Managing Quality in Health and Social Care
What is managing quality in health and social care?
Unit 27 Managing quality in health and social care is a part of the HND health and social care curriculum. This is unit 27 for health and social care course and develop different perspective of health and social care quality among learners. This unit develops the tool to evaluate the service quality among healthcare users so as to empower them. Concept of healthcare service quality is essential and comes with the different interpretations. Aspect of healthcare service quality is equally important for the users as well as external stakeholders. So it becomes essential for healthcare service providers to manage the quality of health and social care services so that they can gain user confidence. Key learning objectives for this Unit 27 Managing quality in health and social care are as under:
LO1 Understand differing perspectives of quality in relation to health and social care services
LO1 for managing quality in health and social care deals with the quality perspective from service users and external bodies. Service quality assessment can be done based on the Servqual or Zeithaml, Parasuraman and Berry parameters. Quality can be discussed on various aspects such as functionality quality, technical quality, quality audit, quality control or quality management etc.
LO2 Understand strategies for achieving quality in health and social care services
LO2 for the Unit 27 deals with the development of strategies in order to achieve quality parameters in health and social care. Standards, benchmarks and indicators are set in order to attain the quality as per the requirement of service users.
LO3 Be able to evaluate systems, policies and procedures in health and social care services
LO3 deals with the evaluation of the service quality in health and social care through tools such as continuous improvement and total quality management aspects. Similarly, guideline issued in regard to the quality management by NHS and other organisations prove of immense importance for evaluation of service quality. Finally, improving the quality through putting people first and internally developing standards of quality in health and social care.
LO4 Understand methodologies for evaluating health and social care service quality.
LO4 deals with the methodologies available in health and social care for evaluation of the service care quality such as focused group methods and questionnaire which are generally used or primary data collection. Service care users are involved in the service delivery model through empowering them and creating awareness.
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Introduction to managing quality in health and social care
This assignment is regarding the importance of quality in the health and social care sector. In present case, Wiltshire, social and health care organization at London has to face an inquiry highlighting the poor quality standards followed by them.
Task 1 defines what quality means for the health and social care units and the perspective of quality for the different stakeholders. We will look perspective of internal management, clients and the supervising authorities and professional into this. This task will also analyze the role of external agencies in the healthcare quality. Further in this task is the assessment of poor practices why standards are important while understanding the barriers in providing quality.
- Perspective of Quality in HSC:
In general terms, quality refers to delivering above average services. Perspective of Quality differs for each set of group basis the job which is expected to be performed by them and the expectation of user of services. Quality as defined by the Agency of Healthcare research and quality, US healthcare department- Quality refers to the degree of achieving the desired health outcomes through health care services which are consistent with the current professional knowledge. (Kominski G.F., 2007)
The prime objective of the HSC is welfare of the patients and all policies formed shall be ‘Patient Centric’.
Quality Perspective: Employer perspective of quality is to provide the best services to the patients but with the optimum use of the resources. The quality for the employer is the customer satisfaction and also keeping costs under control. For Patients, the quality is good medical care and hygiene. Also, they expect the moral support from the staff with open communication for the treatment provided. For the professional, quality means the skills of the staff. For professional, this means the technical qualification and experience of staff and types of machines and equipment used. (Cowles 2012) For employee, quality means the standards of consumables and training provided to them for getting update regarding the new treatments and methodologies.
The quality definition as provided by US department emphasis on the degree of desired outcomes. Looking the points raised in enquiry, it seems that desired outcomes are low and hence, low quality standards are followed by Wiltshire.
- External Agencies:
External agencies put up the control and are also important source of knowledge for the staff of Wiltshire. Wiltshire has to follow and comply with the regulations and rules framed by these agencies and the compliance are verified by the regular visits and inspection. These agencies are looking almost in every area of service of Wiltshire whether its sanitation, staff behavior, nursing or the equipment availability. Collaborative working between these external agencies is required for achieving the high standard of healthcare. The roles of these external agencies are:
CQC: CQC is the independent regulator. It registers the health and social care units and also makes sure that the care provided in the homes is as per the government standards.
NICE: National institute for clinical excellence helps the professionals in their clinical judgments. NICE ensures that the care provided is based on best possible evidence.
