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Different perspectives of quality

Developing Workshop Handouts for Health and Social Care services on:

The handout for the Workshop on Managing Quality in Health and Social Care organisations will need to include two sections. You will have to develop these handouts with an audience in mind and therefore these will have to be equally very informative and well referenced as well as easy to understand and well structured.

a.Different perspectives of quality

You are required in this subsection to explain perspectives that stakeholders have regarding quality, assess the impact of poor service quality on stakeholders and then analyse the role of external agencies in setting standards at The Royal United Hospitals (or in relation to your own practice in a health and social care setting).

b.Strategies for achieving quality

In this subsection of your workshop handouts, you will need to analyse potential barriers to delivery of quality service, evaluate different approaches to implementing quality systems and finally explain the standards that exist for measuring quality at The Royal United Hospital (or in relation to your own practice in a health and social care setting).

Please use examples from your own experience and also you can use prior knowledge you gained from other units, this can be obtained from specific assessment criteria, for example

Influence in Health and Social Care Organisations, Health and Safety,Communication in Health and Social Care Contexts and Principles of Health and Social Care Practice.

Discussion workshop and Individual Written Summary of the Discussion:

a.Discussion with another colleague methodologies for evaluating the quality of services

Please discuss with your colleague about how the quality if managed in their organisation (the preferable route), or in relation to the given Case Study. After the discussion, you will need to write a short summary of the discussion where you will evaluate methods for evaluating quality with regards to external and internal perspectives and discuss the impact that involving users of services in the evaluation process has on service quality (in relation to your colleagues practice in a health and social care setting or in relation to the case study).

b.Evaluation of systems, policies and procedures related to quality

Following on from the discussion and your short summary of it, please develop a report for your colleagues where you will reflect on what was discussed and provide feedback and recommendations. Firstly, analyse other factors that influence the achievement of quality, secondly evaluate the effectiveness of systems, policies and procedures used in achieving quality in the service(s) offered and lastly suggest ways in which quality could improve (in relation to your colleagues practice in a health and social care setting, but also based on your experience, or focused entirely on the case study).

Different perspectives of quality

Quality is an important and a key concern in the area of health and social care for the stakeholders that determine satisfaction level and leave a positive impact on its stakeholders. Therefore, quality should be the primary objective of healthcare organisations. There are various factors that determine the level of quality in the services of a particular organisation but in healthcare organisation, it mainly depends on people beliefs, thoughts, and preferences of the stakeholders that are part of the healthcare system. The meaning of quality in health and social care services includes all the dimensions of their service which they provide to their customers. There are some external and internal agencies that determine the quality of services in healthcare organisation such as CQC and NICE. By formulating policies and procedures these regulatory bodies monitor and guide different health and social care organisations. Therefore in current scenario special attention has been given to understand the effect of quality services on the customers and their beliefs about the service quality in health and social care. Later the challenges in managing the quality in these types of service organisation will also be discussed.

Within the health and social care organisation, all the people who are involved in any act are called stakeholder. In health and social care organisation, both patient and caregivers are stakeholders. There are different categories of stakeholders in social and healthcare organisations such as Health Services Commissioner, families of the patients, Facilitator, patient, caregivers, employers and Care Quality Commission (Blake, Sparrow, and Field, 2015). Caregivers facilitate the customer (Patient) by delivering services and the customer payback for the same services he/she avails, and normally they are the main users of the facilities, where others are regulatory bodies that determine the quality of services that user avail in the service organisation (Cowles, 2012). These bodies provide the users, safe and secure services that full fill their demand and meet their expectations of the service facilitators.

According to the patient opinion, the quality of the healthcare services depends on the responsiveness of the caregiver, the consistency in their services, and the bond which they form with them (Boltz, et. al., 2010). As per the employees’ perspective, the quality of the service depends on their positive approach towards their duty and work in a supreme and ideal manner (Hu, 2014). Those employees, who take this care work as a job rather than interest, tend to leave the job when they get a better job in terms of money (Janamian, Jackson, and Dunbar, 2014). To avail, the best quality services of nurses and employees the organisation should retain them through proper training because these people provide best service quality to the patients. For patients, it will be needed to provide best quality care services without compromising with their expectations.

