By:

Hannah Araba Hanson

Tutor: POCCN SCHOOL
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1. Introduction to Quality 6. Principles of Quality
Assurance
Assurance (QA) in
healthcare 7. Role of the healthcare
manager in Quality Assurance
2. Quality Assurance in
Nursing 8. Role of nurses in the
implementation of Quality
3. Uses of Quality Assurance Assurance
4. Perspectives of Quality 9. Benefits of Quality Assurance
5. Quality Assurance process 10. The Role of Clients in
Quality Assurance
IMAGE 1 IMAGE 2
• Is Quality of
care the basic
right of every
patient??

9/10/2025
What is Quality?

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 “….interventions that are known to be safe,
that are affordable to the society in question,
and can produce an impact on mortality,
morbidity, disability, and malnutrition”.
M.I. Roemer and C. Montoya Aguilar, WHO,
1988.
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 Quality is NOT…

 yelling at people to work harder, faster, or

safer

 creating protocols and then failing to monitor

their use or effect

 research (but they can co-exist)

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 The field of quality assurance is as old as
modern nursing . “FLORENCE NIGHTINGALE”
introduced the concept of quality nursing
care in 1855 while attending to the soldiers
in the hospital during the Crimean war.

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Quality assurance necessitates that institutions and health
professionals render care in a most efficient ,effective and
economical manner. This entails a cost benefit analysis to
define strategies for optimum utilization of resources, focus
on cost effective methods and introduce systematic ongoing
quality control programs to continuously monitor and
improve the quality of care rendered.
9/10/2025

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 Our patients/clients and the general public often
complain on the radio, television and even in the
community about the poor quality of care that
patients have received from us in our health
facilities.

 We ourselves at times do experience this poor

quality in our health facilities when we are sick.
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v Many definitions are based on different
points of view:
 From a Process point of view- Conformance
with process standards & specifications
 From a Product point of view– Degree of
excellence at an acceptable price
 From a Cost point of view– Best combination
between costs & features
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 From a Customer point of view-
Service &/or product meeting
customer needs
 Fitness for Use = does it do what it
is supposed to do?

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 “The process for objectively and systematically

monitoring and evaluating the quality and

appropriateness of patient care, for pursuing

opportunities to improve patient care for

resolving the identified problem”.

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 Quality Assurance is a set of activities that are
planned for, carried out systematically or in an
orderly manner and continuously to improve
quality of care. It involves:
 The setting of standards;

 Monitoring to see if there is a gap between what

is being done now and what is expected;
 and addressing the gap on a regular basis
(quality improvement).
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 Quality assurance is a dynamic process
through which nurses assume accountability for
quality of care they provide. It is a guarantee
to the society that services provided by nurses
are being regulated by members of
profession.
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 Quality assurance in nursing refers to the ongoing
process of ensuring that nursing care meets or exceeds
established standards and guidelines, with the ultimate
goal of improving patient outcomes and experiences. It
involves systematic monitoring, evaluation, and
improvement of nursing practices, processes, and
outcomes.
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 This means setting goals with patient care and
doing everything within the nurses power to work
toward this goal while providing the absolute best
care possible. Nurses are required to meet
standards of care in order to provide quality care
to their patients. Quality care in nursing is very
important.
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 Patients will be more confident in your services if you can
show their quality.

 Quality standards are generally determined by the intended

users of a service or those that commission or regulate it.

 Quality assurance is normally sought through a set of activities

that are intended to ensure that services satisfy customer
needs and requirements in a systematic and reliable manner.

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Break into three groups and lets
discuss the following:
Perspectives of Quality ,
The patient/client
The healthcare staff/provider
The healthcare manager
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 The health staff, health manager,
clients and communities are all
stakeholders in service delivery.
 Each of these groups may expect

different things from health services.

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The Patient/Client
 Research done in various parts of the country
shows that our patients/clients want services
that:
v Are delivered on time by friendly and
respectful staff;
v Are safe, produce positive result and that they

can afford;
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v Adequate information about their
condition and treatment;
v All needed drugs must be provided

v Privacy is provided

v Service is within reach (distance)

v Information is given in a language they

can understand
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v Adequate knowledge and skills.
v Enough resources (staff, drugs, supplies,
equipment and transport etc..)
v Safe and clean workplace.

v Opportunity to regularly improve

himself/herself.
v He/ she is well rewarded and motivated both
financially and non financially for good work.
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 The health care manager sees quality
care as:
v Managing efficiently the resources of the
health facility.
v Health staff achieving set targets.

v Health staff being regularly supported

and supervised.
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v Having adequate and competent staff
to provide care.
v Staff being disciplined.

v Providing enough resources for work.

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 Planning for quality assurance

 Developing guidelines and setting

standards (i.e. input, process and output
standards)

 Communicating standards and

specifications
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 .

 Monitoring quality

 Identifying problems and selecting

opportunities for improvement

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 .
 Defining the problem operationally
 Choosing a team

 Analyzing and studying the problem to

identify its root causes
 Developing solutions and actions for
improvement
 Implementing and evaluating quality
improvement effort.
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 It encourages health workers to:
v Examine the services they provide,

 Assess their own work and come out with what

they can do with the limited resources to improve

the quality of care.
 For supervisors and managers, QA calls for

change from the status of an inspector to that of a

facilitator, and expects the health workers to
identify and solve problems.
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 1: Meeting the Needs of Our Clients
 Satisfy Clients.

