QM Audits in Nursing: Guaranteeing High Quality

The step into a nursing home is difficult for many people because they have to leave their familiar surroundings and adapt to new living conditions. For their retirement, they therefore want a facility whose care standards meet high standards. Quality management audits are an effective means of ensuring first-class standards.

Care standards are an indispensable element of quality assurance, especially in professional care work. This is not a new insight: as early as 1984, the World Health Organisation (WHO) defined standards for the quality of care. Today, current results of nursing science research are incorporated into the definition of nursing standards. These standards define goal-oriented and verifiable rules on how appropriate care should be provided. The regulations offer a certain room for manoeuvre. In addition, these standards represent the criterion by which the quality of care can be checked. As a rule, care standards contain concrete specifications that can be clearly measured. This offers the opportunity to make concrete changes in the practical care process according to these specifications. Care standards must be checked at regular intervals. Audits within the framework of quality management serve this purpose.

Legislator has created framework conditions

For a long time, there were no legal regulations for quality standards in care. As a consequence, the quality of care varied greatly between facilities. This also applied to the services of outpatient care services. Finally, the legislator realised that binding specifications were necessary in care. Therefore, uniform quality standards were developed for the sector and care institutions were obliged to set up a quality management system. With the Nursing Care Quality Assurance Act (Pflege-Qualitätssicherungsgesetz, PQsG), the German legislator amended and supplemented the Eleventh Book of the Social Code (SGB XI, Soziale Pflegeversicherung) with effect from 1 January 2002. Here, regulations on quality assurance and rules for the protection of persons in need of care were added, especially in the Eleventh Chapter of SGB XI. These regulations can be found in paragraphs 112 to 120. The objective was to ensure and further develop a high quality of care. In addition, the rights of persons in need of care as consumers were to be strengthened. For the first time, all outpatient, semi-inpatient and inpatient care facilities were obliged to introduce quality management in the institution. Accordingly, proof of quality and performance must be provided at least every two years.

Quality awareness has evolved

However, quality awareness within the sector has also developed since then. That is why many care facilities nowadays have themselves certified according to DIN EN ISO 9001. In this way, the company ensures that it complies with the legal regulations and guarantees the well-being of the persons to be cared for. Quality management is also an important tool for constantly raising the level of care and thus providing ever better care for those in need of care.

Principles of quality management in care facilities

The following principles of quality management should apply to every care facility, whether it wants to be certified according to ISO 9001 or not:

• Customer orientation: The persons to be cared for are at the centre of all activities. Quality management has also to focus on their well-being.
• Employee involvement: The employees of the care institution should be informed about the essential occurrences and measures. Communication plays a crucial role here. Opportunities for further training should also always be offered.
• Management: Clear and unambiguous guidance and control of the care facility is required. Management is responsible for the establishment and application of quality management.
• System orientation: The management of the care facility should identify and use interrelationships in the institution.
• Process-oriented management approach: When introducing a quality management system, it is essential that many competent employees are involved. Therefore, it makes sense to set up a process team for implementation.
• Systematise decision-making: The basic rule here is that decisions must be made on the basis of data and facts. Factuality should be the top priority.
• Maintaining business relations: In order to be able to guarantee a high-quality standard in the long term, it is necessary to maintain good contacts with doctors, physiotherapists and psychotherapists as well as pharmacies.
• Improvement as a permanent goal: The striving for ever better quality must not only take place at a certain point in time, but must be a permanent goal; therefore, the services in the care facility should be permanently evaluated and improved.

If a care facility observes and documents these principles of quality management, the most important foundation stone is laid to continuously improve the services in the interest of the residents.

ISO 9001 certification process

If a care facility wants to be certified according to ISO 9001, then five areas of the facility in particular must be checked for quality:

• Economic success: Several criteria should be included in the assessment, such as turnover, profit, capacity utilisation, cost structure.
• Satisfaction of those in need of care: This can be determined, for example, by means of surveys of residents and their families at regular intervals.
• Staff satisfaction: In addition to surveys, personal conversations with staff about the perceived situation at the workplace (working conditions, atmosphere) can be used here.
• Complaint management: What possibilities exist for relatives and residents to articulate dissatisfaction, is there a central contact point and prepared complaint forms?
• Results of external audits: What are the assessments of the home supervisory authority, the health authority or the medical service of the health insurance funds (MDK= Medizinischer Dienst der Krankenkassen)?

In particular, the way an institution deals with internal and external assessments is an important indicator of the importance attached to quality management in the institution. Is QM taken seriously and how intensively does the institution strive to constantly improve? The results of the audits allow conclusions to be drawn about these issues.