Strategies for achieving quality

There are few external agencies that facilitate Social and health care services are as follows:

In 2008, by the ‘Health and Social Care Act 2008’ the CQC (Care Quality Commission) was established. It is a non-governmental and self-regulating public organisation in the UK (CQC, 2018). The CQC helps in to set and follow standards in health and social care that the different stakeholder can avail and also regulates and supervise the quality services in home care (McKee, Figueras, and Saltman, 2012). The CQC protect the rights of individuals who are suffering from poor service quality. CQC also take corrective action against those healthcare organisations who do not meet the set standards.  

NICE formulate guidelines for National Health Services (NHS) in the UK. NICE responsible for framing guidelines, setting standards and give advice on a regular basis to all healthcare organisations (Leng, 2012). These guidelines are focused on healthcare providers and practitioners, commissioners, service users of healthcare and their careers. The fundamental role of NICE is to provide recommendations on “what works” linked with both the excellence and effectiveness of health and social care services (NHS: Health Research Authority, 2018). To develop quality standards NICE plays an essential role and help all those healthcare organisations those are suffering from poor quality amenities.

MHRA is a Public and administrative regulatory body that investigates about the quality of medicines, devices, blood components, and equipment that are used in healthcare and ensure that all the devices and equipment used and work in proper manner. MHRA is an administrative agency that is also responsible for ensuring that organisations improve their service quality in safety and care services. It is also responsible for supply chain management for medicines, medical devices and blood components and ensuring that is it safe or not. It also supports research and development that’s beneficial in providing quality drug products and equipment to its users.

Healthcare Inspectorate is responsible for investigating and monitoring all the activities within a health care centre and ensures that they provide better facility to its patients. After performing this task it is also responsible for disclose its findings to the public and help the customer to make their best choices among all available healthcare centres.

The quality service in the healthcare organisation is an important factor. The poor quality of facilities can adversely affect the image of the service organisation. Because of the poor quality of services, the profitability and productivity of the organisation also be adversely affected. Royal United Hospital (RUH), Bath is a great example of it where the customer lost their trust in the services of the hospital and move to other healthcare centres. The satisfaction level also decreased because of poor services that can lead the organisation to shut-down. The external agencies like CQC and MHRA may have to take certain legal action against the poor services of the health care centre that destroys the brand image of such type of organisations.

Discussion with another colleague methodologies for evaluating the quality of services

Poor quality of services can leave a bad impact on the users. This can lead to negative word of mouth publicity among the users and their trust decreases in the organisation. It is psychologically proven that if patients feel tensed and stressed, then the recovery speed of health has been reduced and it slows down their capability to respond towards the care and treatment. If quality services will not be provided as per the patients’ expectations, it can put a negative effect on their health (Pejovi, et. al., 2016). Currently, RUH Bath facing problems related to quality and proper fund utilization. To improve the quality of services they must focus on maximizing the fund utilization thus the patient can get better and quality healthcare services. They must improve their quality services regarding patient treatment and care.

Quality standard determines that the user of the healthcare services gets quality services from the service facilitator. It is essential for both large as well as small healthcare organisations. Now in the days, the services in health care are getting more complex, thus the healthcare organisation has to adopt more integrated approaches (Glasby, 2017). Quality standards also support in improvement of services in healthcare and social care organisations. It helps the user of the healthcare services to understand the quality of service which they want to seek.

The NICE quality standard program was formulated in 2009 to improve the quality of services in the healthcare organisation. NICE quality standards were developed with the help of Health and Social Care Directorate that is helpful in government program ‘NHS and social care system’ which is focused on providing the quality services to the service seekers (Rawlins, 2015). NICE set high-priority areas for improvement in quality in a healthcare organisation. Each standard contains a set of measurements and standards that are derived from evidence-based guidance (Ozok, 2012). NICE help organisations to improve their quality by providing standard measures of best practices to identify the weak area for improvement.

The main objective of setting standards in Healthcare centre is to provide quality services to its users. CQC, Code of Practice and NMC standards all ensuring that guaranteed quality facilities must be provided to the users of the healthcare services (National Quality Board, 2011). When we talk about the quality services and its standards it means service provider must consider quality assurance and quality of equipment that is used in the treatment of the patient. QA measures are helpful in countering the inconsistencies within these types of services. The health segment basically depends on both technical and human intelligence factors to remove ineffectiveness in the services and provide guaranteed quality services and care to its users (NHS: Health research Authority, 2018).

