The P.D.C.A. Approch To Quality Improvement

P.D.C.A. APPROACH

This chapter introduces the innovative concept of the P.D.C.A. approach to provide a framework for identifying problems and seeking solutions for improving the quality of services at different levels in the continuum of care.

Introduction

The P.D.C.A. approach is a systematic framework for identifying, addressing and measuring problems and for advocating for quality improvement at various levels of service delivery. Mentors will adopt this approach in all areas of their work from the block level down to the individual provider. 
The role of nurse mentors is to be always thinking of what is the problem and its cause, how can these problems be managed, how can she know that things are being achieved and how can she continue to advocate for good quality services. 

During mentoring, the NM has to teach and help the providers understand and internalize this approach, showcase its usability and benefits, and ensure providers practice and master the same in every aspect of their work, from how they manage health facility-level issues, to how they manage the individual patient.

The Plan-Do-Check-Act (PDCA) cycle is an element of the ability for attention improvement model for healthcare, a straightforward but powerful tool for fast quality improvement. 
Once a team has set its Associate in Nursing aim and established its membership, the Associate in Nursing develops measures to work out whether or not an amendment results in an improvement, subsequent step is to check a modification within the actual work setting.

The PDCA cycle is shorthand for testing a change by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method, used for action-oriented learning.

The steps in the PDCA cycle are:


Step 1: Plan-Plan the test or observation, including a plan for collecting data 

Step 2: Do-Try out the test on a small scale 

Step 3: Check-Set aside time to analyze the data and study the results

Step 4: Act-Refine the change, based on what was learned from the test

Following are a few examples to guide to address a gap:

Example 1: Availability And Timely Administration of Injection Oxytocin




Example 2: Availability And Real-Time Use of Partograph



Using the above approach, the underlying gap (which may be related to the infrastructure, logistics, practices or processes) can be identified and a strategic implementation plan should be formulated based on the level of the underlying concern


Quality improvement

The PDCA approach is to be used with core principles of quality improvement (QI) in mind. This section explains quality improvement principles and why they are important.


Quality improvement (QI) is a continuous process where individuals/organizations make an effort to move from the current level of 'ACTUAL PRACTICE to a level of BEST PRACTICE.

In a healthcare setting, quality improvement encompasses proper delivery of services that are available, accessible, safe, respectful and affordable to the target society that ultimately leads to an impact on mortality and morbidity in the area.


Quality Improvement (QI) uses a set of tools and techniques to ensure that services consistently meet the community's health needs and improves the health status of their populations.


The three fundamental principles of Quality Improvement (QI) adapted for the UPTSU project, that should be used to improve access and quality are:


  1. Promotion of client and provider rights

  2. Self-assessment 

  3. Teamwork

Promotion of client and provider rights

One important principle of QI is that clients' rights to quality services are central to any quality improvement intervention. To ensure that clients are able to access services, it is important that a health facility is available and accessible, with all the required services, that timings are convenient for clients and that there is a good awareness in the community of the range of quality clinical services available.

The clients should feel confident that they will receive information to take an informed decision, will be treated with will receive evidence-based diagnosis and treatment for their health needs, safely provided by competent providers, so that they feel confident to return for continued care.


The health facility providers also have the right to have systems that support them to provide the best possible care and to be able to fulfill their obligations to their clients.


This includes opportunities to practice and develop new skills, to be updated on policies and standard operating procedures, to have a safe and supportive work environment and to have systems in place that facilitate smooth service delivery.


Self-assessment

Self-assessment involves evaluation by a staff person (or team) of behaviours and practices in the facility as a whole, rather than simply evaluating their own performance and acting on the evaluation findings. Self-assessment is a low-cost approach to improving and monitoring the quality of care.

Based on interviews and focus groups with persons who engaged in self-assessment, self-assessment encourages learning from experience, facilitates effective functioning, strengthens commitment to competent performance and fosters self-agency and authority.


Teamwork

A key principle in improving quality is the notion that quality improvement of services is everyone's business at the health facility and that it is an ongoing process.

This requires that the staff/health care providers are helped by the nurse mentors to identify the issues, own those issues, understand the cause of those issues and identify and implement practical and realistic solutions to them.

The staff within the facility often has answers to the problems themselves without outside help: a self-assessment process can encourage and empower the providers to continuously stay focused on improving service delivery within the facility.


Advantages of adopting Quality Improvement principles 


  • Providers within the health facility feel ownership of quality issues and are encouraged to find solutions at their facility


  • All staff are seen as experts which results in a high level of confidence and respect among the health facility healthcare providers/ staff


  • Staff are sensitized to understand the mindset and needs of the clients 


  • QI processes teach staff to focus on systems and processes within the health facility rather than finding faults with an individual


  • QI encourages staff learning and development in an open way


  • Ql promotes teamwork and cooperation amongst the health facility staff.


Remember!!!


The three principles of Quality Improvement are:


  1. Promotion of Client and Provider's Rights

  1. Self-Assessment

  1. Teamwork

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