Integrated Medical Education Resources: 140311P - QUALITY: AN ISLAMIC PERSPECTIVE

Presented at the 7^th International Nursing Symposium under the theme ‘Advancing Nursing Care Road Map to Excellence’ organized by the KFMC Nursing Division March 11, 2014 by Dr Omar Hasan Kasule, Sr. MB ChB, MPH, DrPH (Harvard); formerly QA Consultant Physician, SCIP Hospital, Pittsburgh, PA USA currently Professor, Faculty of Medicine, King Fahad Medical City, Riyadh

1.0 EVOLUTION OF QUALITY CONCEPTS

· Quality: intangible thing, culture, philosophy of life and not fixed procedures parameters, or indices

· Quality Control (QC)

· Quality Assurance (QA)

· Quality Improvement (QI)

· Beyond QI: a quality professional with internalized quality values

· For Muslim nurses quality is a religious obligation.

2.0 QUALITY CONTROL (QC)

· QC aims at eliminating defects and was first used in factories.

· QC does not fit the total paradigm of the practice of medicine whose aim is improving quality of life and not mere elimination of pathology or preventing death[1]

· QC fits only the paradigm of disease prevention and health protection but does not fit the paradigm of health promotion

· QC is not relevant in nursing.

3.0 QUALITY ASSURANCE (QA)

· QA ensures that a certain level of quality once achieved must be maintained.

· QA, being static maintenance of the status quo, has no future in the era of rapidly advancing medical knowledge and technology; what is today’s quality care will be inadequate care tomorrow.

· QA violates the paradigm that rejects the same level of performance on consecutive days. He who has the same level of performance on 2 consecutive days is a loser[2]

4.0 QUALITY IMPROVEMENT (QI)

· QI requires continuous change to achieve even higher levels of perfection.

· Continuous QI is a philosophy that is committed to continuous and consistent improvement in quality.

· QI involves training for quality, making the necessary changes in the organizational structure, nurturing a long-term perspective.

· The aim is not to perform at a pre-set standard but to constantly improve and get better.

5.0 QUALITY IN NURSING

· Quality in nursing is a universal human concern because life is involved

· There is a link between nursing and quality[3] reflecting the centrality of the nursing role

· Quality in medical care is continuous and does not come about by accident. The whole culture, leadership, and organizational design must be structured to ensure high quality all the time and in all circumstances.

· Quality can be measured using specific instruments[4]

· PUBMED cursory search shows that most nursing quality assurance[5]^,[6] and quality improvement[7]^,[8] research is in nursing homes ?quality is more prominent where technology is minimal

6.0 4 PRINCIPLES OF QUALITY

· Ihsaan (quest for excellence),

· Itqaan (quality performance),

· Muhasabat (evaluation),

· And muraqabat (control).

7.0 QUEST FOR EXCELLENCE, Ihsaan

· Ihsan is the highest of the 3 fundamentals of the Islamic creed.

· In its purest form ihsan it involves perfection of worship in the full realization that the Creator is ever watchful[9]. All human actions with sincere intentions are worship

· Lower levels of ihsaan involve attempts to do good and achieve excellence in all human endeavors.

· QI is consistent with the concept of ihsan which is restless efforts towards perfection. Improvement must be continuous.

· Humans can never reach perfection and rest on their laurels. They must always strive to approach it; the nearer the better.

8.0 QUALITY PERFORMANCE, Itqaan

· Creation is quality and perfection[10]

· The Prophet in his words and practice[11]^,[12] taught quality performance.

· Quality performance can only be achieved if there is consistency in the work[13] and tasks started are completed[14]

· Quality is achieved if action conforms to words[15]

9.0 EVALUATION, Muhasabat

· Muhasabat is the very basis for QI. By continuous self-criticism and self-evaluation[16]the care-giver can identify what is done well and continue or improve and identify what is not done well so that corrective steps can be taken.

· The practising nurse must be aware that he/she is personally accountable for all what he does, big or small[17]^,[18] this sense of personal responsibility and accountability produces quality work.

· Muhasabat may sometimes come too late after the damage has been done[19]. A control, muraqabat, system is therefore the better approach.

10.0 CONTROL, Muraaqabat

· Muraqabat is the process of being on the watch-out for any deviations. A human is prone to err[20] and continuous vigilance is needed to be able to catch those errors quite early.

· The nurse should be the first to watch performance. Nurses should be aware that all performance or non-performance is observed by the Creator[21]^,[22] so they should try their best to keep their conscience at ease.

· The nurse should accept control by others not an invasion but as a welcome assistance in case there are deviations from good care that can be detected early and can be improved.

11.0 SYSTEMATIC QUALITY IMPROVEMENT PROGRAMS

· It is a moral and professional requirement that institutions that deliver medical care should set up quality assurance and quality improvement programs.

· The most sincere and committed people can make mistakes. Perpetrators of a mistake may not even be aware of what they are doing.

· Quality improvement programs will succeed only when nurses develop the value of being ready to admit mistakes and change course[23].

· A quality improvement program must develop objective criteria and measurement instruments. All judgments and improvement plans must be based on evidential facts.

· Decisions are made according to what is seen externally; the internal intentions are not fathomable to ordinary human beings[24].

12.0 RESEARCH: FACTORS OF NURSING QUALITY

· The organizational culture[25]

· Nursing leadership[26]^,[27]

· Staffing levels affect quality[28]^,[29]

· Top management leadership style[30]

· NEED RESEARCH AT KFMC IN A DIFFERENT CULTURE

NOTES

[1] Kasule, Omar Hasan: Islamic Perspectives of Medical Education. Paper presented at the Annual General Meeting of the Islamic Medical Association, Khota Bharu Malaysia July 1996

[2] "Man istawa yawumaahu fahuwa maghboon" Sunan Al Daylami Hadith No. 1033. Marfu. Weak sanad.

[3] Naylor MD1, Volpe EM, Lustig A, Kelley HJ, Melichar L, Pauly MV. Linkages between nursing and the quality of patient care: a 2-year comparison. Med Care. 2013 Apr;51(4 Suppl 2):S6-14.

[4] Lindgren M1, Andersson IS. The Karen instruments for measuring quality of nursing care: construct validity and internal consistency. Int J Qual Health Care. 2011 Jun;23(3):292-301.