The General Populace from Social and Health Care Services - Essay Example

TOPIC: MANAGING QUALITY IN HEALTH AND SOCIAL CARE SUPERVISOR NAME: WORD COUNT: STUDENT NAME: STUDENT NUMBER: DATE: ABSTRACT The conclusion of this essay will examine methods with which quality can be reviewed in Health and Social Care agencies. It will seek to narrow down definitions of quality and its different perceptions in the field; and link it to principles of care. Subsequently, it will analyse these methods with a view to identifying the problems that these can present, and the opportunities to progress towards ‘best practice’. It will begin by defining what quality is to the various stakeholders, and then move on to explore the review process of quality; examining the pros and cons of these; while taking into account the points of view of various stakeholders that is, external agencies, local authorities, service providers and the end user as well. AN ANALYSIS OF DIFFERENT CONCEPTS OF QUALITY IN RELATION TO HEALTH AND SOCIAL CARE Quality is a very relative term and there are many individual definitions to the term, depending on the outlook and attitude of the respondent. There are common denominators though, as to what constitutes quality care for different groups. As a concept in health and social care, it originated in the 1980’s when the Conservative party was in power. The government’s main agenda at the time was to revolutionise the way that public services, health and social services were structured, managed and delivered. Although it is a theme featured and highly regarded in Health and social care agencies, it remains an elusive concept to define. The word quality however, implies a degree of excellence or worth. The department of health produced a document; ‘A Quality Strategy for Social Care’ (DOH, 2000b) that while it does not quite define quality it does provide guidelines on what consists of quality service vis a vis the process of transforming and improving service so that they are both accessible and consistent; and delivered by a competent service providers that cater adequately to the end users’ needs. This quality can be a challenge to measure though. The Servqual-Zeithmal, Parasuraman and Berry method (Fedoroff, 2010) is used to perform a gap analysis of an organisation’s service quality performance against customer service quality needs. The perceptions of service quality for the organization in question are compared to those of an organisation that is ‘excellent’. The difference between the two is then used as the driver for service improvement. Parameters of measurement are; 1. Tangibles – these consist of the physical facilities i.e. chairs, tables, computers etc; equipment which may be any machines or gadgets necessary for testing, staff and communication equipment. This also includes the facilities available and whether or not they are up to date. Whether or not these facilities cater well to the clients’ needs. For example a hospital waiting room should have adequate and comfortable seating for their clientele. 2. Reliability- ability to perform the promised service dependably and accurately. For example in the case of Nigel Wilson; a 79 year old resident of Cally Hill Residential Home suffering from dementia – the care workers at the home are duty bound to ensure that his rights are taken care of. These rights include control over his own life, choice and independence as far as he is able. He also has a right to his dignity and privacy so he does not feel sick, vulnerable or frightened. 3. Responsiveness- willingness to help customers and provide prompt service. 4. Assurance – this is the self-confidence displayed by employees gleaned from their knowledge of their craft and general courtesy and ability to instil trust and confidence in the clientele. 5. Empathy – The ability to understand and relate to another’s feelings is important for the firm to provide care and personalised attention to its customers. A radio program surveyed its listeners on how they knew that someone loved them. The general response was that they knew they were loved when they felt heard. This was reported by a client. Henwood et al (1998) used focus groups and individual interviews to come up with criteria for quality commonly mentioned by service providers in homes for the aged; these included staff reliability, service from staff whom users knew well, and staff readiness to help with a broad variety of household problems. A quality assurance framework was developed, which promotes the organisation of service to all older Home Care clients according to such a uniform set of values (Henwood et al 1998). The National Institute for Health and Clinical Excellence (NICE, 2010) has developed a system to standardize the quality of care offered by the NHS. This system covers a range of markers that encompass the treatment and prevention of different diseases and conditions; using very specific and targeted statements that serve as benchmarks for high-quality, cost-effective patient care. It does this through the QIPP (quality, innovation, productivity and prevention) which helps the NHS address inefficiencies and improve patient care. These standards of quality assist care givers and health professionals make decisions based on the latest evidence and best practice. The Care Council for Wales, the General Social Care Council, Northern Ireland Social Care Council, and the Scottish Social Services Council all worked together to come up with a code of Conduct for its members that is aimed at raising the standards of care in the community. Clients are directly impacted by the quality of care provided by health workers and that is why it is important to have the code of conduct and a set of principles of care. This set of principles includes; Confidentiality: Unless it is extremely necessary to share the information, as in case of preserving life, then and only then may this code of ethics be broken. Collaboration: the range of health professionals involved in patient care is wide, making proper collaboration and communication very essential in health care