HSE: HSE is national regulator for workplace health and ensures that proper methods and safety shall be provided to the workforce in homes to ensure their good health and safety while providing services.
LGA: Local authorities are responsible for the improving the health of local population and providing the services to avoid the misuse of drugs and alcohol.
All these agencies need to work together to ensure the effective working in the health care units and to promote the healthy environment for the users of services. (Lancaster 2015).
- Key areas of poor practice:
Considering the observations raised by the CQC, major issue seems at the staffing function, lack of strong policies at top level and low employee motivation.
Poor practices at time of hiring the employees and low employee motivation directly affect the patients as low skilled and low knowledgeable employee will not be able to provide complete and high quality services which has resulted in incidence of abusing the clients. Weak policies at the top levels make the breach of standard easy and low standards services become the practice which depletes the organizations goodwill and restricts their growth opportunities.
The poor practice followed in the Wiltshire has a direct impact on stakeholder specially the patients. Patients are directly impacted by the low quality standards. Poor hygiene in the homes increases the chances of infection and spreading communicable diseases in the patients. Patients not only need the good medical treatment but also require the support for their quick recovery. A low support environment and use of abusive languages puts down the employee morale and affects their mental health. At organization level, it brings the disrepute to the organization which can result in poor employee and patient retention ratio and this also causes more external organization intervention. Poor services results in bringing down the patient confidence in the Homes (Lillian Wald, 2016) which also affects the organization financially. In worst scenario, this can result in closure of Wiltshire.
- Importance of standards in health and social care sector:
Standards are the benchmark of services to be provided by organization or industry. Healthcare industry deals with the humans and hence, high quality standards are required to provide a good healthcare to the individuals. (Ahn, W., 2012) Standards describes that what need to be done and how same to be done in a given circumstances. These standards are prepared in accordance with the various regulatory authorities.
For Wiltshire, commissioners have the role of safeguarding and they provide the standards to be followed by Wiltshire to reduce the risk of any harm to patient, any abuse to patient and neglecting the health of patient.
Other regulators as explained above like CQC,NICE, HSC also issues various guidelines and standards to ensure the patients and workers safety and these standards have to be followed by the Homes while providing services.
Care Act 2014 is also an important legislation providing for six principles which are Empowerment, Prevention, Accountability, Partnership, Proportionality and protection. These standards also provide the evaluation basis of working at Wiltshire and help them to fulfill any lags in actual working in comparison to formed standards. Adoption and adherence of these principles helps in achieving the stakeholder expectation and helps to bring better working environment in the Wiltshire by providing quality and promoting accountability.
- Approaches to implement the quality systems:
For Wiltshire, the major issues seem to be in the top management policies and the middle and lower level employees who are actually working on the ground. To deal with these, there is need to formulate a complete different policies for these matters and to improve the workings. The change in approaches requires is to be completely client centric and the policies and actions to be concentrated towards the welfare of clients. Management policies related to the manpower needs to be more liberal and employee friendly and new way needs to be developed to look upon the employee where they are the vital part of success of organization. Efforts shall be made for restricting the employee turnover by providing them at par wages with industry, motivation to work better and regular trainings and knowledge up gradation programs.
The approach for considering the employee as major pillar for the organization’s success to be accompanied by the rules to penalize the employee found to breach any regulation. A strict message shall be sent to employees for breaching any quality standard at the Homes. Thus, motivating employee along with strict control and supervision upon results can be useful approaches to implement the quality systems in the organization.
- Potential barrier for quality services:
Organization is the group of individuals working together for common goal. Each employee has their own experience and knowledge as developed by the past incidents. Working as per their own experience only without considering the organizations policy and lack of open communication and respect between the internal team can be one of barrier to quality services.
Middle and lower level employees are important part of implementation of any policy or plans. To put the desired plans in action, it is important that organization’s plans and policies are clearly explained to them and employees shall be motivated via both financial and non financial factors to provide the quality healthcare. Any dissatisfaction in employee is the hindrance in providing quality services. Clients of Wiltshire needs the emotional support along with medical support and team shall be developed feeling of belongingness with the patient.
Working in the medical field requires continuous updating of skills and knowledge. New inventions are made to make procedures easier and faster for treating the patients. Hence, the professionals involved shall make themselves continuous updated and also organization shall arrange to make the related staff updated by arranging seminars or other related activities. Non learning of new sills can be as barrier for potential service by Wilshire.
