MANAGING QUALITY IN HEALTH AND SOCIAL CARE
Management of quality needs to be the main responsibility of health and social care in terms offering products and services to users. Quality management ensures safety and consideration of different aspects for dealing with patient-centric standards in the health care setting environment. For this purpose, the aim of the study is to explain the management of quality in the care setting and for this reason; the study signifies different perspectives of stakeholders in maintaining quality. Hence, the study will refer to given case scenario of Russell House Care Home for the improvement of effective quality in care home.
Task 1: LO1
1.1 Perspectives that stakeholders have in health and social care
Quality management seeks to improve patient satisfaction with the service by improving the effectiveness of treatment. According to the viewpoint of Blais(2015), quality in the health care refers to the fulfilment of patients requirements as they are ones who actually judge the appropriateness and effectiveness of treatment and service. In relation to this, it can be stated that quality management is all about the delivery of consistent quality in terms of reliable process. Hence, reliability refers to the existence of risk reduction procedure, performance goals and reward mechanisms. Organization needs to maintain some quality improvement policies and latest technologies to maintain the quality in the regular business practices.
For managing quality in the health care, different stakeholders have different perspectives and in this relation, it can be stated that, the stakeholders are those who are affected or involved by course of action with the various health care services (Cherryand Jacob, 2016). In the entire health care setting environment, different stakeholders are involved such as care users, medical professionals, Government, protective associations and societies, professional licensing authorities, trade unions, suppliers and the community as well in which the organization operates.
Different stakeholders in case of RHCH belong to different categories and to gain understanding of stakeholders, the following table can be provided
Table 1: Category wise stakeholder examples
It is worth mentioning that, different stakeholders have different perceptions regarding the service quality of the concerned organization. Hence, different perspectives of three different stakeholders can be marked below.
Service users are the ones who judge the quality of the service and the effectiveness of the treatments (Mossialoset al. 2015). Needs and requirements of patients are changing over the course of time and thus quality management calls for continuous improvement and monitoring to satisfy the service users.
Legal bodies such as care quality commission and national institute of clinical excellence set the benchmarks for care setting environment so that, it becomes possible for the service provides and other staffs to maintain the performance activity to meet the need and requirement of the service users.
Care providers are liable and responsible for maintaining quality in the aforementioned healthcare setting RHCH.
Hence, it can be stated that, the care providers provide quality service to patient when they feel motivated and for this reason, RHCH provides monetary and non-monetary reward to the care providers to maintain quality in the entire activities.
1.2 The role of external agencies in developing standards
Overview related to external agencies:
The External agencies include the governmnet, ministerail departments and the govermnment agencies all of which play a crucial part in stting of standrads. while the goibvernmenmt consist of the DH, the government agencies come under the ministerail department (DH). These standards are followed by varies hospitals, care homes and clinics thereby adopting various safety measures to enhance their level of quality and standard. The organisations that lie within carry out an effective training session to look after the care workers further thereby developing their quality of services further. This in turn enables them to stay updated and maintain balance.
The external agencies and authorities are responsible to analyse the needs and conditions of the patients in the changing environment. In relation to the concerned health and social care organization, different external agencies are associated with care setting who evaluate and develop the standard for quality in the care services such as offering the information, effectiveness of services and like (Glasby, 2017). In the given case scenario, different external agencies include NHS Foundation trusts, care quality commission and National institute for care excellence.
Role of 3 external agencies and their relation to RHCH:
The role of different agencies includes:
Care quality commission
Care quality commission is an independent organizational entity that regulates in the care setting environment in UK. The roles of CQC includes ensuring perfect services in order to meet the basic standards and requirements of services. Along with that, it also helps regulating, monitoring and protecting in the care setting so that, it follows standards continuously.
It has been evident thatRussell House Care Home (RHCH)has enacted these CQC roles effectively thereby seeking to improve the quality of services in the care home. By carrying out an effective CQC inspection, they have further been able to carry out a research using all the available sources to focus on the organisation’s quality further.
Nursing and midwifery council
The responsibility of this body are to monitor all the providers in the care setting environment so that, care providers become able to maintain quality (Cameronet al. 2014). Further, it is the responsibility of this body is to operate out fair observation and investigation over the care services. RHCH has adopted the ideas based on this council to focus on their work environment thereby ensuring that their patients are comfortable enough thereby investigating each employee’s performances.
