Quality & Effectiveness

Effective Systems & ProcessesLeanne Matthes

College of Registered Nurses of Manitoba

Nelson KarpaChrispin Ntungo

City of WinnipegAssessment & Taxation Dept.

Leanne Matthes, Policy Consultant, College of Registered Nurses of ManitobaLeanne spent the past 16 years as a policy consultant in a variety of healthcare settings and was a lecturer in political studies at University of Manitoba. She has a Master of Arts in Political Studies, University of Manitoba, and her certification in Continuous Quality Improvement from the Canadian Healthcare Association.

Nelson Karpa, Director, City of Winnipeg – Assessment & Taxation Dept. Nelson has been with the City of Winnipeg for 20 years and previously held positions with the Province of Manitoba. He is a Sessional Instructor at the Asper School of Business. Nelson has a Bachelor of Commerce (Honours) degree and a Master of Business Administration degree from the University of Manitoba, and also holds a Post Graduate Certificate in Valuation.

Chrispin Ntungo, Ph.D. Supervisor, Strategic Support Services, City of Winnipeg – Assessment & Taxation Dept.Chrispin studied Agribusiness Management and Agricultural Economics at the University of Manitoba, and previously held positions with Manitoba Public Insurance. He is

involved with the American Society for Quality, is a Certified Quality ProcessAnalyst, and is a Sessional Instructor at the University of Manitoba.

Registered Nurse Regulation

Public Protection, System Support and Process Improvement Intersect

Presenter: Leanne Matthess, 

College of Registered Nurses of Manitoba

Who We Are

• Regulatory body for registered nurses in Manitoba

• Mandate is public protection• This is done through:  

– Regulation and registration of RNs– Support for professional practice– Approval of educational programs– Maximizing scope of practice for registered nurses– Professional conduct management

Privilege of Profession‐led Regulation

• Legislative requirements drive:– process change

– Innovation

• Regulated Health Professions Act

• Fair Registration Practices Act

• Agreement on Internal Trade

Processes Evolve to Meet Need• Internationally Educated Nurses

• Best practice in professional practice support

• Evidence informed professional conduct, complaints management

• Educational programs adapt to increasing knowledge, technology

• Demands of the system rise

• Public accountability

Registration of Internationally‐Educated RNs • Applicants who apply to several Canadian jurisdictions.  – Candidates abandon process 

– Candidates unable to come to Canada to write exam

• Requirements to open a file changed– Completed application form, application fee, language test results, proof of ID & proof of immigration status

Registration of Internationally‐Educated RNs (2)• Additional requirements will help to streamline our workload– Will allow us to concentrate limited staff resources on serious applicants who are able to enter Canada in order to write the exam or undertake assessment or bridging.

– Ethical  ‐ will help reduce the number of rescheduling fees for the national exam

Practice Audit

• Self‐employed RNs at registration renewal– Accrual of hours for renewal and holding selves out as RNs

• On renewal form would categorize as self‐employed, but would provide no other detail

• Audit– Were asked to complete a self‐assessment of practice for review by CRNM against the standards of practice and code of ethics

Practice Audit (2)

• Of the >100 audited, <5 were advised that their practice was not RN practice– Unable to accrue hours for renewal and must stop holding out as RNs in the position.

• Renewal form changed– If check “self‐employed” a new form with additional questions appears.  CRNM practice consultants then follow‐up.

Continuing Competence

• Continuing competence requirements help to protect the public by ensuring that RNs have a minimum number of practice hours to maintain their knowledge, skill and judgment, and are able to reflect upon their practice.  

• Continuing competence programs are not uniform either within or across professions.  There is no “gold standard” in the literature.

Continuing Competence (2)• RNs & RN(EP)s

– Practice hour requirement 

– Annual self‐assessment

– Annual completion of self‐development plan

• Additionally, RN(EP)s must undergo an annual peer review of three cases they managed as well as an annual quality of care evaluation.