Task 2 for the assignment is touching the need of evaluating the process, procedure and structures for their effectiveness. There are certain other factors such as organization’s culture and the motivation levels for the quality services; we will be discussing the same. Other methods are provided for improving the quality in HSC.
3.1 Evaluation of effectiveness of policies, plan and systems for quality healthcare:
Policies, plans and systems are designed for the effective working in the organization. Policies and plans are the written documents of what are need to done and what not need to be done. Same way, the systems are designed to respond quickly and accurately to internal and external customers. No matter how broad and detailed polices and plans are made and how well planned a system is, the actual outcome depends on the way these plans and policies are adopted and the systems are used by organization. Without implementation on board, all plan and procedures can only be called as paper pieces. Thus it is important the all plans and principles are effectively implemented and the systems designed shall also be effective working for the organization.
Organization needs to continuously check and verify the effectiveness of system and policies. Effectiveness of policies and plans can be checked by analyzing the actual working in the Wiltshire and then comparing whether the set procedures are performed or not. Policies regarding to admission in homes, deciding the treatment to be given and taking up patient for different treatment shall be well defined. These can be sample checked at the various intervals. Also, the observations in the report of any outside agency are also an effective source for same. These observations are to be compared with set guidelines and accordingly the implementation or planning loop holes to be filled in.
For effectiveness of system, the solution generating capacity and the time taken to sort out the solution are the test of effectiveness. The management shall review the issues faced and how the system has resolved such issues. Whether the time consumed was justified considering the level of complexity of issue. In case the system taking too excess time, this needs to be made simpler with delegating the powers to local levels for routine decisions made.
3.2 Other factors influencing the Quality:
Other than the formal agreements and arrangements, there are various other informal factors which cannot be fully written down in policies but plays an important role in quality improvement in HSC.
Looking closely the observations in Wiltshire, we will find that these are mostly related to behavioral issues of the staff and the poor communication. The observation whether related to abusing or for the poor hygiene conditions or below average support is all related to behavioral issues of the staff dealing with the clients. Now, these can be written in the policies to deal politely with the patients but in order to actually implement this, a sound culture which motivates the employees to perform in better way needs to be there. Culture is how the organization and its member behave. Thus, a good culture at the Wiltshire will itself resolve the behavioral issues of the staff. Other major observation is regarding the communication aspect. Communication at ground level is between the doctors and base nursing staff and between organization and the clients. Clients need information regarding the treatment which is applied upon them and the effect of such treatment on them. This can also be done through a culture building where things are transparent and open communication is allowed between the internal and external environment. Also, cooperation of experienced staff and mutual respect helps to train new employee in much faster and efficient manner.
3.3 Ways to improve quality:
As discussed above, improving quality in healthcare needs both formal and informal methods. Formal methods are the development of the plans and procedures to be followed and the outcomes of not performing the same. Informal methods are providing a cordial and open management interaction and motivating the employees to perform better. For Wiltshire, it is extremely important to understand the requirement and need of human resource in their business and how their business is dependent on the Human resource. The reason for low performance of employees can be low pay numbers or the de motivating culture in the organization without the mutual trust and respect and employees are not allowed to take decisions even after they get experienced in their field. Wiltshire shall look for development of human resource policy in extensive manner. Another requirement is in the recruitment process where persons with specific qualifications and experienced shall only be hired. In Wiltshire, the sickness rate of even staff is high which means that staff is not with adequate precautionary equipment to save them while treating the patients and their diseases are affecting the staff. Wiltshire shall seriously look into this factor.
Another important point of improvement in quality is the monitoring of actual working. A separate team needs to be developed for supervising the quality aspect in the services. Team shall be looking into the behavior of staff with the patient, hygiene in the homes, basis of treatment provided and adherence of set procedures for the tasks performed. Quality supervision team can also prescribe the minimum requirement to get hired in the Wiltshire.
Policies for generation of periodic reports shall be formed and these shall be presented before the management along with the consequence and affects of breaches. A policy of taking the independent feedback from the client can also helps to know the lags and the area of improvement for the organization.
This part of assignment discusses the methods of evaluating the quality from internal and well as external perspective. The difference will come as the internal management is also interested to keep cost under control while providing the customer satisfaction. The second part includes one important component, end user in the evaluation procedure. As these are the one for whom all processes are formed, including them in the evaluation process will be a critical factor to improve the quality.
