Small and medium sized food processing businesses all over the world In the case of exporters, these standards are becoming more and more strict. The following examples highlight the shortcomings of a simple quality control approach. Quality assurance (QA) is a way of preventing mistakes and defects in manufactured products For instance, the term "assurance" is often used as follows: Implementation of inspection and structured testing as a measure of quality assurance This can be contrasted with quality control, which is focused on process output. Rigorous internal audit processes; Certification / notified body audits; Regulatory Each site follows strict Quality Control and product release protocols, which.
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That is why you need to assure quality in the very beginning. You need someone to introduce you to the best way how to manage your project. Someone who knows how the things work and someone who will present you how to develop in the best way.
Quality assurance makes software development run more smoothly, minimise the chances of defective products going to market, and in general keep massive system failure from occurring. That is why Quality assurance is necessary. Everyone in the company can benefit from Quality assurance implementation — engineers, testers, software architects, and managers.
It will positively affect their productivity. If understanding what needs to be done is at a high-level, then each task will be delegated to the individual who is best qualified to do it. Everyone will know more precisely what they need to do and how their efforts fit into the whole project. Quality Control involves product-oriented activities; it focuses on the identification of defects in products.
The goal of Quality Control is to identify any defects after a product development but before its release to production. If the company wants to implement an effective Quality Control program, it must first decide which specific standards the product or service must meet.
Then comes determining the extent of Quality Control actions. Next comes collecting of real-world data and reporting it to management personnel. After this, developers should take corrective measures.
If too many unit failures or instances of poor service occurs, a plan must be devised to improve the production or service process and then that plan must be put into action. Finally, the Quality Control process must be ongoing to ensure that remedial efforts, if required, have produced satisfactory results and to detect recurrences or new instances of trouble immediately. In many places, we can find Quality Assurance and Quality Control reduced to the same. Although they are similar, they are different!
It takes steps to control and prevent problems. Quality Control is a failure detection system that uses a testing technique to identify errors or flaws in products and tests the end products at specified intervals, to ensure that the products or services meet the defined requirements.
Process-oriented activities are something that Quality Assurance involves, while Quality Control involves product-oriented activities. When applied together, Quality Assurance and Quality Control can help develop a quality product from start to end. On the Quality assurance side, developing and adhering to processes can contribute to preventing defects. On the Quality Control side, product testing can help identify defects.
Quality assurance activities ensure that the process is defined and appropriate. Methodology and standards development, process documentation, developing checklists and conducting internal audits are examples of Quality Assurance activities.
In contrast, Quality Control activities focus on finding defects in specific deliverables. Performing testing and performing inspections are examples of a Quality Control activity.
In combination, Quality Assurance and Quality Control are the perfect matches — they point out defects in current processes and the product itself, which gives valuable feedback. By having good and consistent Quality Assurance and Quality Control, every project will be successful. When starting a project, you must be sure that it will be completed on time that the costs will be in the budget and ensure that all the team members are focused on the delivery of the completed project.
But, there is one more piece of the puzzle that makes every project successful, and it is quality. So, there is a real need to ensure that quality is central to any project. With creating a good project quality plan, all the tasks, and activities that need to be undertaken to ensure the quality that client is asking will be identified.
The quality plan needs to clearly identify who is responsible for what in the team and give details of all the procedures and systems that will ensure a quality project. Although structure and process measures are still considered valuable, greater importance has been placed on ensuring that a regulated entity achieves a desired goal, instead of merely complying with basic capacity standards and procedural steps that presumably lead to the achievement of that goal.
This shift can be seen in the Clinton administration's initiation of a far-ranging series of regulatory reforms and in Congress' passage of the Government Performance and Results Act of , which requires federal agencies to develop clear statements of what their regulations are intended to accomplish GAO, d.
The shift to outcomes measurement has recently picked up momentum in the field of home and community-based care. The Health Care Financing Administration HCFA is sponsoring work on the development of an outcomes-based quality improvement approach, which has the capability to examine specific patient-level outcomes, for use by Medicare home health agencies and the Medicare system Peter Shaughnessy, University of Colorado, personal communication, September 22, Many residential care facilities are also reviewing their practices to place a greater focus on achieving better resident outcomes MAHA, Although the division is somewhat arbitrary and the lines are sometimes blurred, quality assurance and improvement strategies and programs can be classified in two ways: Both types of programs are needed; neither is sufficient on its own to ensure that the highest quality of care is provided IOM, Thus, in understanding how issues of measuring and assuring high-quality care in home and community-based environments might best be addressed, all parties from patients and residents to providers and clinicians, researchers, payers, and policymakers will need to take both external and internal quality assurance strategies into account.
External quality assurance programs are, in general, those implemented by outside agencies and entities such as the federal government or private accreditation organizations. They attempt to define and maintain at least minimum standards for quality; often, they can serve as a catalyst for provider organizations to establish or enhance their own quality improvement efforts.
