Quality principles and

Patient safety
2024/2025
 Introduction

Patient Safety and Quality Improvement resources are vital

to a hospital's internal compliance process, and to all levels in an
organization to encourage continuous systems improvement.
Patient safety is often considered a component of quality, thus,
practices to improve patient safety improve the overall quality
of care.

Definitions
Quality:
The process which seek to attain the highest degree of
excellence in the delivery of patient care.

OR
The degree to which patient care services increase the
probability of desired patient outcomes and reduce the
probability of undesired outcome given the current state of
knowledge.
Quality of care:
It is provide comprehensive components of care based on
community facilities to reach the optimal health services.
Quality assurance:
It is an ongoing process that ensures the delivery of agreed
standards.
The Keys to Improving Quality through Patient
Safety

• Safe: avoiding injuries to patients from the care that is

intended to help them

• Effective: providing services based on scientific

knowledge to all who could benefit and refraining from
providing services to those not likely to benefit (avoiding
underuse and overuse)

• Patient-centered: providing care that is respectful of and

responsive to individual patient preferences, needs and
values

• Timely: reducing waits and sometimes harmful delays for

both those who receive and those who give care

• Efficient: avoiding waste, in particular waste of

equipment, supplies, ideas and energy

• Equitable: providing care that does not vary in quality

because of personal characteristics such as gender,
ethnicity, geographic location and socioeconomic status.
 • Accessibility of care.

• Appropriateness of care.

• Continuity of care.

• Privacy of care.

• Participation of patient and family in care.

• Confidentiality of care.

Benefits of quality

1) To organization:

 Acknowledges the organization commitment to quality

and safety

 Facilitates higher accreditation scores

 Markets the organization and prospective staff as employer

of choice

 Promote cost containment

 Identifies weak areas in the structure, process, and

outcome of the staff that must be changed.

2) To patients:

• Improve patient outcome.

 • Shorter length of stay.

• Higher patient satisfaction.

3) To staff:

• Higher job satisfaction

• Reduce turnover and vacancy rate

• Opportunities for staff training and development.

Quality management principles:

1. Customer-focused organization.
2. Leadership.
3. Involvement of people.
4. Process approach.
5. System approach to management.
6. Continual improvement.
7. Factual approach to decision making.

8. Mutually beneficial supplier relationship.

Objectives of quality management

Preparing the internal processes of organization to
global standers.

Enhancing quality, productivity, and total performance

of organization.
 Enriching the quality of work life of it is employee.

• QM processes
QM processes are divided into four sequential categories:
plan, do, check, and act (the PDCA cycle).
Planning phase: people define the problem to be
addressed, collect relevant data, and define the problem's
root cause.

Doing phase: people develop and implement a

solution, and decide upon a measurement to gauge its
effectiveness.

Checking phase: people confirm the results through

before-and-after data comparison.

Acting phase: people document their results; inform

others about process changes, and make recommendations
for the problem to be addressed in the next PDCA cycle.
Tools for process quality management:
1. Cause and effect diagram (also known as the " fishbone".

2. Stratification (flow chart or run chart).

3. Control charts

4. Scatter diagram.

5. Check sheet.

6. Histogram.
7. Pareto chart.

 Cause and effect diagram: identifies many possible

causes for an effect or problem and sorts ideas into useful
categories.

 Stratification: a technique that separates data gathered

from a variety of sources so that patterns can be seen
(some lists replace" stratification" with" flow chart" or
"run chart".

 Control charts: graphs used to study how a process

changes over time.

 Scatter diagram: graphs pairs of numerical data, one

variable on each axis, to look for a relationship.

 Check sheet: a structured prepared form for collecting and

analyzing data a generic tool that can be adapted for a
wide variety of purposes.
 Histogram: the most commonly used graph for showing
frequency distributions or how often each different value
in a set of data occurs.

