ACCOUNTABILITY

& QUALITY
ASSURANCE
 ACCOUNTABILITY
OBLIGATION OF AN INDIVIDUAL, FIRM OR
INSTITUTION TO ACCOUNT FOR ITS
ACTIVITIES, ACCEPT RESPONSIBILITY FOR
THEM AND TO DISCLOSE THE RESULTS IN A
TRANSPARENT MANNER.

RESPONSIBLE TO SOMEONE
OR FOR SOME ACTIVTY.
 ACCOUNTABILITY
THE ABILITY AND WILLINGNESS TO ASSUME
RESPONSIBILITY FOR ONE’S ACTION AND
ACCEPTING THE CONSEQUENCES OF ONE’S
BEHAVIOUR.

EXTENT TO WHICH A PERSON IS

ANSWERABLE TO A HIGHER
AUTHORITY.
 ACCOUNTABILITY IN NURSING
THE OBLIGATION OF BEING ANSWERABLE FOR
ONE’S OWN JUDGMENT AND ACTIONS TO AN
APPROPRIATE PERSON OR AUTHORITY
RECOGNIZED AS HAVING THE RIGHT TO DEMAND
INFORMATION AND EXPLANATION.

PROVIDING AN EXPLANATION OR
RATIONALE FOR WHAT HAS BEEN
DONE IN NURSING.
• PRIORITY ACCOUNTABILITY
• PROGRAMME ACCOUNTABILITY
• PROCESS ACCOUNTABILITY
• FISCAL ACCOUNTABILITY
TYPES OF NURSING ACCOUNTABILITY
GROUNDWORK FOR ACCOUNTABILITY

THEORETICAL BASE.
CLINICAL &PROFESSIONAL COMPETENCE.
LEADERSHIP SKILLS.
ETHICAL FRAMEWORK.
NURSE IS ACCOUNTABLE TO
THE PROFESSION

THE CLIENTS

HEALTH CARE TEAM

EMPLOYING AGENCY

SELF
ACCOUNTABLE TO THE PROFESSION

ANA CODE FOR NURSES.

ANA STANDARDS OF NURSING PRACTICE,
SERVICE AND EDUCATION.
NURSING QUALITY ASSURANCE AND
QUALITY IMPROVEMENT PROGRAMMES.
PARTICIPATE AS A MEMBER OF
PROFESSIONAL NURSING ORGANISATIONS.
ACCOUNTABLE TO CLIENTS
 CLINICAL COMPETENCE.
 SAFE NURSING CARE.
 PARTICIPATE CLIENTS IN NURSING CARE.
 RESPECT INDIVIDUAL CLIENT DIFFERENCES.
 ALTRUISTIC INTERVENTIONS.
 SERVE AS CLIENT ADVOCATE WHEN NEEDED.
 ACCOUNTABLE TO EMPLOYING AGENCY

 QUALITY OF WORK.
 PROTECT AGAINST UNSAFE PRACTICE
SITUATIONS.
 ATTITUDE CONVEYED ABOUT THE AGENCY.
 ACCOUNTABILITY TO SELF

 MAINTAIN PROFESSIONAL STANDARDS.

 BE TRUE TO ONESELF.
 TAKE CARE OF PERSONAL, PHYSICAL,
MENTAL & SPIRITUAL HEALTH.
 PROTECT SELF FROM HARM.
 BENEFITS OF
ACCOUNTABILITY
 INCREASED RESPECT.
 REWARDS.
 EFFECTIVENESS.
 CONTROL.
 ACTION.
 RESPONSIBLE.
 MAINTAINING SAFE STANDARDS.
 Quality
Assurance
 QUALITY

 ORIGINATED FROM
LATIN WORD “QUAILS”
MEANS “WHAT KIND OF”

 TOTALITY OF FEATURES AND CHARACTERISTICS

OF A PRODUCT OR SERVICE THAT BEARS ITS
ABILITY TO SATISFY STATED OR IMPLIED NEEDS.
 QUALITY ASSURANCE

ORIGINATED IN MANUFACTURING INDUSTRY.