These approaches classically involve regulation—various kinds of licensure, certification, and accreditation; inspection and audit functions—and a focus on poor performance.
In this context, external programs might be directed at home care agencies, at individually employed home care providers, or at occupations. In the public sector, they might be carried out on the federal, state, or local level, but the private, voluntary role is not insignificant.
Other external strategies may involve structuring or financing care in ways believed to promote quality of care; such steps might involve the use of case management or managed care procedures of many sorts.
Finally, an array of consumer advocacy or complaint resolution programs exists to offer some protection against poor care, fraud, and abuse. Generally, home care and residential care are regulated separately. Some overlap occurs, however, because certain of the same types of services can be furnished in either setting. For example, home health care services are often provided in residential care settings.
Both federal and state governments have enacted a number of laws and regulations regarding home care services. Some of the most far-reaching involve the conditions that agencies and providers must meet to become certified to participate in Medicare and Medicaid.
Many states have also imposed their own licensure requirements on agencies and providers. As part of their licensing and certification duties, states conduct inspections and surveys.
They can impose civil fines, order the suspension of payments, or decertify providers giving substandard care. The regulation of home care services varies tremendously from state to state. One indication of this can be seen in state licensure laws; in , 39 states required compliance with their own licensure requirements in addition to federal requirements for Medicare-certified home health agencies, 35 states applied such licensure requirements to non-Medicare-certified agencies, and 20 required individual providers of home care home care aides, homemakers, personal care assistants to obtain a license from the state NAHC, For example, Massachusetts and Ohio do not license home care agencies at all, whereas California licenses only those agencies that are certified to provide services to Medicare beneficiaries.
Regulation also varies within states; for example, home health agencies in Minnesota are classified into one of five separate categories, each with its own set of standards. Unlike home care, which receives a fair degree of federal oversight as a result of Medicare and Medicaid's role as a major purchaser of care, the regulation of residential care is primarily a state responsibility.
Even within a single state, multiple classes of facilities can exist, each with its own target population and its own set of rates and regulations concerning staffing, admissions, and standards of care Hawes et al. A recent survey of assisted living entities again, defined differently by each state by the National Academy of State Health Policy revealed that 22 states had passed or issued regulations or otherwise implemented assisted living regulatory programs through Medicaid home and community-based waiver programs Mollica et al.
An additional six states have issued draft regulations or have legislation pending that would establish such a regulatory program. Throughout the country, many local officials such as county fire marshals, health inspectors, and building inspectors also exert considerable influence on and regulation of residential care facilities. The abovementioned survey also revealed that states have typically chosen one of three approaches in their regulation of residential care: Institutional approaches focus on the facility's physical structure and generally maintain strict admission and retention standards to exclude individuals who could qualify for care in a nursing facility.
Housing and services approaches are designed for two purposes: Services approaches require that the provider of services be licensed and certified, rather than the setting in which those services are provided.
Two private national accreditation organizations have been granted deeming status for home health agencies by HCFA: Agencies that receive accreditation through these organizations are deemed to have met, and in some places, to have exceeded the federal conditions for participation in the Medicare program. No similar accrediting organizations currently exist for residential care settings.
Agencies and providers seek such accreditation for several reasons. Second, in some states, deemed status allows providers to bypass the state survey process, which they may regard as more intrusive, onerous, or unenlightening than the professional accreditation effort. Finally, many payers, such as managed care organizations, are now requiring private accreditation as a condition of participation in their own programs.
As these market forces gain more power, agencies across the quality spectrum are increasingly seeking accreditation in an effort to remain competitive. According to JCAHO, the profile of agencies that it now accredits which exceeds 4, organizations is changing. Whereas a group in the past often achieved accreditation with commendations, agencies seeking and receiving accreditation now are increasingly accredited with some known deficiencies about two-thirds of home care organizations in ; Dennis O'Leary, President, JCAHO, personal communication, October 17, Various mechanisms are available for advocacy and complaint resolution in both home and residential care settings.
In a few states ombudsmen also investigate home care complaints, but the implementation of such programs has been extremely limited to date IOM, Protection and advocacy agencies are more broadly charged with advocating for the rights of individuals with disabilities. In addition, many states operate consumer complaint hotlines, hold public hearings, and utilize appeals processes to detect and resolve consumer complaints.
Under home and community-based waivers and state-funded programs, most states have developed well-articulated case management programs separate from the internal case management programs sometimes offered by home care providers Justice, Such case managers usually social workers, nurses, or teams of both typically act as the consumer's advocate by assessing the client's need for service, developing a service plan, and monitoring the cost and quality of care given by providers, as well as client outcomes.
Thus, case managers have the potential to assess and influence quality. Some programs consciously expect their case managers to perform this function Kane and Degenholtz, A few states have developed computerized information systems used by their case managers to inform a quality assessment and improvement effort Kinney et al.
