficiency: AI-driven chatbots assist
patients with scheduling appointments and
managing their health queries.
 Top Healthcare Technology Trends in 2023-2024

2. Telemedicine & Remote Care: Telemedicine uses

telecommunications technology to provide healthcare
services remotely. It allows patients to consult with
healthcare providers through video calls, apps, and other
digital platforms.

1. Growth: Expected revenue of USD 24.74 billion by

2029.
2. Benefits:
1. Reduced Hospital Burden: Remote monitoring
devices can track patient health metrics like
blood pressure and glucose levels.
2. Home Treatment: Patients can receive
consultations and follow-up care from home.
3. Immediate Access: Mobile apps provide real-
time communication with healthcare providers.
 Top Healthcare Technology Trends in 2023-2024

3. Increased Investment in Cybersecurity: Cybersecurity

involves protecting systems, networks, and data from
digital attacks. In healthcare, this includes securing
patient records and other sensitive information from
breaches and ransomware attacks.
1. Growth: Market projected to surpass $15.25
billion by 2028 with an 18.1% growth rate.
2. Focus:
1.Data Protection: Encrypting electronic health
records (EHR) to prevent unauthorized access.
2.Secure Communications: Implementing secure
communication channels for telemedicine.
 Top Healthcare Technology Trends in 2023-2024

4. Adoption of the Internet of Medical Things (IoMT): IoMT

consists of interconnected devices and systems that collect,
process, and analyze health data in real-time. These devices range
from wearable fitness trackers to smart implants and hospital
monitoring systems.
1. Growth: Market expected to grow to $187.60 billion by
2028.
2. Benefits:
1. Reduced Medical Errors: Continuous monitoring
devices alert healthcare providers to patient issues in
real-time.
2. EHR Transfer: Seamless data transfer between devices
and electronic health records systems.
3. Disease Management: Chronic disease management
through regular data monitoring and feedback.
 Top Healthcare Technology Trends in 2023-2024
5. Hyper-automation: Hyper-automation involves the use of advanced
technologies like AI, Machine Learning, and Robotic Process Automation
(RPA) to automate complex processes and enhance efficiency in healthcare
operations.
1. Growth: Funding in hyper-automation technologies expected to
increase by 34% in 2023.
2. Benefits:
1. Faster Data Processing: Automated systems can handle large
volumes of data more quickly and accurately.
2. Resource Efficiency: Reduces the need for manual labor in
repetitive tasks, freeing up healthcare professionals for more
critical work.
3. Improved Patient Care: Automated administrative tasks allow
more focus on patient care.
4. Robotic Process Automation (RPA): Automating patient intake
processes and billing.
5. Intelligent Automation: Using AI to analyze medical images
and assist in diagnosis.
6. Smart Document Processing: Automating the handling of
medical records and insurance claims.
Interphase Demo (Populus)
Session 12: Healthcare Technology and Quality Management

Thank you