SYSTEMATIC PROCESS OF CHECKING TO SEE

WHETHER A PRODUCT OR SERVICE BEING
DEVELOPED IS MEETING SPECIFIC
REQUIREMENTS.
 Quality Assurance in
Nursing
• The proper performance (according to
standards) of interventions that are known to
be safe, that are affordable to the society in
question, and that have the ability to produce
an impact on mortality, morbidity, disability,
and malnutrition.
(Roemer and Aguilar, WHO, 1988)
 QUALITY ASSURANCE IN
NURSING
FLORENCE NIGHTINGALE INTRODUCED THE
CONCEPT IN 1855.
“IT IS THE JUDGMENT CONCERNING THE
PROCESS OF CARE, BASED ON THE EXTENT TO
WHICH THAT CARE CONTRIBUTE TO VALUED
OUTCOME.”
 QUALITY ASSURANCE IN
NURSING
IT IS THE MONITORING OF THE ACTIVITIES OF CLIENT
CARE TO DETERMINE THE DEGREE OF EXCELLENCE
ATTAINED TO THE IMPLEMENTATION OF ACTIVITIES.
(BULL 1985)

IT IS THE EXTENT OF RESEMBLANCE BETWEEN THE

PURPOSE OF HEALTH CARE AND THE TRULY GRANTED
CARE.
 APPROACHES FOR QUALITY
ASSURANCE PROGRAMME

 GENERAL APPROACH

 SPECIFIC APPROACH
 GENERAL APPROACH
• OFFICIAL BODY’S EVALUATION OF A PERSON
OR AGENCIES’ ABILITY TO MEET ESTABLISHED
CRITERIA OR STANDARDS AT A GIVEN TIME.
IT INCLUDES:
 CREDENTIALITY
 LICENSURE
 ACCREDITATION
 CERTIFICATION
 CREDENTIALITY
• FORMAL RECOGNITION OF PROFESSIONAL OR
TECHNICAL COMPETENCE AND ATTAINMENT
OF MINIMUM STANDARDS BY A PERSON OR
AGENCY.
COMPONENTS
TO PRODUCE A QUALITY PRODUCT.
TO PROTECT PROVIDER AND PUBLIC.
TO CONTROL THE PROFESSION.
 LICENSURE
IT IS A CONTRACT BETWEEN THE PROFESSION
AND THE STATE, IN WHICH THE PROFESSION IS
GRANTED CONTROL OVER ENTRY INTO AND EXIT
FROM THE PROFESSION AND OVER QUALITY OF
PROFESSIONAL PRACTICE.
 Accreditation

IT EVALUATES ON AGENCY’S PHYSICAL

STRUCTURE, ORGANISATIONAL STRUCTURE
AND PERSONAL QUALIFICATION.
 CERTIFICATION
 VOLUNTARY PROCESS WITHIN THE
PROFESSION.
A PERSON’S EDUCATIONAL ACHIEVEMENTS,
EXPERIENCE AND PERFORMANCE ON
EXAMINATION ARE USED TO DETERMINE THE
PERSON’S QUALIFICATIONS.
 SPECIFIC APPROACHES
METHODS USED TO EVALUATE IDENTIFIED
INSTANCES OF PROVIDERS AND CLIENT
INTERACTION.
THEY ARE:
PEER REVIEW
STANDARDS
AUDIT
 NURSING AUDIT

IT IS AN EXERCISE TO FIND OUT WHETHER

GOOD NURSING PRACTICES ARE FOLLOWED.
IT IS A MEANS BY WHICH NURSES
THEMSELVES CAN DEFINE STANDARDS FROM
THEIR POINT OF VIEW AND DESCRIBE THE
ACTUAL PRACTICE OF NURSING.
 NURSING AUDIT Contd…..