 Pareto chart: shows on a bar graph which factors are

more significant.
Role of nurse in quality improvement

1- Follow policies, procedure, and protocols.

2- Communicates with and educates peers immediately.

3- Reports quality and safety issues to supervisor.

4- Participates actively in the quality improvement activities.

5- Implement Plan of nursing quality and performance

improvement.

6- Focus on transformational leadership at all levels of

nursing.

7- Redesign care to optimize nurses’ professional expertise

and knowledge.

8- Engage nurses to work with other members of the

healthcare team to ensure safe and reliable care.
9- Build systems and a culture of safety that encourage,
support and spread vitality and teamwork in all areas of
nursing.

10- Put in places structures and processes that ensure patient-

centered care.

11- Establish a quality learning system so that nurses at all

levels throughout access to measurement and feedback about
innovative care delivery.
Patient's rights
Today’s patient is viewed as an active member of health team
rather than a passive recipient of care, rights are green and red
traffic lights showing where people can stop and where people
can proceed, rights are for the people and accorded by the
people (Katz, 2006). Patient's rights mean receiving Patient's
centered real care and equality in accessibility to health care
services; these are emphasized in all international patients’ bills
of rights.

Right is: the word right is used for quite personal aspects of
living.
Right is: the fundamental normative rules about what is allowed
of people or owed to people, according to some legal system,
social convention, or ethical theory.

Patient rights: are general statement adopted by most

healthcare professionals, covering such matters as access to
care, patient dignity, confidentiality, and consent to treatment.

Patient rights
 The right to dignity and privacy.
 The right to know the identity of the health care provider.
 The right to safe surroundings.
 The right to representation.
  The right to confidentiality of information.
 The right to receive medical information.
 The right of access to the medical record.
 The right to consent to treatment (Informed consent).
 The right to additional expert opinion.
 The right to ensure the proper continuity of care.

Patient responsibilities are:

The patient is responsible to follow hospital rules and regulations,
affecting his/her care and conduct and is expected to cooperate in the
treatment program specified by his/her physician, by answering
questions honestly and completely and to tell how he/she feels about
the treatment and the effects of the treatment on him/her.

Patients Responsibilities

 Provide the staff with correct, precise and full information

about his/her health condition.

 Inform the staff about allergies and sensitivities to

medications.

 Inform the staff about any details connected to his/her

illness that may endanger the health of health care
 providers and other patients, especially concerning
contagious diseases.

 Inform the staff about any change in his/her medical

condition that may influence your treatment.

 Ask the staff for clarifications when you are not sure or
don't understand all the aspects of the treatment.

 Respect the dignity of the staff treating him/here and to

behave politely toward them and other patients.

Respect the visiting hours according to department

policies.
 Preserve the cleanliness and quiet.

 Not to smoke within the entire hospital area.

Error

 The Institute of Medicine (1999) defines an error as the

failure of a planned action to be completed as intended or the
use of a wrong plan to achieve an aim. Errors can include
problems in practice, products, procedures, and systems.
 Something incorrectly done through ignorance or
inadvertence a mistake, e.g. in calculation, judgement,
speech, writing, action, etc
 It is the label for nearly all of the problems harming patients.

Harm

 Anything that impairs or adversely affects the safety of

patients in clinical care, drug therapy, research investigations,
or public health
 Physical or psychological damage or injury
 Harm is a deliberate injury or damage to someone or
something

Medical Error

- A medical error is a preventable adverse effect of care,

whether or not it is evident or harmful to the patient. This
might include an inaccurate or incomplete diagnosis or
treatment of a disease, injury, syndrome, behavior, infection,
or other ailment.
- Unintended physical injury resulting from or contributed by
medical care (including the absence of indicated medical
treatment), which requires additional monitoring, treatment
or hospitalization, or results in death.

- Medical errors are often described as human errors in

healthcare. Whether the label is medical error or human
 error, one definition used for it in medicine says that it
occurs when a healthcare provider chooses an inappropriate
method of care or improperly executes an appropriate
method of care. It has been said that the definition should be
the subject of more debate.

