Continuous quality improvement through team supervision supported by continuous self-monitoring of work and systematic patient feedback.

Abstract

Evaluation of clinical supervision (CS) and exploration of its effects on the quality of care is a timely topic for research. The current emphasis in nursing is shifting towards continuous quality improvement (CQI), and the integration of this with CS seems to be an interesting challenge. So far the studies have relied mainly on supervisees' self-report data and patients have rarely been involved in research. However, the perspective of CQI requires that patients are involved in the quality improving efforts. The aim of this study is to describe how CQI was implemented through team supervision and supported by continuous self-monitoring of work and systematic patient feedback. The team supervision intervention was organized on five wards between 1995 and 1998. The methods of statistical process control and control charts were applied in the study as part of the intervention. Improvements in both patient satisfaction and the staff's self-monitoring of work were evidenced. A slow and minor upward trend was detected in the control charts and the variation decreased in the assessments. The patients' high and the staff's critical ratings drew nearer towards the end of the study. However, significant differences were found between the wards and not all wards showed improvements. Staff found it difficult to discern the effects of continuous patient satisfaction feedback and self-monitoring. The findings of the study show that CQI integrated with team supervision improves patient satisfaction and the overall quality of care.