• Compliance is determined through annual audits.

Continuing Competence (3)• Recommendations 

– Enhanced definition of “competence”• “The application of knowledge, skills, judgment and personal attributes required for the delivery of safe, competent and ethical RN care, within the context of public health, safety and welfare.”

– Appoint public representatives to the continuing competence audit committee to work alongside RN auditors during the audits.

– Addition of mandatory reflective practice component

Continuing Competence (4)• Recommendations (cont’d)

– Integration of testing of core jurisprudence knowledge

– Maintain minimum practice hours, but include currency requirements.

– Allow hours accrued to renew specialty practice certification to count as practice hours.

– Implement random practice visits/audits on a percentage of the membership based on practice setting in which majority of hours accrued.

We Have Only Just Begun...

• Change is constant

• Profession led regulation is valued by the public, governments and professionals

• Concept of a global village; nursing is an internationally mobile profession

A Quality System for Managing the Assessment Function and

Continual Improvement

Nelson KarpaChrispin Ntungo

Presentation AgendaPART 1• Introduction• Our focus on ISO 9001PART 2• Our quality management system specifics• How we use our quality management system

Legislative Framework• Provincial Legislation governs the assessment

function (Municipal Assessment Act).

• Market value is the fundamental basis of assessment in the Province (as of a set reference date).

....the amount that the property might reasonably be expected torealize if sold in the open market in the applicable reference year by a willing seller to a willing buyer.

Strategic Planning

• How do you set the direction for the organization?

• How do you ensure linkage from the bottom to the top?

• How do you ensure that you are focused on the “right” issues?

What kind of environment would you like to work in?

• Mutually supportive environment• Customer friendly environment• Customer understanding environment• Organizational transparence environment• Satisfied stakeholder environment• Professional staff environment• Respectable department environment

Strategic Positioning• Vision statement• Mission statement• Guiding principles and

values• Risk analysis• Business strategy• Balanced scorecard• Quality policy

Ensurelinkage

Risk Analysis

• A methodology for identifying sources of risk.

• Review the likelihood of occurrence and the level of impact.

• Context risks and resource risks.• A great way to “double check” your

strategy / projects.

Strategies

Five Strategies:• Stakeholder Relationships• Product Development• Assessment Roll Management• Human Capital Development• Organizational Excellence

PEQMS

Why the PEQMS?

• Strategic system to help achieve organizational excellence.

• A means for managing continual improvement.

Why register with ISO 9001?

• Public recognition of our commitment to continual improvement culture.

• Public recognition of our excellence in assessment.

ISO 9001 Reputation

Why do firms seek certification? • Will it make an improvement to their

product? – Yes. – Perhaps marginally.

• Is there a “marketing” effect?– Yes.

ISO 9001 Reputation

So what will it do for us? • Improve our product.• Improve the attitude about ourselves.• Improve the outside perspective of what

we do, and how we do it.– Public confidence

What is ISO?

• International Organization for Standardization.

– Sets standards of specifications and criteria for products and services.

– Ensures quality and customer satisfaction.

– Common ground that bridges suppliers and consumers.

Not just manufacturing

• Many “office” applications of ISO.• Can be harder to envision as the

“product” is defined easier.• Real life existence in both the private

and public sectors.

Benefits of ISO registration• Better control of business processes.• Better records management.• System of accountability, efficiency and

consistency. • Provides for checks and balances.• Ensures improvements continue to be made.

What others say about ISO 9001 registration? Cont’d.

• “Managers are enabled to bring control and consistency to the operation. – . . . . decreases costs by making processes

faster and cheaper."

Penny Silberhorn, Manager, Conformity Assessment Division, Acquisitions Branch.

In Canadian General Standards Board, Doing Business with PWGSC, Summer 2006

Applicability to the Assessment and Taxation Function

• We are a service organization. • Focus not just on the quality of

assessment but the overall bundle of services that we provide.

