Quality standards for Health Care Organization

Pateints Rights

Objectives : Learn the concepts and principles of the standard rights of the patients and clients in both
hospital and community settings;

Patents Rights and Organizational Ethics

Every rights in every individual involves a corresponding duty in others to respect the rights and not
violate it.

Types of Patients Rights

1. Right to competent care

The nurse need the necessary education, training, experience and personality to carry out the services
for which they are responsible- lack of these may charge the nurse with incompetence.

 Ex. Burns resulting in the application of hot water bags, vaporizers or heat lamps
 Objects or instruments left inside the patients body such as sponge, catheters, suction tips
during operations


Patients’ right to believe that the kind of nursing care given them will help them regain their health. To
receive care meeting the highest standards regardless of race, religion, national origin, disability gender,
sexual orientation, age, military service, or source of payment for care.

2. Right to Freedom from harm

 The nurse tries to minimize the possibilities of injury to the patient
 Nurse Responsibility
o Protection of clients from harm that may result from disruption in physiologic
and sociologic preventive mechanism.
o There should be an appropriate balance between potential benefits of the
patient medical regimen and the risks assume by the patient
 Example
o Medications are toxics and should be monitored for therapeutic as well as side
effects
 o Without the proper monitoring patients may acquire prolong treatment or
hospitalization
3. Right to Informed Consent – refers to the knowledge or information about the consent to
particular form of procedure or medical treatment
 The nurse is a part of the information giving process and is usually the one who checks
that the consent is transposed in a written form
 Most often she becomes the witness in the changing of information between the
physician and the patients
 Implied consent In an emergency where life of the patient is in danger and patient cant
give the consent, and the relative or legal guardian is not available the law generally
agrees that the consent is assumed
 .
4. Right to Withdraw from Participation Right to refuse to participate in human experimentation,
research, project affecting his/her care or treatment.

This right allows the patient to pull out himself from the procedure he dislikes.
5. Right to Confidentiality of Information
6. Right to be Treated with Dignity and Respect-
 It is the duty of the nurse to be sensitive and responsive to their needs
 Special care should be observe that the patient body is not exposed unnecessarily

7. Right for religious beliefs and assistance

8. Right to disclosure of access to information

9 Right to correspondence and receive visits

10.Right to medical records

11.Right to health education

12. Right to leave against medical advice

13. Right to choose his Health care giver

14. Right to Express grievances

SINCE THE NURSE ARE THE CLOSEST CAREGIVER THEY ARE THE MOST LOGICAL GUADIAN OF THE
PATIENTS RIGTHS

ORGANIZATIONAL ETHICS

Organizations are much more than only a means for providing goods and service.They have
profound influence on employee behavior

Definition of Organizational Behavior

The study of human behavior, attitudes, and performance within an organizational setting

drawing on theory, methods, and principles from such disciplines as psychology, sociology, political
science, and cultural anthropology to learn about individual, groups, structure, and processes
 Daft’s types of organizational culture

Adaptability Culture

 Focus on external environment where innovation, creativity, risk taking, flexibility and change
are the key element for success
 This type of organization create changes in a proactive way in an effort to anticipate responses
and problems
 Ex. A company required to change quickly in anticipation of costumer need.

Mission Culture

 The mission and goals are clearly focused on a high level of competitiveness and profit
making strategies.
 In this type, executives and managers strongly communicate a strategic plans for the
organization employees and expect high productivity, performance goal and fringe benefits
for good attainment

CLAN Culture

 Avenues to satisfaction and focus is on employee needs and the strategies in which the
employees can engage for high performance.
 Leaders taking care of their employees and making sure they have appropriate avenues for
satisfaction and productivity.
 Rapid change occurs in the environment because of changing expectation

Bureaucratic Culture

 Focus on the internal environment

 Leaders develops carry out scrupulous and detailed plans in a cautious and stable
invironment with slow paced change
 Ex. Company runs by husband and wife team that thrives on order, decipline and control

Ethics of an Organization

= refers to an organization attempt to define its mission and values, recognized values that
could cause tension and manage the operation to maintain its values.

Organizational Ethics

is a broad concept that includes not only culture and trust, but also processes, outcomes, and
character and denotes “a way of acting, not a code of principles…. [and] is at the heart, pumping blood
that perfuses the entire organization with a common sense of purpose and a shared set of values”
(Pearson, Sabin, & Emmanuel, 2003, p42).

