Total quality management as a framework towards a proposed quality assurance program in the nursing service - JRRMMC / Marietess M. Nicolas

Thesis (M.A.) -- Pamantasan ng Lungsod ng Maynila, Intramuros, Manila, 2004.;A thesis presented to the faculty of Graduate School of Arts, Sciences, Education, and Nursing, Pamantasan ng Lungsod ng Maynila in partial fulfillment of the requirements for the degree Master of Arts in Nursing.

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ABSTRACT. This study focuses on TQM in the initiation of a proposed quality assurance program in the Nursing Service of Jose R. Reyes Memorial Medical Center. JRRMMC is a 450 bed capacity tertiary training hospital and serve as one of the end referral hospital in the Philippines. This is a descriptive analytical cross sectional study aimed to determine external and internal customer satisfaction towards provisions of quality nursing care. To attain the objectives, the quality nursing care rendered was assessed and analyzed using the Berwicks principles of process management. Inputs includes perceived level of satisfaction to (6) quality indicators; quality nursing care that increase and decrease satisfaction; nursing process; charting of nursing care; existing documents related to quality improvement; and nurse patient ratios. The research design comprehensively analyzes the actual provisions of nursing care in a triangulation. Findings were as follows: 1.) Majority of external and internal customers were somewhat satisfied to (6) items of quality nursing care. Despite limitations in the provision of nursing care the nursing attendants and nursing staff were most satisfied among respondents. Patients and relatives were similarly most satisfied to nursing personnel and nursing process. However, it showed that patients tend to fell equally somewhat satisfied and somewhat dissatisfied to outcome of nursing care. Varying satisfaction among respondents depends on gap between expectation and actual perception of nursing care. This is influence by demographic profile, knowledge and skills in nursing process, understanding patients needs, limitations on structure, process and outcome of care, implementation of nursing caring standards and nurse patient ratios. 2.) Majority of external and internal customers' perception were satisfactory in all aspects of nursing care. Variations of quality nursing care increases and decreases satisfaction. Fair and poor perception suggest needs for improvement. 3.) Null hypothesis is rejected. There was a significant difference between perceived level of external and internal customers satisfaction to quality nursing care. Significant difference was noted on perceived external and internal satisfaction on clinical ward and nursing personnel. Nursing Service Staff were most satisfied on clinical ward set-up wherein patients, relatives, and nursing service staff on nursing personnel. All group of customers fairly rated nurse patient ratios. Variations of satisfaction among external and internal customers were noted on at least one mean score on clinical ward set-up, equipment and materials, medicines and treatments and nursing personnel. Nursing service staff were most satisfied on above mentioned quality parameter. Further, there was significant difference of internal customers satisfaction on conceptual, technical, facilitative functions and outcome of nursing care. The nursing service staff were more satisfied than the medical staff. Findings suggest variations of perception on actual provisions of care. Review of nursing documents reveals absence of functional QAP and Research Committee to set frameworks of validating trends in nursing practice. Direct observation of nursing process was found below standards. Nurse patient ratios and other factors hindered application of nursing process. This resulted to poor documentation of prioritized nursing care and evaluation outcome. Thus variations of satisfaction are related to inappropriate provisions of nursing caring standards that increase customer satisfaction. Hence, a problem focused quality assurance program is strongly recommended to address findings of the study.

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