Control provide an organization with a way to adjust its course if performance fail outside acceptable boundaries
Without effective control procedures, an organization is not likely to achieve its goals
Controlling is essential in order to check, test, regulate, verify and adjust
Controlling: is regulation and monitoring of organizational activities in order to their goals.
Purposes of control:
· To detect deviations from desirable standards
· To take preventive and corrective actions in order to ensure that the organization’s mission and objectives are accomplished as effectively and efficiently as possible
· To guide behavior and set in to motion plans for the future
Types of control:
1. Anticipatory control: planned and preventive measures can save time, money, errors and legal problems. Manager need:
· Review mission and goals
· Review past success and failures
· Assess needs
· Project for the future
2. Concurrent control: this type of control deals with present rather than the future or past
It involves monitoring and adjusting ongoing activities and processes to ensure compliance with standards. Manager need:
· Monitor ongoing activities
· Make adjustment
3. Feed back control: involves gathering information about an ongoing or completed activity, evaluating that information and taking steps to improve that activity or similar activities in the future. Manager need to:
· Gather information on ongoing / completed activities
· Learn from mistakes
· Take steps to improve situation
QA is the process of establishing a target degree of excellence for nursing intervention and taking action to ensure that each patient receives the agreed upon –level of care
Approaches to Q
1. Structural Element: including physical setting, instrumentality and conditions through which nursing care is administered, such as philosophy, objectives, policies, procedures, records, organizational structure, financial resources, equipment and expectations and attitudes of patients and employees
2. Process Element: includes steps of the nursing process itself “assessment, diagnosing, planning, implementation, and evaluation” and all subsystems within the nursing process “ health history, physical examination, making a nursing diagnosis, determining nursing care goals, writing a nursing care plan, performing each care, cure and coordination of tasks and reporting patient’s response to treatment.
· It is the criteria for measuring nursing care to determine if nursing standards of practice are being met, so they are task oriented
3. Outcome Element: it includes change in patient health systems that result from nursing interventions
· Examples: modifying in S&S, knowledge attitudes satisfaction, skill level and compliance with treatment regimen, & established patient outcome criteria
Steps of QA:
1. Setting standards: standards is a desired quantity, quality or level of performance with reference to a criterion against which performance is to be measured
· ANA has designated generic standards of nursing practice
· In addition each patient care unit must designate standards specific to the patient population served
· These standards are the foundation upon which all other measures of QA are based
· Standards define nursing care outcomes as well as nursing activities of structural resources needed.
· They are used for planning nursing care as well as evaluating it
2. Assign responsibility: assign responsibility to individual or committee
3. Delineate scope of care: develop an inventory including the type of patients served, the conditions and diagnoses treated, the treatment or activities performed, the type of practitioners providing care, the site where care is provided. This will provide a bases for subsequent steps in the evaluation process
4. Identify important aspects of care: priority should be given to those aspects of care which occur frequently, affect large number of patients, involves risk or serious consequences or will deprive patient from substantial benefit if the care is not provided correctly, or problematic behavior
5. Determining criteria: criteria must be determined that will indicate if the standards are being met and to what degree they are met
· Criteria must be general and specific to the individual unit.
· Criteria is the value-free name of a variable that is known to be reliable indicator of quality
6. Data collection: sufficient observations and random samples are necessary for producing reliable and valid information. A useful rule is that 10 percent of the institutional patient population per month should be sampled
Data collection methods include:
a. Patients observations and interviews
b. Nurses observations and interviews
c. Review of charts
7. Evaluation performance:
The methods include:
a. Reviewing documented records
b. Observing activities as they take place
c. Examining patients
d. Interviewing patients. Families, and staff
Records: are most commonly used source for evaluation but they are not as reliable as direct observations.
It is quiet possible to write in the patient’s chart activities that were not done or to not record these things that were done.
The chart indicates the care provided but it does not demonstrate the quality of that care
For the stated criteria example:
– Record will be examined to determine if care plans were written on each patient within 12 hours of admission
– To measure quality of the care plan. Every care plan will include patient education appropriate to the patient’s medical diagnosis, nursing diagnosis, interventions planned, and discharge planning
8. Problem identification: analysis and reporting of the data gathered from the evaluation process will lead to problem identification and isolation, and the evidence is gathered through round, observation, and records.
The nurse’ manger responsibility is to look for pattern or trends of deviation from normal, further data collection and analysis could be done for the identified problems
9. Problem solution: once the problem has been defined and isolated, plans are made to solve them on a priority bases
o Those are critical, which involves safety and welfare of the patient take first priority
o Other factors used in determining priority will include severity, frequency, benefit, cost, and liability
o First step is nursing unit must determine how much deviation from the standard is acceptable before changes are made
o After collecting all pertinent information about the possible causes, the nurse manager after consultation with staff and /or supervisor should make plans for correcting deficiencies in performance
10. Monitoring and feedback: follow up o how effective changes have been in improving performance is very necessary step in QA process.
The purpose of QA program is to measure and improve the quality of patient care delivered in the organization:
1. Nursing audit:
It is a method for evaluating quality of nursing care through the appraisal of the nursing process or outcomes of care as it is reflected in the patient care records
There are two types of audits:
– Concurrent audit
– Retrospective audit
2. Peer review:
It is a process by which nurse evaluate one another’s job performance against accepted standards
3. Patient care profile analysis:
The analysis of longitudinal or cross sectional complications of data about patients with a particular diagnosis or problem
4. Quality circles
Is a small group of 5 to 15 employees who perform similar work and meet for one hour each week to solve problems related to their work.
5. Patient satisfaction: (client feedback)
Is used as one of several indicators of quality
Giving feed back to the staff:
Information about nursing structure, nursing process, and patient outcomes must be continuously fed back to nurses at all levels of organizational hierarchy.
– Faulty practices will persist.
– Reports of favorable findings would be helpful in reinforcing desirable performance by caregivers
– Solve work related problems