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Paradigm Shift in Health Care: From Quality Assurance to Continuous QualityImprovement

机译：医疗保健的范式转变：从质量保证到持续质量改进

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The concept of quality in health care is discussed throughout this paper, withinan historical perspective, including key forces influencing quality assurance (QA). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been identified by Schroeder (1991a) as probably the most significant influence on QA structures and approaches in the United States. The revised nursing care standards delineated by JCAHO in the 1991 Accreditation Manual for Hospitals (AMH) will be discussed in this paper. A Systematic Internal Review (SIR) program to be utilized as a self assessment of compliance with the new standards is introduced. In addition, the monitoring and evaluation (M and E) process used to measure the quality of care as set forth by JCAHO is described. The concept of quality and the shift from a traditional QA philosophy to a continuous quality improvement (CQI) philosophy is explored with implications for health care and nursing presented. The importance of nursing staff as well as an organizationwide commitment to and involvement with CQI activities is emphasized.

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