National institute for clinical excellence
This external agency (NICE) provides legal advices to the National Health Services (NHS). Hence, the roles and responsibilities of this entity include generation of guidelines and delivery of advices to the health care setting. In addition to that, it provides wide range of information to the concerned health care setting. It is evident that RHCH has adopted several legal advices based on national health services to utilise them as guidelines for better delivery of service care to the patients. This further enhances the knowledge of the employees based on the setting of health care thereby enhancing their performance and productivity.
1.3 The impact of poor service quality on the stakeholders of health and social care
Poor service quality is all about dissatisfaction of service users regarding less influential services in the care unit. This poor service quality impacts different stakeholders in the organization in some of the different ways (Livingstonet al. 2014). Sometimes, the employees are untrained and therefore fail to deliver the suitable quality of services to them which result in poor quality of service.
It is worth mentioning that, the concerned organization is associated with some of the internal and external agencies. For example, service users, care providers, government and other external agencies.
3 stakeholders from RHCH:
The three main stakeholders of the company of RHCH include customers, staffs and the overall organisational heads. While customer are given the best quality of service so as t ensure that they do not remain dissatisfied and are able to experience the best services possible. The staffs working within the company are given sufficient training and developmental programs to ensure that the staff members are able to enhance their skills and knowledge thereby being motivated at all times. Demotivation on their part may even result in a negative impact on the company’s overall productivity. The organisation heads which include the managers and the HR are solely responsible to maintain a good reputation of the company a avoid any form of negatives aspect from hampering the company further. This in turn would result in their growth and development.
Poor service quality in RHCH provides bad impact on every stakeholder significantly.
Impact on Service users:
If the service level of the concerned organization decreases, then it would create negative mouth of publicity and for this reason, the customer loyalty of the company get damaged (Brettet al. 2014). Further, the poor service quality can reduce the health quality of the service users accordingly.
Impact on service providers:
The poor service quality may reduce the level of motivation and skills from the health care professionals. The service providers do not use latest technologies and thus, the quality of services decreases. Hence, it may reduce the entire productivity of the organization as a whole.
Impact on external agencies
Poor service quality may lead to introduction of certain legal actions against the organization. Hence, the care users may reduce the confidence level from the external agencies that are liable to maintain quality in the concerned organization.
Task 2: LO2
2.1 The standards that exist to measure quality in health and social care
The health care organizations need to follow all the standards and it is worth saying that, various external bodies introduce different standards to maintain quality in care setting environment. A quality standard is all about the requirements, specifications and characteristics regarding the quality that needs to meet the purpose of the services or the processes.
Different external agencies set standards in the health and social care because of some certain purpose (Boulwareet al. 2016). The standards are set in the health care environment so that, no service users get discriminated and all the service users get equal opportunity in the care unit. Further, with the help of these standards, it becomes possible for the organizations to maintain quality in the care services.
There are different agencies that set standards in the health and social care unit and they can be marked as CQC standards, Code of practice standards, NMC standards and the other one is all about NICE standards.
Different standards set by different agencies can be provided in the following section.
Care quality commission:
There are different standards set by CQC and the concerned organization needs to follow all the standards so that, it becomes possible to maintain quality in the care services. One of the standards of CQC requires service providers to provide training to the staffs and ensure that staffs have adequate experience and skills. As per example, the concerned organization fails to meet the standards because the service providers fail to provide training to the staffs. There is lack of service providers in the organization. Bank and agency staff are used to cover the vacancies in the staffing level and thus, all the agency staffs are not enough qualified to maintain standards in the workplace.
NICE provides guidance on the management of medication in the health and social care setting and this has published in the year 2017. This standard is required to ensure safety of people in terms of medication in the care units such as RHCH. As per example, it can be stated that some of the issues are found in the concerned organization. Hence, the service providers are not aware about the nutritional level of service users while delivering services to the care users.