Evaluation of systems, policies and procedures related to quality

To deliver quality and strategic services to the users it is required that health and social care organisation directly work with the health department in different health care programs to manage and short the customer’s queries and health-related issues. Standards that are set by these bodies help the users that they will get quality world-class facilities in reward for the money they spent for the betterment of their health and conditions.

Quality standards of healthcare service lead to an important role in changing the world. The quality level in home cares services can lead to the healthcare organisations at the pick level. RUH Bath implementing different models for quality control and provide a wide understanding of the quality elements to its users (Sahel, et. al., 2015). The quality services in home care organisations also helpful in structure equation method and investigation of it so that the best fit method can be adopted for providing better services to its customer. Other than this RUH Bath also implemented the Total Quality Management (TQM) to practice standard quality service practices (Kahveci, et. al., 2018).

There are few quality systems that are used in health and social care organisations such as TQM, Benchmarking, CQI and Quality Control. TQM predominantly, are generally favoured in analysing data. In the health and social care organisations, both CQI (Continuous Quality Improvement) and TQM used interchangeably in the continuous quality improvement of services (Mosadeghrad, 2013). TQM is especially useful in auditing, monitoring, and review of performance indices. Where CQI is helpful in developing clinical practices and its main objective is to facilitate and provide improvement opportunity to all social and healthcare organisations (Talib, and Esmam, 2013). However, numbers of health and social care organisations using QA programs since them usually an emphasis on problems associated with accreditation monitoring of organisations such as issues related to records, revising and removing false procedures.

RUH Bath can apply TQM for the continuous growth and improvement in healthcare related the services. Continuous quality improvement can be very crucial for the development of healthcare services (RUH, 2014-16).  Generally, the home care organisations favour the quality assurance because of its focus on the problems related to standardization in services, documentation of work and administration process (DuMouline, Haastregt, and Hamers, 2010). In RUH Bath, TQM can be considered as the best system because using this method the broad and close analysis can be done in the hospital. By adoption of the TQM, poor service quality can be standardized and improved in the home care services and also it leads to the customer satisfaction.

Health and social care organisations like RUH Bath can face two types of barriers, External barriers and internal barriers. Internal barriers are those barriers which arise due to lack of technological advancement, lack of standard equipment’s facilities, and lack of proper communication system. These barriers can cause dissatisfaction among the customers and service seekers. These concerns generally cause to a serious and aggressive patient behaviour and failure of the organisation in providing quality services to its users.

External barriers can be health insurance issues, lack of financial resources, and lack of support from family and society. These external problems can be more dangerous than internal barriers and may create more adverse conditions. For example, lack of financial resources can cause ineffective service facility by RUH Bath, because the employee of the hospital cannot give their best to the patients. By lack in the communication system, RUH Bath cannot care or handle the patients neither workers do their best in patient caring work. Apart from this, poor management causes inefficiency in unable to initiate new and innovative changes. Problems related to health insurance can also cause inefficiency in the confirmation of various health-related programs. Inefficient management and inappropriate financing planning can also cause lack of operational work and inefficiencies in the technological equipment’s and resources that should be available for the users and for their healthcare (Wargo, 2016). If proper management with the professional mind-set is not doing in these types of organisation it can be caused by poor results. For example, in pain and disease management it will be beneficial to control the situation by understanding the situation of the patient and their family for initial intervention management. In old age people, Palliative care cannot be completed without conferring the related health issues.

Quality improvement is an important factor that should gain immense primacy by RUH Bath. Quality can easily be identified in its non-appearance. There are many public perceptions in healthcare that determines the service quality in healthcare organisation such as waiting times, illness, waiting list size etc. Popularly there are three methods used for analysing and evaluating the quality of health in respect to external (CQC) and internal (RUH):

The Care Quality Commission is a self-governing organization that controls and regulates health and social care and makes sure that the service seeker will provide safe, secure, effective, compassionate, and the best quality care with improvement. The CQC helps to maintain the documented records of the external factors within the health and social care framework. CQC helps in to determine the fundamental level of quality and safety standard and it discloses and publish clear and comprehensive information and record what it finds with performance ratings, to help service seekers for selection in the best care services organisation. It will make superior use of collected information and expert inspection to evaluate services in healthcare organisations. It also listens to and takes appropriate action on people’s views and experiences of care, if service care organisations are failing to provide quality services.  