 Involve them in healthcare

 Address their needs

 Respect patients’ rights to participate in

healthcare delivery

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There are two types of clients in
the quality assurance
programmes:
Internal and

External clients.

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 Those who directly use our services and
those who have special interest in our
services.
 Patients, relatives and friends and the
community as well as
 Other organizations: NGO's, District

Assemblies, Ministries, Development

partners (Donors) etc.
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 Workers in the health facility.

 Their needs must also be catered for so that

they can provide quality care.

 Client's needs can be assessed either through

surveys (interviews) or discussions with
individuals and groups within the community
who use our services.
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 Systems are the various aspects or components of
service delivery that have to operate together as
a unit in a facility to deliver quality health care.
 Staff are often blamed when things go wrong with

health services.
 In most cases, the problems lie in all the areas of

service delivery (inputs, processes, and outcomes)

which need to be looked at in totality when
addressing the problems.
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 We collect a lot of information (data) in
our health facilities but we just send
them on to the District Director without
making use of them.
 These data are very useful.

 They can tell us where there are

problems in service delivery.
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 E.g. data on:
v No. of people who attend the OPD, their
age and gender.
v No. of cases of malaria, diarrhoea,
mothers dying from pregnancy, delivery
and after delivery.

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 The information can be used in planning services
and for monitoring.
 It can also be used in identifying resources

(people, drugs, supplies and the amount of money)

required for health services.
 Data can be analyzed and use locally to improve
services
 Some of these data can be shared with community
members.
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Sources of Data
v The health management information

system (HMIS),
v Surveillance system and

v Surveys.

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 Quality assurance uses teams in problem solving
and quality improvement.
 A team is a group of people who work together
to achieve a common goal.
 In health service delivery we have different kinds
of health workers working together.
 They all play important roles and if they work
well in the team, the outcome is always good
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 A team can:
v Do a thorough analysis of problems,

v Determine the best solution(s)

v Develop plans and

v Implement them.

 Strong leadership support and commitment are

needed to start and sustain QA programme.
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 In health delivery there is communication
between:
 Health worker and Patient;
 Health worker and Community;
Health worker and Health worker

Health worker and Patient

 Good communication increased client’s
compliance to treatment satisfaction
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Health worker and Community
Health workers should have regular
interactions with their communities to
share information on service delivery
and their role in healthcare.

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 Good communication between
health workers to ensure effective
dissemination of information,
understanding among staff and
effective teamwork.

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 Quality assurance is beneficial to everybody –
 The client,

 Community,

 Health workers,

 Health managers and

 The health institution

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Benefits to the Clients
 Good health outcomes.

 Client satisfaction.

 Value for money.

 Less frustration
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Benefits to Health Providers
 Health staff become more
satisfied with their work.

 Health workers understand

patients better.

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 Information flow among staff is
improved.
 Health staff who perform well are
rewarded.

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Benefits to the Health Institution
 Patients become more satisfied with the services.

 More patients may use our services.

 The environment will become clean and beautiful.

 The facility will have a good reputation.

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 Definers of quality
 Evaluators of quality

 Co-producers of quality

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 Informants on quality
 Contributors to Quality Practice

 Reformers of health services

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 Paying attention to patients’ or clients’

needs.
 Using methods that have been tested to be
safe, affordable and can reduce deaths,
illness and disability.
 Practicing according to set standards as

laid down by clinical guidelines and

protocols.
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v It is important to show respect to our clients;

v Feel for our patients (empathy);

v Not be rude or shout at them (responsiveness &

courtesy);

v Not disclose information we get from patients to

other people (confidentiality).
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 Head of Maternity
 Deputy Director of Nursing

 Medical Director/Superintendent

 Hospital Administrator

 Midwife

 Staff Nurse/Paediatric Nurse

 Medical Doctor - maternity unit

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 Medical Doctor - neonatal unit
 Pharmacist

 Laboratory in charge

 Nutrition officer

 Community Representative

 One newborn care champion

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 What support do you need from your BMC head
to help implement effect QA Team, and how can
you obtain this support?

 What are the best ways to improve QA among

providers in your BMC/facility?

 What benefits do you see in involving

management and facilities in QA?
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 Hospital A QA team Hospital B QA team
 In Hospital A the QA  In Hospital B the QA
team comprises: team comprises:
 Medical superintendent  Medical superintendent

 Nurse Manager  Hospital matron

 All unit heads  Biostatistician

 Quality assurance co-  Pharmacist

ordinator  Laboratory technician
v Compare the composition of the QA teams for
Hospital A and Hospital B as indicated in slide 63
and answer the questions below.
1. Which of the two teams is better composed? Give
reasons to support your answer.
2. What differences exist in the two teams in terms of
membership.
3. Suggest an alternative to the two teams discussed
and give reasons why your composition is the best.
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 What did you like in today’s presentations?
 Do you feel as though all your questions

were answered?
 Were the presentations engaging?

 How could we make this presentation

better?

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