• Quality is in everything that we do, and quality is everyone’s responsibility.

Our Vision

– Registration with ISO 9001 is one piece of evidence of achieving our vision.

• Industry leader recognized for excellence in assessment and taxation services.

The ‘Birth’ of the Pursuit of Excellence Quality Management

System

Part II

Customer Focus

Product/Service

FairOpenUnderstandableDefensible

Staff/Process

EfficientEffectiveResponsive

Continual learningIntegrityRespect

The Missing Link and Rough Edges Model

Vision • Mission • Values

Products • Services

Gap

Well defined. Well documented.

Well defined,but not so well documented.

Solution to the Problem

Vision • Mission • Values

Products • Services

QUALITY STANDARDSand GUIDELINES

PROCESS DOCUMENTATION

Close Gap

Excellence Models (Frameworks)

Baldrige NQI ISO 9001

1. Leadership Leadership Customer Focus 

2. Strategic Planning Planning Leadership 

3. Customer Focus Customer Focus Involvement of People 

4.

Measurement, Analysis and Knowledge Management People Focus Process Approach 

5. Workforce FocusProcess

ManagementSystem Approach to 

Management 

6. Process ManagementSupplier/Partner

Focus Continual Improvement

7. ResultsFactual Approach to Decision 

Making 

8.Mutually Beneficial Supplier 

Relationships

Result

Vision • Mission • Values

Quality Standards/GuidelinesDocumented Processes

and ProceduresManaged Records

Product/Service Quality Audits

ISO 9001Standard requirements

1. Say what you do2. Do what you say

3. Show that you have done what you said you were going to do

• Quality Management System• Management Responsibility• Resource Management• Product Realization• Measurement, Analysis and Improvement

ISO 9001 Clauses

• Organization Chart (5.5.1)• Strategic Plan (5.4)• Quality Policy (5.3)• Quality Objectives (5.4.1)• Quality Manual (4.2.2)• Quality Plan (5.4.2)• Modeling Activity Plan (7.1)• Internal Audit Program Plan (8.2.2)

Documentation Requirements

• Control of Documents Procedure (4.2.3)• Control of Records Procedure (4.2.4)• Internal Audit Procedure (8.2.2)• Control of Nonconforming Product (8.3)• Corrective Action Procedure (8.5.2)• Preventive Action Procedure (8.5.3)

Documentation Requirements

1. Process Ownership2. Process Description3. Process Activities4. Process Quality Attributes5. Process Quality Standards6. Process Flowchart

Business Processes

1. Accessibility2. Accuracy3. Attentiveness/Helpfulness4. Availability5. Care6. Clarity7. Cleanliness/Tidiness8. Comfort9. Commitment10. Communication11. Competence12. Completeness13. Consistence14. Convenience

15. Courtesy 16. Ease of use17. Fitness for use18. Flexibility19. Friendliness20. Integrity21. Perceived value22. Quantity23. Reliability24. Responsiveness25. Security26. Time27. Timeliness28. Other

Process Quality Attributes

Products & Services

Quality Policy

Quality Objectives

Quality Audit Criteria

Management Reviews

Quality Performance

Targets Business

Processes

Quality Standards

Vision/Mission

Structure of the PEQMS

How we use the PEQMS• Library of business processes• Library of controlled documents and records• Employee training in quality principles• Employee orientation• Internal audits provide insight for continual

improvement • Preventive actions• Corrective actions

Opportunities for Continual Improvement

• Improving the product• Improving stakeholder relationships• Improving risk management• Improving customer service

Reputable Branding

Conclusion

• Control of business processes • Staff awareness and practice• Consistence in strategic and work planning• Performance measurement• Improved public perception

Contact Info:

Nelson KarpaE-Mail: nkarpa@winnipeg.caPhone: (204) 986-2953

Chrispin Ntungo E-mail: cntungo@winnipeg.caPhone: (204) 986-8309

This presentation&

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