Organizational Trust

The essential ingredients, the lubricant facilitating everyday business and interactions (Shone
2007)

Trust in Nurses Organization

1. Trust promotes economic value within an organization

2. Trust increases strategic alliances, teamwork and productivity
3. Nurses experience a more positive practice environment as a results of trust
4. Nurses experience increase empowerment, autonomy, and overall job satisfaction because of
organizational trust(William (2006

Organizational ethics as Organizational Image

People who work in the organization are the ones who behave unethically or illegally and therefore are
what shape the ambiance and character of the organization

PATIENTS CARE STANDARD

What is a STANDARD

• A general agreement of how things should be (Wandelt, 1970).

• Delineate the best possible condition that should exist in the organization for it to attain quality
performance.

• Set maximum achievable performance expectations for activities that affect the quality of care, like
compliance with patient pathways which emphasize the interface between management units.

What is STANDARDS OF CARE

• These are the skills and learning commonly possessed by members of a profession (Guido, 2006, p. 55)

. • These are used to evaluate the quality of care nurses provide and, therefore, become legal guidelines
for nursing practice.

What is Nursing Standard

• It is a valid definition of nursing quality and includes criteria which can be used to assess efficiency
(Mason, 1994).

Why is Nursing Standards important?

• Outlines what the profession expects of its members

• Promotes guides and directs professional nursing practice – important for self-assessment and
evaluation of practice by employers, clients and other stakeholders

• Provides nurses with a framework for developing competencies

• Aids in developing a better understanding & respect for the various & complimentary roles that nurses
have.

Why is QUALITY OF CARE important?

• Jonas and Rosenberg (1986) have identified four broad categories which explain the need for quality
of care:

• Hippocratic oath principle of primum non nocere (“First do no harm”);

• The social and humanitarian motivation to use resources for the good of those in need;

• Professionalism;

• Survival.

Why is QUALITY OF CARE important?

1. Tougher Competition

2. Frequent Medical Errors

3. Rising Costs, Limited Health Expenditures

4. Rising Demands, Limited Health Resources

5. Concern with Variations in Health Care Outcomes and Costs

Where Quality of Health Care Starts

Quality health care, whether delivery is seen at the patient’s end or from the provider organization’s
perspective, starts with two principal actions:

1. Decision-making – selection of the most appropriate health intervention.

2. Performance action – effective, efficient and timely application of the selected intervention.

Health Care Customers

INTERNAL CUSTOMERS

1. Staff and Employees

2. Funders

EXTERNAL CUSTOMERS

1. Patients

2. Payers of Health Care

3. Contractors

24. Quality of Care Dynamics: Dimensions and Cross-Dimensional Issues

Dimensions of Quality Health Care

• Most clusters of quality indicators were and often continue to be comprised of the

5Ds— death, disease, disability, discomfort, and dissatisfaction—rather than more positive components
of quality.

• The most recent IOM work to identify the components of quality care for the 21st century is centered
on the conceptual components of quality rather than the measured indicators:

quality care is safe, effective, patient centered, timely, efficient, and equitable.

• Thus safety is the foundation upon which all other aspects of quality care are built.

• The work of the American Academy of Nursing Expert Panel on Quality Health focused on the
following positive indicators of high-quality care that are sensitive to nursing input:

 achievement of appropriate self-care

 demonstration of health-promoting behaviors
 health-related quality of life
 perception of being well cared for,
 Symptom management to criterion.

Six Aims for Improving Health Care Quality Aim Description

1. Safe care Avoiding injuries to patients

2. Effective care providing cared based in scientific knowledge

3. Patient- centered care providing respectful and responsive care that ensure that patients values guide
clinical decisions

4. Timely care Reducing waits for both recipients and providers of care

5. Efficient care Avoiding waste

6. Equitable care Ensuring that the quality of care does not vary because characteristics such as gender,
ethnicity, socioeconomic status, or geographic location.

CLASSIFICATION OF STANDARDS

1. Internal Standards
 Job description
 Education
 Expertise
 Institutional policies and procedures
2. External Standards Nurse Practice Acts
 Professional Organizations
 Nursing Specialty Practice Organizations
 Federal Organizations and Federal Guidelines

PATIENTS CARE STANDARDS (refer to Handouts)

A. Each patient shall be treated as a whole, irreplaceable, unique, and worthy person.
B. The patient’s safety, health, or welfare shall be protected and shall not be subordinated to
organizational, staff, educational, or research interests or to any other end.
C. The privacy of the patient and the confidentiality of every case and record shall be maintained
D. Patients and/or responsible family shall be informed at all stages of care about personnel
responsible for the patient’s care; treatment plans and activities for the patient; facilities;
services available to the patient; and responsibilities of the patient and family (referred to
collectively as “patient’s care”).
E. Behavior reflecting the dignity, responsibility, and service orientation of health care
professionals, worthy of the public’s respect and confidence, shall be practiced by all individuals.
F. Each patient shall have a responsible attending physician or dentist.