4.1 : Method of evaluating quality from internal and external perspective:
Quality is an important aspect for the HSC. The quality needs to be continuously assessed for the continuous customer satisfaction. There are different methods of evaluating the quality. In addition to provide effective services, the internal perspective is also to keep the lowest. Below methods can be used for evaluating quality:
- Donabean model: The model provides a framework for examining health service provided and assessing the quality of healthcare. The model takes structure, process and outcomes as the basis of assessing the quality of HSC. These three factors calees as dimensions of healthcare. For the Wiltshire,
Structure refers to the complete system of delivering the service including the indirect factors. (Donabedian, A. 1978) This includes the medical and other equipments, staff experience and training. Indirect factors include the payment method for the facilities.
Process: Process is the total procedure performed for the healthcare. This includes assessing the patient/client for the type of services required, performing test and diagnosis and the methods of delivering the services.
Outcome: Outcome is the end result of the processes performed by using the structure. It refers to the changes in the health state of the individual taking services of the Wiltshire. Outcome measurement is a typical process although the customer feedback and tests report can be important basis for the same.
- External agencies report: Report of external agencies is also important source of the quality delivered by the Wiltshire. External agencies are looking for the compliance of the set procedures and the rules and highlight the area of deviation. External agencies such as CQC help to know the area which requires the immediate attention by the management to improve.
- Questionnaire: These are set of question with the options available from rating high to low different services availed by the clients. Although, questionnaire does not allows for the detailed knowledge of the misdoing but is extremely helpful to know the problem causing area. Wiltshire can divide the questionnaire into different parts related to different departments and divisions. Overall level of quality delivered at the department or function level can be easily obtained. Looking the present scenario, the nursing staff will score low ratings in the questionnaire.
- Effectiveness and efficiency of operations: HSC units are with prime objective of serving the clients and patient. Although, internal management is also interested to keep the total cost low to ensure the survival in competitive environment. Hence, they are also interested to know the efficiency of operations. The revenue generated from same business activity under different methods can be assessed and one with similar effect but low cost can be selected.
4.2 Involving the users of service in the evaluation methods:
Customer is called king for today’s businesses. No business can survive without providing the quality services to the customers. As said, customer satisfaction is the only basis to get succeeded and even to survive in the marketplace. This factor becomes more important in the HSC sector as this sector is inspected by various outside agencies. Hence, quality delivered shall be high.
One of the important elements to assess the quality of services is to include the actual users in the evaluation process. If the users are satisfied with the services provided, it is clearly implied that high quality services are provided. There can be various methods for assessing the user experience of Wiltshire which includes making the questionnaire, conducting short interviews, providing complaint boxes, asking for the feedbacks from the clients and relatives. Another method can be to compute the client business is getting through reference of existing clients and their relatives.
Short interviews allow one to one communication with the users. This is direct and verbal form of feedback and allows the interviewer to assess the emotions and feeling of end user. Also, conducting frequent interviews at the care units allows to compares the actual position with the feedback received during the interviews. Wiltshire can also use the small complaint boxes at the homes where the user can write their complaints and grievances from the services. These boxes to be opened by top management and give important information of any poor services provided by the staff. Asking feedback is another method to know the customer experience. Wiltshire shall put mandatory requirement of obtaining the client feedback at regular intervals. This feedback serves an important part to improve the future services and make the management aware of shortcoming in any areas. (Martin LA 2017)
Including end user in the evaluation process is an important part of assessing the quality as all procedures and policies are framed for customer satisfaction only and unless the level of customer satisfaction is clear indication of the quality of services. However, it is also important for management to compare any unusual customer feedback with the actual working environment before taking any strict action basis same.
This assignment is regarding the quality in the HSC. The quality is providing above average services and the perspective of different users with relation to quality. We learn that external agencies through their expertise help to know the loop holes in the system and processes. The poor area for the Wiltshire is the behavior of staff and the staffing policies. We learn that how effective implementation is important and without that all policies are just paper pieces. We learn that the culture and mutual trust also helps to achieve the quality. In last part, we have discussed the methods for assessing the quality and including end user experience helps in improving quality extensively for the Wiltshire.
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