In internal settings of the health care centre the TQM investigate all the problems and issues related to service quality, the behaviour of buyers, and consumerism as well as their impact on the environment. At RUH Bath, management use TQM to analyse different internal and external forces that affect the organisation. TQM approaches a strict and standard practice for organisational development, waste reduction, value services and commercial optimization. TQM determines that health care centre will provide quality services to its client because if client satisfied with the service that offered, their expectations exceed and more their loyalty becomes. On the other hand, QA (Quality Assurance) also helps in documentation and administrative processes (RUH, 2014-15). QA along with TQM help the organisation to ensure the competitive advantage over the competitors and provide sustainable growth to the organisation.

Involving the patient in the service means understanding their expectations from health care. It is one of the most important aspects of healthcare service that can be taken into special consideration by the various healthcare organisations (Barber, et. al., 2011). If the hospital full-fill user's demands and meet their expectations, it can put a positive impact on the mind of its existing users and in its potential customer as well. In RUH Bath, the impact of the connected service seekers of the organisation in the evaluation process on the service standard and quality can be both positive and negative. RUH Bath can focus on the establishment of the assessment of quality system by more focusing on the collective and hard work of all the service facilitators such as nurses, physicians, and medical experts. Through this approach, the RUH Bath gives significance to the quality service assessment in the safe and secure environment. Quality of the service has a broader perspective when we talk about the users need and their expectations from the hospital. Sometimes the failure of involvement of patient may cause the injuries and also can adversely affect the recovery process of their health (Dyer, 2013). So, it can be difficult to analyse the quality of service of any healthcare organisation when such type of cases involved and they have to practice in quarantine from its stakeholders or other concerned parties. So, by focusing on collective work as a standard of quality measurement, RUH ensures that the quality of service will not be compromised with the practice of caregiving which leads to standard and best quality social care. Involvement of service user determines the success of the healthcare centres and provides emphasis to quality assessment within caregiving environment (RUH Bath, 2013). The demand for a good relationship between caregiver and service user relationship is a broader perspective in the context of healthcare service quality. But when users bring or suggest some unique and innovative viewpoint that can help in enhancing the quality of services in health care centres, can lead to the organisation towards modernisation and more creativity (Dyer, 2013).  In RUH Bath, there is a need for quality measures that help in quality decisions and supervision of activities that set the standard of performance.  RUH Bath can also enhance its facilities in the premises and purchase some modern equipment thus more patients can be served in less time.  These means of enhancement will not only benefit the users and staff but will also favourable for the whole health and service care trust leading to a win-win condition for both sides.

The policy framework is an important aspect of operational provisions and helps in determining what they should be like. The policy outlines help suitable provision in exploration and while avoiding abstruseness in the current research governance framework and the problems that this has contributed to (Thorogood, and Coombes, 2010). At the RUH Bath nurses and healthcare professionals provide care service to the service seekers. Patients who are suffering from heart attacks and cancer can also be treated and care by these healthcare professionals and nurses. These patients need necessary intensive care treatments, which is helpful in the treatment of the patient (Anderson, 2015).

The quality health and service centres are merged with those services oriented organisation that seek to offer quality services in healthcare services. The main objectives of these types of organisation to provide quality services to its users by putting various policies such as launching better programs related to healthcare awareness, incentives for health care providers and provide an opportunity for non-physician practitioners like nurses including the establishment of patient-oriented therapeutic homes. It also required the best technology and a good pay scheme which is based on the performance of the employees. That may also include non-monetary rewards like gifts on festivals and a trip for their family.

The federal legislation supports those organisations which are capable of providing quality services to its customer, and minimise the cost of care services by projecting best policy and procedure that supports to its customers.