It is a quality standard agency and it provides certain standards that the nurses and midwives need to maintain in the working practices. The standard requires midwives and nurses to maintain health and safety and encourage service users to take part in the decision-making process. Hence, the aforementioned organisation fails to attend the standards regarding the maintenance of respect dignity in the care user’s care and treatment (Wageret al. 2017).
2.2 Different approaches for implementing quality systems
The quality system refers to the specific implementation of methodologies and tools to achieve quality related goals. According to the viewpoint of Valentineet al. (2015), quality standard is all about managing the quality of the organization activities, policies for formulating and implementing quality management approach.
There are different approaches for implementing quality systems in the health care environment includes total quality management, bench marking, continuous quality improvement (CQI) and the other one is Quality control.
Continuous quality improvement (CQI)
CQI refers to the measuring of performance within the organization to enhance the skills of internal employees, customer satisfaction and work efficiency. CQI encompasses some of the benefits along with some pitfalls (Burwell, 2015). As stated by (), CQI uses quantitative information instead of subjective one and this helps to improve the entire business process effectively. Further, it helps to improve staff morale and productivity of the employees as a whole.
Total Quality management (TQM)
Total quality management refers to the effective competitive approach in long run of health and social care setting. The advantages of TQM include reduction in cost, areas of scrap and the reduction of warrant cost. On the other hand, the disadvantage of this system is all about employee resistance. As per example, it can be stated that, when the management fails to communicate with the team approach of TQM, the staffs become fearful and this may lead to staff resistance.
Approaches of TQM:
TQM uses the PDCA approach for improvement of the care setting environment as a whole. As opined by Hardymanet al. (2015), the PDCA refers to plan, do, check and the other one is act. This PDCA cycle is a four-step management process used for continuous improvement in business process. Further, the RHCH needs to follow the approaches of TQM to improve the quality. One of these approaches includes focus on customer needs. It is beneficial for the care unit to up-to-date the services as per the user’s requirements to improve the quality of services. Leadership is the other approach that needs to be followed by the organization. Hence, to improve the administration process, it is necessary to introduce effective leadership to improve the performance of the staffs by introducing effective training. Continuous improvement needs to be carried out throughout the process to improve the performance of the organization in providing quality service as a whole. Further, process approach needs to introduce in the regular working practices to manage the quality in the services.
Hence, the concerned care setting needs to establish objectives, implement plan, check the measure results and then apply changes as per the results. Maximum focus has been given on understanding current needs of the customers thereby meeting up to their expectations at all levels. Furthermore emphasis is given on establishing a healthy leadership thereby maintain the internal environment of people which aims at meeting the company objectives. Hence, it will be beneficial for the company to use the TQM approach as it uses less resources and time to bring efficiency in the business process.
2.3 Potential barriers for delivering quality in health and social care
Understanding of barriers:
Several factors contribute towards gaining access to health and social care which if gets obstructed in any manner can be referred to as barriers in health and social care. The barriers can be of various types such as physical, financial and educational which may impede the access tomedical care.
There are various problems in health and social care setting and thus, barriers refer to anything that makes it difficult for an organization to reach to the ultimate objective (Hardymanet al. 2015). The concerned organization faces some issues in delivering quality service to the users and some of them are lack of resources, poor communication, heavy caseloads and lack of employees.
Potential barriers of the organisation:
Lack of employees:
The concerned care setting has lack of employees and most of the designations are filled by bank and agency staff. Thus, all the staffs are not skilled to deliver quality services to the care users. For this reason, some of the relatives of the service users of RHCH stated that, use of agency and bank staff led to inconsistent care for the care users. The inspection on CQC finds that, service users are not supported by regular staffs and this tend to inconsistent care. In the past year, 13.5 full time equivalent employees had left RHCH and till now, the care setting has 10 full time care employee vacancies.
Lack of resources:
Lack of adequate resources makes it difficult for the company to deliver quality services. Hence, lack of resources refers to lack of time, money and employees in the workplace.It is worth mentioning that, there is no management presence in the workplace of RHCH and therefore, employees feel their job impossible.
The staffs are able to communicate in local language but they are inefficient in communicating in other languages. Hence, it becomes difficult for the care providers to communicate with the care users who use different language. One of the relatives of service users states that, use of agency staff in RHCH could affect their family members and this is because, the agency staffs have communication difficulties. Agency staffs are unable to understand the difficulties of service users because of the lack of effective communication competence.
