Office of Nursing

Quality Assurance/Quality Improvement

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History

Since the 1970's, there has been a wide range of quality assurance and quality improvement models and processes used by the health care industry. Quality assurance has been defined as a widely accepted system that compares the care provided to institutionally held standards, evaluates data, identifies problems, plans and implements activities to alleviate the problems, and determines whether the activities achieved the desired results (Rowland & Rowland, 1987). Models of quality assurance frequently incorporate three types of standards (outcome, process and structure). Outcome standards define expectations in terms of desirable and achievable benefit, either at the individual client/patient level or at the community level. Process standards reflect expectations in terms of best practices, policies, procedures and interventions, which are evidence-based. Structure standards indicate the operational requirements, staffing characteristics, materials and/or space requirements necessary to provide quality services.

In the 1980's, the concept of total quality management (TQM) or continuous quality improvement (CQI) received considerable attention in the health care arena. TQM/CQI represents an all-encompassing management philosophy that permeates the organization's management infrastructure, policies and practices. TQM principles call for a focus on the customer, an emphasis on systems, the use of data-driven decision-making, the active involvement of leaders and employees and continuously improving performance in all areas (Deming, 1986).

In the 1990's, the emphasis on accountability for public health began an important evolutionary process as part of the health system(s) within the community. This community-based process involves the selection of community indicators that can be used to measure the process and outcomes of intervention strategies for health improvement. Performance improvement should promote health improvement in a context of shared responsibility and accountability for achieving desired outcomes (IOM, 1996).

In 1997, the District Health Directors requested that a more coordinated approach to QA be developed. The Nursing Section was charged with leading the new approach to QA/QI. Some highlights of the QA/QI initiative are here.

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