There are several factors that affect the efficiency off RUH Bath, such as documentation of affirmative treatment records in the organisation. RUH Bath also pursues to provide the increased honesty to its stakeholders to attain the quality. In my opinion, the quality of healthcare services relies on clinical effectiveness, the positive result of treatment, the rate of survivals, symptoms, complications and patient health recovery (Humphries, 2015). The safety measures, safe and secure environments, and care of people is the crucial element of healthcare centres (GOV.UK, 2018). The supreme goal of any healthcare organisation should avoid financial barriers for the users and provide a world-class facility to the patient.  It is important in healthcare services to provide value for money, patient-focused care, dignity and respect, and avoidance of unnecessary involvements (Health and Social Care Act -Section 2, 2012). Healthcare organisation should also be responsible for measuring, inspecting and improving patients' happiness, experience and satisfaction.

By establishing strong quality systems which contain a strict set of rules and regulations RUH Bath can control these factors which affect its quality service. Without a strict code of conduct, an organisation cannot control the unnecessary events or activities in the organisation and it leading to bad image among the customer and society.

Overcrowding remains a real problem of RUH Bath that decreases the capability as well as the competence of the employees. Overcrowding creates problems related to beds because extra beds are occupied by a large number of service seekers in the hospital (Burns, et. al., 2011). The patients of RUH Bath also have to wait in the long queue for the service they want to avail. Another major issue in RUH Bath is the inadequate number of staff members and lack of equipment. As a result of these problems, the hospital has to face difficulty in admitting and provide quality services to new patients and management of home care was also unable to retain the quality standards. Another problem associated with RUH Bath is resource utilisation. Resource management should be properly done with proper resource utilisation that any hospital possesses. Failure in proper waste management may lead to the inefficiency in operations and can diminish the level of quality.

These problems should immediately be identified by the hospital and should take corrective action to remove from the organisation. RUH Bath can use palliative as well as comprehensive approach to remove these problems because it is the necessity of the organisation. To remove problem regarding understaff, the organisation can hire new talented employees and it can also update its technology system to make its working atmosphere more effective.  For this, the organisation has to expand its infrastructure and premises as well.  To combat with lack of modern technology and equipment RUH Bath should purchase the most updated equipment to facilitate the growing demands of users (Dyer, 2013).

Conclusion

At the end it can be concluded that, quality plays a crucial role in the health and service care organisations where different perspective of stakeholders which includes service seekers or patient, service provider, legal bodies, technicians, and employees can be considered as the pillar of the organisation who determines the success or failure of the healthcare organisation. The two main external agencies CQC and NICE play a vital role in the determination of service quality and its standards and monitor and suggest these organisations to improve its quality standards. The poor care of the patient can lead to the organisational failure and damage its image in the society. Therefore, measuring the quality of service is an important aspect of healthcare organisation and it is measured, monitored, and control lack of quality operation by some internal and external quality measures such as CQC (external) and TQM (internal) techniques in RUH, Bath. These quality measure techniques evaluate the effectiveness of systems, policies, and procedures which are used in service in RUH Bath and ensure that these policies and procedure helps the organisation to achieve the standard quality in the service. The effective use of resources such as workforce, financial resources and the equipment that is used by the RUH Bath determines the service quality level and organisational image in the society. The user involvement in the service also plays an essential role in the quality service as if he/she suggests or recommends some unique or innovative idea to improve the quality of service. RUH Bath lacks in proper documentation, lack of information management, lack of inappropriate infrastructure, and lack of modern equipment. This cause problems for the patients and creates a poor image in the mind of its service users. To remove these problems RUH bath can expand its premises and but modern equipment to provide quality health and social services to its customer. To improve service quality RUH Bath should also focus on the needs of caregiver and employees and trained them about how to handle customer complaints and concern. Health and social care organisations need to create new definitions in service delivery and should focus on customer satisfaction with advanced facilities and equipment that increase the user's confidence in the concept of caregiving.

References

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Barber, R., Beresford, P., Boote, J., Cooper, C. and Faulkner, A. (2011) Evaluating the impact of service user involvement on research: a prospective case study. International Journal of Consumer Studies, 35(6), pp. 609-615.

Blake, A., Sparrow, N., and Field, S. (2015) Care Quality Commission. InnovAiT: Education and inspiration for general practice.

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