Quality Assurance in nursing

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La Consolacion University Philippines
(formerly University of Regina Carmeli)
Graduate School Department

CHAPTER OUTLINE:
CHAPTER 2: Group Processes in Health Care Quality
improvement
■. Definition of Terms
I. Introduction: Teamwork in Health care
II. Teamwork Concepts
• Principles of group dynamics
• Eight Characteristics of effective team
III. Use of Teams in Organizations
•Principles that guide QI efforts
•Approach to team projects
• Project Selection
• Selecting the Team

LEARNING OBJECTIVES:
By the end of this chapter, participants will be able to:
I. Identify the importance of Teamwork in relation to
Quality improvement on healthcare.
II. Discuss outlined approach to team projects that can help
optimize the possibility of success.
III. Determine the principles/ basic tenets that guide
Quality Improvement efforts (on their approach to team
projects) and apply them to their respective settings.
IV. List and explain what are the eight characteristics of an
effective team.

DEFINITION OF TERMS:
•Team: comprises a group of people or animals linked in a
common purpose or goal.
•Teamwork: is “work done by several associates with each
doing a part but all subordinating personal prominence to
the efficiency of the whole.”
• Teamwork in Healthcare: “a dynamic process involving
two or more healthcare professionals with complementary
backgrounds and skills, sharing common health goals and
exercising concerted physical and mental effort in
assessing, planning, or evaluating patient care”(Systematic
concept analysis in 2008).
•Group dynamics: is a system of behaviors &
psychological processes occurring within a social group, or
between social groups.
•Cross-functional team: is a group of people with
different functional expertise working toward a common
goal.

I. INTRODUCTION
Teamwork is the cornerstone of quality
improvement (QI) efforts. One of the major thrusts of
quality improvement efforts is to capitalized on the group
process to solve problems collaboratively. Physicians and
other health professionals make good team members when
they are aware of the rules of the game and their opinions
are respected.
As health care moves into an era of continuous QI,
the team approach will gain even more importance, not just
for providing innovation, but also for improving the work
environment (Macy & Izumi, 1993).

II. TEAMWORK CONCEPTS
A basic understanding of group dynamics provides
an appreciation of the fundamentals of organizing and
promoting teams within an organization. Principles include:
■ Teams function best when all members are
exhibiting similar behavior (not demonstrating deviant
behavior relative to the norm of the group).
■The best method for change is to create a shared
perception of the need for change.
■Information must be equally available to all
members of the group.
■Team member motivation will be highest when
the team member is invested in the results.
Conflict is a natural part of the work of any group,
and well-managed conflict can lead to constructive change.
Good communication between team members, as well as
with organizational management, will prove effective in
converting conflict to change.

The following are eight characteristics of effective
teams. They were identified by Larson and LaFasto in their
book titled “Teamwork: What Must Go Right/ What Can
Go Wrong (Sage Publications 1989)”:
1. The team must have a clear goal.
2. The team must have a results-driven structure.
3. The team must have competent team members..
4. The team must have unified commitment.
5. The team must have high standards that are
understood by all.
6. The team must have a collaborative climate.
7. The team must receive external support and
encouragement.
8. The team must have principled leadership.

III. USE OF TEAMS IN ORGANIZATIONS
W. Edwards Deming (1986) was a pioneer in QI in
Japanese and American industry, and he articulated
Principles that guide QI efforts around the world. They can
be adapted to health care as follows (basic tenets):
1. Create constancy of organizational purpose to
become more competitive.
2. Adapt to the new economic age.
3. Include & implement continuing education in
every worker’s job profile including self-improvement
throughout the organization..
4. Improve management techniques and styles to
incorporate leadership principles that empower workers
(place managers in charge of improving processes).
5. Drive out fear. Make every worker unafraid to
speak out and suggest innovation. Error reporting is
encouraged & Handle mistakes to improve quality.
6. Eliminate functional silos in the organization.
Encourage communication throughout the enterprise to
promote teamwork and learning.
7. Eradicate the barriers in the system that does not
allow workers to feel pride in their work. Empower
workers to feel ownership of their work make them
8. Eliminate any impediment that keeps
professionals from feeling pride in their work.
9. Everyone in the organization must be committed
to the change for success.

APPROACH TO TEAM PROJECTS:

1. PROJECT SELECTION
Select projects that have a high probability of
successful completion. The following are the criteria for
selecting a project:
STAKEHOLDER CRITERIA
Internal Customers
(anyone within an
organization who at any
time is dependent on
anyone else within the
organization, example, if a
secretary is dealing with
computer issues, the IT
department considers that
person an internal
customer and makes as
• Project is achievable using
existing resources and
budgets.
• Project will improve some
area that involves the
individual’s work or
compensation.
• Cycle time is short that
results can be produced
quickly (to avoid operation
disruption)
much of an effort to meet
her needs)
• Interventions have been
piloted on smaller systems
prior to implementation
system wide.
NOTE: They actually
implement any project
designed by the team, so their
commitment to these
interventions is paramount.
Executive Management •Improvement will benefit
profitability and/or customer
satisfaction.
•Cost-benefit ratio is
favorable
External Customer • Project will improve the
quality of the products or
services bought from the
organization.
• Cost will fall.
Regulators • Project will not violate any
regulations or contractual
obligation.
Accreditation Agencies • Project will improve the
quality of products or
services, allowing better
performance on accreditation
reviews.

2. SELECTING THE TEAM
The process of team selection depends heavily on
organizational structure. Some will appoint people to teams
through a relatively straightforward top-down procedure.
Others promote the formation of cross-functional task
forces, usually through the appointment of an
OVERSIGHT TEAM- that helps guide the project team’s
activities.























The oversight team can manage from one to three
project teams. They establish parameters for the project,
including goals and objectives, needed resources, and
baseline information. NOTE: In smaller organizations, they
may eliminate the oversight teams and have executive
managers provide these functions for the project teams.
Whoever provides this oversight, however, must have
regular meetings with the project team leader(s) to ensure
that project goals are being met in a timely manner.



The PROJECT TEAMS must have a team leader
and staff members who are expert in areas that are
important to the success of the project. Project team
leader facilitates meetings, manages administrative details
of the meetings, and interacts with the oversight team. They
should have the ability to lead through example and
encouragement. Project team members are selected for
their expertise and commitment to the team’s goals.


REFERENCES:
•Lighter D. and Fair D. (2004). Quality Management in Health
Care: Principles and Methods, 2
nd
edition, Jones and Barlett
Publishers Inc.
• Larson and LaFasto, “Teamwork: What Must Go Right/
What Can Go Wrong (Sage Publicaations 1989).

Prepared by:
Allan M. Manaloto

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