• PROCESS OF ANALYSING
DATA ABOUT THE NURSING
PROCESS OF PATIENT
OUTCOMES TO EVALUATE
THE EFFECTIVENESS OF
NURSING INTERVENTION.
PURPOSES OF NURSING AUDIT
EVALUATE NURSING CARE GIVEN.
ACHIEVES DESERVED AND FEASIBLE QUALITY
OF NURSING CARE.
STIMULANT TO BETTER RECORDS.
FOCUSES ON CARE PROVIDED NOT ON CARE
PROVIDER.
METHODS OF NURSING AUDIT

CONCURRENT
REVIEW RETROSPECTIVE
REVIEW
 CONCURRENT REVIEW
EVALUATION CONDUCTED FOR PATIENTS WHO
ARE STILL UNDERGOING CARE.
ASSESSING THE PATIENTS AT BED SIDE.
INTERVIEWING THE STAFF.
REVIEWING THE PATIENTS RECORDS AND
CARE PLAN.
RETROSPECTIVE REVIEW
INDEPTH ASSESSMENT OF QUALITY AFTER THE
PATIENT IS DISCHARGED.
PATIENTS CHARTS ARE THE SOURCES OF
DATA.
FOCUSES ON TWO FACTORS
DISCHARGE STATUS.
COMPLICATIONS.
 AUDIT CYCLE
SET
STANDARDS

IMPLEMENT OBSERVE
CHANGE PRACTICE

COMPARE
WITH
STANDARDS
 COMPONENTS OF QUALITY
ASSURANCE PROGRAMME
DEFINING
QUALITY

QUALITY
PATIENT
CARE

MEASURING
QUALITY IMPROVING QUALITY
MODEL OF QUALITY ASSURANCE
DONABEDIAN MODEL

STRUCTURE

OUTCO
ME

PROCESS
DONABEDIAN MODEL
 Stories of success…
Stories of success…

Improved drug storage at RHC

TOOLS FOR QUALITY ASSESSMENT

NURSING AUDIT.
ANECDOTAL RECORDS.
CHECK LISTS.
RATING SCALE.
ACHIEVEMENT TESTS.
CUMULATIVE RECORDS.
QUESTIONNAIRE.
 METHODS FOR QUALITY
ASSESSMENT
DIRECT OBSERVATION.
CLIENT SATISFACTION SURVEY
INTERVIEW WITH HEALTH CARE PROVIDERS.
REVIEW OF RECORDS.
 FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING CARE
LACK OF RESOURCES.
PERSONNEL PROBLEMS.
IMPROPER MAINTENANCE.
UNREASONABLE PATIENTS AND ATTENDANTS.
ABSENCE OF ACCREDITATION LAWS.
LACK OF INCIDENT REVIEW PROCEDURES.
LACK OF GOOD HOSPITAL INFORMATION
SYSTEM.
 FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING CARE Contd….

ABSENCE OF PATIENT SATISFACTION SURVEYS.

LACK OF PATIENT CARE RECORDS.
LACK OF GOOD SUPERVISION.
ABSENCE OF KNOWLEDGE ABOUT
PHILOSOPHY OF NURSING CARE.
LACK OF POLICY AND ADMINISTRATIVE
MANUALS.
FACTORS AFFECTING QUALITY ASSURANCE
IN NURSING CARE Contd…

SUB STANDARD EDUCATION AND TRAINING.

LACK OF EVALUATION TECHNIQUE.
LACK OF WRITTEN JOB DESCRIPTION AND JOB
SPECIFICATION.
LACK OF INSERVICE AND CONTINUING
EDUCATIONAL PROGRAMME.
 REFERENCES
Potter A P, Perry G A. Fundamentals of Nursing.
6thed. St. Louis: Mosby publications; 2006. Pp
9,315.
Basvanthappa B T. Textbook of Nursing
Administration. New Delhi: Jaypee publications;
2004. Pp 432-433,435-437.
Berman A, Synder J S, kozier B. Erb’s
Fundamentals of Nursing. 8thed. New Delhi:
Dorling Kindersely (India) pvt. ltd.; 2008. Pp
85,516,239-240,154.
 ON LINE REFERENCES
• http://www.csun.edu/meh20426/303/6Accountability
• http://www.bellaonline.com/articles/art57183.asp
• http:current nursing.com/nursing-management/total-
quality-management-health-care.html
• http://currentnursing.com/nursing-management/
quality-standards-nursing.html
• http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1055277
THANK YOU