Yet other efforts may be directed more specifically at certain types of caregivers. For example, the Omnibus Budget Reconciliation Act OBRA 87 requires states to maintain a registry of nursing aides who have been found to have been abusive to patients. Internal quality assurance and improvement programs are developed and used by provider organizations of their own accord as a way to improve the systems and processes that help them realize the goal of providing excellent care that continues to improve over time JCAHO, Hospitals, hospital systems, and various types of managed care organizations tend to be in the forefront of implementing quality improvement programs.
Little if any progress has been made in adapting these approaches fully to providers such as home care agencies or to settings such as homes or residential care settings, although some providers primarily Medicare-certified or privately accredited home care agencies have developed and begun implementing elements that are critical to successful quality improvement efforts.
Many agencies and residential care settings develop internal guidelines or standard operating procedures to guide the way in which services are to be provided by their organizations. These steps increase the consistency of services and provide a benchmark against which to gauge the quality of service provision.
Although the actual procedures followed may vary according to the needs and desires of the individual consumer, many organizations with good internal quality improvement programs develop individualized care plans for consumers that are based on input from the consumers, their families, and the various professionals and paraprofessionals involved with the consumers' care.
Care plans are then monitored, through ongoing involvement as well as retrospective record reviews, to ensure that the plan remains suitable for the consumer's needs. Having a highly trained and motivated staff is one way for an organization to ensure that it has the basic capacity to provide quality services.
Therefore, many organizations expend a sizable effort on such issues as staff recruitment, training, placement, and supervision. Nevertheless, in certain settings e.
For settings and providers in which organized quality assurance programs or staff development efforts are less well established, this situation doubtless is also an appreciable issue. Training in quality assurance and improvement is an important element of long-term staff development. Internally provided case management or utilization management typically plays a very different role from externally provided case management. In this situation, case management is used to coordinate and control the services given to a consumer.
Although greater coordination is generally seen as beneficial, concerns arise when the dominant function of a case manager is to limit costs or find alternatives to costly services, rather than to fill the breadth of services that the consumer needs.
The degree to which services are limited by a case manager may have a negative impact on the consumer's overall well-being. Conversely, internal case managers may want to maximize service use if they are being paid on a fee-for-service basis and might arrange unnecessary services. Put another way, in terms of assuring and improving quality, the questions could be posed as follows: This committee could not and did not seek to answer those questions definitively.
Rather, it has identified several problem areas in regard to the overall appropriateness, effectiveness, and adequacy of existing quality assurance and improvement strategies as they might be directed at services rendered in home and community-based settings.
In identifying these issues, the committee noted, with concern, how little information is presently available that would permit a quantitative examination of these topics. In the broad area of home and community-based care, this is often a more difficult issue to come to terms with than it might be in the general area of inpatient and outpatient medical care rendered in traditional settings.
For one thing, in this broader arena, the services stretch beyond well-known medical, nursing, or rehabilitation care to a variety of other personal assistance and social services that have not traditionally been the focus of organized quality assurance programs.
Thus, what exactly constitutes a set of appropriate quality assurance or improvement procedures for this growing area of care cannot be answered definitively by this committee. Moreover, as is true in health care as a whole, consumers, caregivers, providers, and purchasers all have differing views of what constitutes quality. One consumer may consider a service to be of high quality; another may regard it as poor. Differences between consumers or residents on the one hand and providers or purchasers on the other may be even greater, because of differences in preferences, in the kind of information brought to bear on the question, or in the criteria used to evaluate quality.
Some programs have begun to develop frameworks and practical tools to help reconcile these differences, but much work remains to be done in this arena New England SERVE, Apart from how judgments about quality may differ depending on who is doing the evaluation, there is the issue of differences between intended and achieved effects.
Some strategies to ensure quality may have the opposite effect in practice. For example, Florida requires that any resident of an adult congregate living facility who remains bedfast for longer than 14 days has to move to a facility that can provide a higher—and presumably more appropriate—level of care.
An approach that allowed more flexibility so that consumers could remain in the least restrictive setting could, in fact, prevent some individuals from receiving care in an institution.
Some strategies to protect the health and safety of residents may, even with all good intent, go too far and deny some individuals certain rights established under the Americans with Disabilities Act and other laws.
Thus, what on paper may appear appropriate as a quality assurance mechanism may, in the event of its implementation or enforcement, have entirely unintended consequences. How actually to implement quality assurance and improvement strategies can be a complicated proposition, particularly given the remarkable diversity of the population receiving home and community-based care.
Substantive evaluation never relies on only one type of measure or approach. A variety of flexible strategies needs to be developed to deal with a variety of situations; one predetermined strategy may well not be appropriate for all circumstances. For instance, an approach that relies heavily on consumer input and feedback to monitor the quality of care may not be suitable when consumers are cognitively impaired, even if surrogates or proxies for those individuals are available. Finally, assessing and improving care involve costs.
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