Lack of training:
It leads to unsafe practices and because of this, care users suffer from risk of lives. One of the permanent staffs state that, they feel pressure while working with bank and agency staffs. Agency staffs are not enough trained regarding the handling of medicines. They are not aware about the allergy issues among the service users from a particular medicine. Staffs are not able to handle weekly records and thus, it becomes difficult for Russell House Care Home to meet the quality of the services.
Hence, it is essential for the care unit to eliminate the barriers to improve the quality of service.
Task 3: LO3:
3.1 The effectiveness of policies, systems and procedures to achieve quality in health and social care services
Systems, policies and procedures are the three main pillars on which the entire quality of health and social care services depends. Effective policies and procedures are required to meet the quality of the services (Panagiotiet al. 2014). Hence, different systems such as operation, management and administration are liable to achieve the quality in the care setting environment.
The health care setting needs to use effective management system for the improvement of productivity of the service providers. The management system is responsible for providing training to the service users so that, the organization can deliver effective service to the users.
The administrative system is responsible for the entire administration of care setting environment. Hence, the organization uses effective administration system to improve the entire business process.
The care users are needed to inform regarding the availability of service providers and other resources and thus, the operation system is responsible to deliver this information to the service users.
3.2 The factors that influence the achievement of quality in health and social care service
Staffing level can be referred to as having the right people for the right places and times. It is ensured that the staffs that are present possess the required knowledge and skills able to operate effectively and safely.
Importance of staffing level:
The importance of staffing level lie in indicating the quality of outcome based care thereby decreasing the patient’s ratio level to cope up with the changing work environment. They further help to ensure a smooth and efficient running of the right employees thereby delivering the best possible services. They are one of the most effective ways to deliver the bests services possible since the right people are chosen for eth right jobs so as to deliver the services in time.
Importance of training:
Further training is provided to them so as to ensure that their skills and knowledge are sharpened and enhanced which would further ensure that they would deliver the best services possible to their potential customers thereby meeting to all their needs and expectations duly.
Limited resources and its importance:
They can be defined as restricted amount of inputs in a given business or economy which lacks important aspects such as motivation, staff, finances, raw materials and production facilities. The social and business environment is responsible to deal with a scarcity situation which would consist of the limited resources thereby tending towards a constant pressure which would impact the individuals and the companies at large. The importance of limited resources lie in ensuring that all the proper aspects and elements are properly made sue of in the health care services so that the customers are able to receive the best services and care possible.
Different factors are responsible for providing quality in the health and care setting and these factors are all about presence of management, keeping records of medicines, maintenance of rules and regulations in the working practice.
Presence of management:
It is important for the concerned organization to focus on the presence of management in the workplace. It is worth noting that, there is no management present in the care place at the weekends. Further, there are only one administration days per week to do the tasks and hence, it becomes impossible for the team leaders to perform their duty within this very short time frame. Hence, the organization needs to improve the administration days to manage the quality care.
Keeping up-to-date records:
It is important for the health care settings to keep relevant records to promote safe care to the service users. Hence, the employees of RHCH do not sign routinely to indicate they have read the relevant records. Hence, it is important for the employees to keep maintain records properly to ensure they are up-to-date on recent changes and it leads to introduce quality in the services.
It is important for the health care staffs to maintain rules and regulations in the working practices, so that, it becomes possible for them to give quality services to care users. Hence, the employees of RHCH are found not to follow the Mental Capacity act of the year 2005. Further, the service providers are found to breach one regulation of Health and Social Care of the year 2008. Thus, it is important for the organization to maintain all the rules and regulations to provide quality services.
3.3 The ways in which health and social care service could improve its quality
From the above-held discussion, it can be stated that, the organization faces some of the issues regarding lack of employees, communication, lack of training and others. Hence, it is essential for the care unit to resolve the issues so that, it becomes possible for the company to improve the quality (Glasby, 2017).
Findings of CCQ report:
The organization has lack of employees and bank and agency staffs fill the vacancies. Thus, the services are not safe for the care users. Hence, proper recruitment method needs to be considered. Further, proper training needs to be provided to the staffs to improve the quality of services.
