The theory and the realityNEA Conference 2009

Dr Sue Armstrong

THE THEORY THE REALITY

A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or the level of quality achieved.

QAP

Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of (health care) a product or service.

Medicalwebends

STANDARDS (Performance that is expected)

CRITERIA (Items or variables which enable the achievement of a standard and the evaluation of whether it has been achieved or not.)

INDICATORS (Qualitative or quantitative measures – see, feel, touch, hear)

THE THEORY THE REALITY

To improve the quality of the organization

State what the ideal is and measure development towards compliance

To comply to requirements to operate

May be licensing, accreditation, certification “Voluntary” or

required Organization has no

say

THE DECISION MAKERS:

HEQC UMALUSI SANC PROVINCIAL GVT

1. APPLICATION FOR ACCREDITATION OF A NURSING EDUCATION INSTITUTION

Conditions for application for accreditation as a nursing education institution

Requirements for accreditation as a nursing education institution

Requirements for the Institutional Portfolio Standards for Approval as a Nursing education

Institution

2. PROCESS OF ACCREDITATION OF INSTITUTIONS

Pre-audit preparation The Audit visit The auditors The audit report The appeals process Types of accreditation Accreditation certificates Re-accreditation and the accreditation cycle Withdrawal of accreditation Application for extension of scope of accreditation

The institutional mission and focus Governance framework for the institution Proof of financial viability Links between planning, resource allocation and

quality management The education programmes to be offered Arrangements for ensuring quality theoretical and

practical teaching and learning Arrangements for creating and applying knowledge Community engagement and service

Structure Standards including human resources, material resources, financial resources, technology, theoretical and practical learning facilities

Process standards including leadership and management of the institution, management of educational programmes, relationships and record keeping and reporting

Outcomes standards including quality of graduates, organizational development, and community outreach.

A panel of auditors is appointed, based on their knowledge, experience and skills in terms of nursing education and quality assessment

They will need to be trained on the auditing process.

 The audit team for a particular visit is selected on a rotational basis

The size of the team of auditors will be determined by the complexity of the institution.

Each team is accompanied by at least one audit officer and an audit administrator from the accreditation body staff

The chairperson of the audit team should have acknowledged credibility and authority who commands respect in the nursing education sector.

Probationary accreditation which enables an nursing education institution applying for accreditation for the first time to offer nursing education for a period not exceeding three years whilst completing requirements for full accreditation.

Provisional accreditation which enables a nursing education institution which has previously been accredited but which complies with most but not all of the required standards to operate for a period not exceeding one year whilst it addresses the areas of concern.

Full accreditation which indicates that the institution complies with all the required standards and may operate for a period of five years before applying for re-accreditation.

Failure to maintain the requirements Continuous failure to maintain standards after

accreditation Evidence that the institution has contravened

the Act and its regulations Evidence that submission for accreditation was

made fraudulently or contained false or misleading information

Failure to inform the Council, in the event of a move

On request for voluntary de-accreditation from the head of the nursing education institution.

THEORY REALITY

The process of systematic examination of a quality system by internal or external auditors

Important part of organization’s quality management system

True when referring to internal audits

Reality is that most organizations only do a self-audit as a requirement preceding an external audit

They are time consuming but very useful if done regularly

THEORY REALITY

Standards should reflect best practices benchmarked on the best in the industry

Should be chosen on high risk, high cost, high volume issues

Reality is they usually reflect best equivalent provider standards

Also reflect values of licensing body

Licensing bodies have to be sure they will not shut down the entire industry!

THEORY REALITY

The outputs of any programme are the most important aspect for assessing quality of education

Tool should be developed so no assessor bias is possible

In reality they are the most difficult to assess and most audit tools have fewer standards & criteria on this aspect than any other

Unless tools are extremely detailed assessors need to exercise some judgement

AREA RELEVANT ASPECTS

INPUT •Programme design•Student recruitment, admission & selection•Staffing•Teaching & learning strategy•Student assessment policies•Infrastructure & library resources•Programme administrative services•Postgraduate policies, regulations & procedures

AREA RELEVANT ASPECTS

PROCESS •Programme coordination•Academic development for student success•Teaching & learning interactions•Student assessment practices•Coordination or work-based learning•Delivery of post-graduate programmes

OUTPUT & IMPACT

•Student retention and throughput rates•Programme impact

DOMAIN: PATIENT RIGHTSSUB-DOMAINS: 1.1 Respect and dignity 1.2 Information to patients 1.3 Physical access 1.4 Continuity of care 1.5 Reducing delays in care 1.6. Emergency care 1.7 Access to a package of services 1.8. Complaints management

SUB-DOMAIN: RESPECT & DIGNITYSTANDARDS: 1.Patients are treated in a way that shows

respect and maintains patient dignity 2.Results of patient satisfaction surveys are

used to inform quality improvement in the establishment

3.Establishments provide hotel services that meet the patients’ expectations

STANDARD: Establishments provide hotel services that meet the patients’ expectations

CRITERIA: The cleanliness and hygiene of the facility

contribute towards patient satisfaction. The linen services contribute to patient

satisfaction. The food services contribute to patient

satisfaction

CRITERIA: The food services contribute to patient satisfaction

MEASURES / INDICATORS: 5 randomly selected patients in the ward

indicate they are satisfied with the temperature of the food served in the ward

5 randomly selected patients in the ward indicate they are satisfied with the quality and quantity of the food served in the ward

CRITERION: The food services contribute to patient satisfaction

WEIGHT

PLACE ASSESSED

TYPE ASSESSMENT

5 randomly selected patients in the ward indicate they are satisfied with the temperature of the food served in the ward

15% In-patient units

Patient interviews

5 randomly selected patients in the ward indicate they are satisfied with the quality and quantity of the food served in the ward

15% In-patient units

Patient interviews

Patient interviews Staff Interviews Document reviews Document analysis Patient record reviews Patient record audits Observation with

checklist

Pass Rate per subject

Ratios 1 tutor to x students

Pass rate per subject Difficulty index of exams

Need to be accredited by both HEQC and SANC

In theory SANC may be used as agent for HEQC

Nurses needed to evaluate nursing aspects especially clinical areas

System of licensing health establishments coming – implications for NEI’s?

Nothing to lose if we do internal quality audits meantime

THE THEORY THE REALITY

“Aim at the sun, and you may not reach it;

But your arrow will fly higher than if you aimed at an object on a level with yourself”

J Howse