- Types/ classification of medical error

- There are two types of errors: active and latent. Active
errors (human errors) are those that involve individuals who
are actually doing a task, and their effects are felt almost
immediately.
- Latent errors are errors in system or process design, faulty
installation or maintenance of equipment, or ineffective
organizational structure.
- Latent errors are present but hidden and may go unnoticed
for a long time with no ill effect. However, when a latent
error combines with an active human error, an event occurs.
The active human error triggers the hidden latent error
causing an adverse event.

Most Commonly Occurring Medical Errors

 Surgical errors.
 Diagnostic inaccuracies and delays.
 Medications errors
 Tubing misconnections.
 Problems related to medical devices and equipment.

 Health care-associated infections (HAIs).

 Falls.
 Accreditation

Introduction

Accreditation means an official approval of an organization.

Accreditation means the act of granting approval to an
organization by an official review board after the organization
has met specific written requirements or standards.

Definitions

Accreditation refers to a voluntary review process of educational

programs by a professional organization.

Accreditation is a process of quality assurance that determines

whether an institution meets established standards for function,
structure, and performance.

Accreditation is the process whereby an organization or an

agency recognizes a college or university or a program of study
as having met certain predetermined qualifications and standard.

Indicator: an indicator is a statistic that represents a measure of

one characteristic

Indicators: are measurable variables or characteristics that can

be used to determine the degree of adherence to standards or
level of quality achieved.
Objectives of accreditation

- Up gradation.
- Improve patient satisfaction.
- Recognition of institution.
- Offer advice.

Purpose

- Administration requirements.
- Uniform standards of nursing education.
- Institutional self -improvement by evaluation and
inspection.
- Prescribe syllabus.
- Inspection.
- Improve the quality of nursing education.
Characteristics of accreditation

a. It’s strong tradition of self-regulation.

b. It’s depending on evaluation techniques.
c. It’s primary concern with quality.
Types of accreditation

1- Institutional accreditation.
2- Specialized or programmatic accreditation.
The accreditation process
The Council for Higher Education Accreditation CHEA was
formed in 1969.

CHEA (2002) stated that the accreditation process typically

involves FIVE major elements:

1- Institutional self- study: it is a self- analysis of

performance completed by the school based on standard of
the accrediting association.
2- Peer review: Peer review occurs because of the broad
involvement of the various stakeholders in the educational
environment such as faculty, administrators, key partners
and the public.
3- Site visit: are typically conducted to verify the results of
the self- study and to provide additional clarification to the
accrediting agency. This action occurs after submission of
the self- study report.
4- Revision.
5- Monitoring and oversight: occurring through the idea of
annual reports by the school.
Functions of accreditation

 Protect the autonomy of health service programmed.

 Preserves the quality of nursing education.
 Protects the public from ill- prepared nurses.
 Protects the institution from political pressure.
  Helps the practioner for the ever expanding or the broad
scope of nursing practices.
Advantages

- Statutory power to punish the wrong doers.

- Maintain the standards education.
Disadvantages

- Time consuming process.

- Expensive.
 References

 Joseph Brant Memorial Hospital (2016): Quality improvement.

Available at: [Link]

 Lippincott Williams & Wilkins, (2020): The Patient Safety and

Quality Improvement Act of 2005: Developing an Error Reporting
System to Improve Patient Safety. Patient Safe & Volume 4,
Number 1, March 2008.

 Pamela H. Mitchell, (2017): Defining Patient Safety and Quality

Care. Available at: [Link]

 The State of Queensland (Queensland Health) (2016): Objective

of Patient Safety and Quality Improvement Service. Available at:
[Link]

 Sale D., and Hodgetts C., (2018): Quality Assurance. 2nd ed.,
London: Macmillan press Ltd Co, pp. 5-10