The organization does not follow Mental Capacity act of the year 2005 and thus, the services provided by the company are not always effective. Thus, the organization needs to follow proper standards to improve the effectiveness of the services.
The service provided by the company is not well-led. Staffs do not maintain records properly and thus, it is essential for the company to employ improve technology to reduce the pitfall.
Task 4: LO4
4.1 Evaluation of methods to evaluate health and social care service quality
Quality audit and review:
The evaluation of health and social care service quality has carried out a project audit, which ensures carrying out of a project management based on standards of the origination.
One of the advantage of this is that the various policies, procedures and processes that are followed by RHCH have been analyzed thereby scrutinizing the methodology and identifying the gaps to carry out the required improvements. Along with that, the quality of Health and Social care act as one of the main issues that is responsible for improving the quality of health and social care services.
One of the disadvantage is the fact that it diminished clinical ownership in the organization. Along with that, it dear of litigation and develops professional isolation
Quality survey and review:
Furthermore, a quality survey has been carried out which helps to measure and analyze the customer satisfaction and experience that is acquired from the research.
One of the advantages is that it emphasis is therefore placed on maintaining the quality of health and social care services displayed by RHCH with focus on the various dimensions thereby following the SERVQUAL measurement instrument with focus on the tangible aspects such as physical facilities and communication materials thereby enhancing the reliability, responsiveness, assurance, and empathy towards the customers (Dickinson and O'Flynn, 2016).
One of the disadvantages is that the surveys involve close end questions which are compose of lower validity rate than others. Along with that respondents may not always provide correct answers or may not always be willing to cooperate at all..
Quality inspection and review:
A quality inspection is carried out which further helps to check and ensure the characteristics related to products and services thereby ensuring effective results and compliances.
A specialized personnel is identified in the process which helps to develop the responsibilities of the production workers further (Cameron et al. 2014). Along with that, carrying out an effective QC in section further enables the company to focus on developing their production services and identify the defects effectively and make attempts to develop further based on the customer specifications.
Rejected products are expensive for the firms that may incur high costs but fail to be sold to the manufacturers. In addition to that, the products that are defective in nature have the tendency to come back to the supplier which makes the suppliers viable to failure and hampering of their responsibility.
Evaluation of quality:
By carrying out the above audits and Inspections, the quality delivered by them in the npro0cess are thoroughly reviewed and checked so as to understand its benefit and usage belter. Failure to meet the company goals would further require them to adopt other effective techniques to enhance their quality of service Care.
4.2 The impact of service users on the service quality in evaluation process
The qualities of services that are delivered by the company determine the public perception and helps them further to measure their quality. The customer's experience to a great extent plays an important role in resulting in a positive outcome thereby assessing their sales and overall growth.
Advantages of RHCH:
The biggest advantage that lie in evaluating the process organizations include an easy assess and approachability which makes it easy for the employee and customer contact (Bowling, 2014). It further helps to develop the communication and competence level thereby enhancing their security and responsiveness. Other than this, it has been found that they are able to inculcate their perspectives further to re-evaluate their delivery of services thereby carrying out an effective treatment. This in turn helps to share a common agenda and promote a constructive work relationship amongst all. This ensures that the company are able to meet the customer care needs duly on a much enhanced level thereby delivering the best customer experience.
Disadvantages of RHCH:
The disadvantage however lies in the risks that relate to security and freedom followed by the dependability and accuracy with which the company needs to deliver their services. Failure to fulfill the desired services and misinterpretation of the patient understands further make it difficult to fulfill the customer needs effectively. Lack of knowledge and skills further make it difficult to cope up with the effectiveness of service users (Issel and Wells, 2017).
It can therefore be concluded that the assignment has demonstrated an effective understanding based on management of skills and quality related to health and social care organization named Russell House care Home (RHCH). The CCQ report has further focused on making necessary improvements in quality in their care home thereby identifying the necessary changes required to improve and manage the quality. By applying effective strategies, a communicative approach has been identified thereby understanding managerial responsibilities. This has helped to understand the various problems effectively and adopt innovative ideas to understand the importance of interdependence which needs to be achieved.
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