institutions. Compassion: A patient’s mental state is as important as the strength of the body in healing. Compassion is a strong tool in strengthening the patient’s attitude and is one of the most effective ways of treating a person with ill health. Competence Care According to the Social Care Institute for Excellence (SCIE), social care is defined as those interventions provided and paid for by agencies; either independent or statutory, that caters to the needs of vulnerable groups, i.e. older people, children and younger adults. These needing assistance in the provision of services due to inability of they or their family members to provide for them without additional support. They go on to state that in certain circumstances, the differing perspectives of stakeholders that is, parents, children, social care workers and policy makers may lead to conflict amongst differing groups. The social workers have to balance for example, the interests of the children (and families) that they administer to, and that of their parents or guardians. This is because although all parties may be interested in the best interests of the vulnerable party, they may have conflicting views on how this is to be achieved (For example, in the context of a Section 47 child protection investigation). The provision of services is further complicated by the concept of parental responsibility and the different ages at which children are lawfully perceived to be competent to specify their own preferences. This is also known as the ‘Gillick competence’ named after a case in which a mother, Victoria Gillick, challenged the right of a GP to give her daughter advice on contraception without consent from her as the child’s parent.(Gillick v West Norfolk and Wisbech Area Health Authority, 1985); Waine et al (2005). AN EXPLORATION OF THE STRATEGIES FOR ACHIEVING QUALITY IN HEALTH AND SOCIAL CARE SERVICES Parliament identified the lack of legislative capacity as a barrier to reviewing current legislation. This could create problems and is addressed by the Regulatory Reform Act of 2001. This act replaced the Deregulation and Contracting-Out Act of 1994 that required strengthening. This act was further fortified by the Legislative and Regulatory Reform Act of 2006 OECD (2010). An important feature of contemporary UK experience has been reform in the public sector. This assures that there is a quality, effectiveness and uniformity in the delivery of public service. These reforms have resulted in an ‘agentification’ of organisations that deal with public service delivery. This is aimed at improving quality, efficiency and accountability by focussing and specialising services. This development is complemented by the creation of an array of quality assurance initiatives. These initiatives include, ‘Citizen’s charter’, ‘Charter Mark’ and ‘Service First’. One of the three international standards used to measure quality systems is the ISO 9001. It is more specific to situations involving contracts between two parties, which require a demonstration of the supplier’s ability Stark (1998). One way to streamline quality is by registration of workers. Inclusion in the register is a public record to prove that the worker has met the minimum requirements necessary for entry onto the register and is bound to abide by the standards outlined in the Code of Practice. Those in need of services can access these records and identify sources of legitimate care. As pointed out earlier, various social councils in the UK have come up with guidelines on the correct behaviour of care workers. The Code for Workers is a guideline that sets down the standards of conduct that social care workers are expected to abide by. This is supported by structures that are institutional which influence the development and articulation of values in social care. These structures are comprised of both the professional and inspectorial bodies. For instance, the General Social Care Council (GSCC) Code of Practice sets out the requirement that the social care worker has to: • safeguard the rights and propagate the interests of the end users and carers • cultivate and retain the trust and confidence of clientele and their helpers. • Allow the service user to retain as much independence as possible without putting them in harm’s way. • have an attitude of respect for the rights of service users while keeping in mind the need to protect them from themselves and ensure others are not harmed by them. • conduct oneself in such a manner as to win and maintain public trust and confidence in social care services • hold the nature and quality of work done with due care and consistently take the responsibility to keep up with new knowledge and maintain and improve skills. (Waine et al, 2005). It ensures that workers know what is expected of them and that the public know what standards of conduct they can expect from care workers. In the case of people who are registered breaking the codes may lead to investigation and action by the Care Council. This is illustrated in the case of Kim Malpas who was struck off for defrauding a service user with mental health problems by obtaining signed checks from the service user which she then used to pay her own bills. She was jailed for twelve weeks. In another incident, the manager of a health centre in Scotland, who breached confidentiality and made racist remarks about her clientele on her blog, was also struck off (McGregor, 2010). The department of health developed a document to determine minimum standards required of independent health care. These standards set the parameters by which the National Care Standards Commission (NCSC) determines whether quality assurance and appropriate safeguards are in place for the safety of their clientele. These standards apply to the management, staff, premises and behaviour of social and healthcare establishments and agencies. Some of the areas it covers are: Information provision – the information disseminated to prospective clients about service provision by the health care provider should be accurate. Patient care and quality assurance come first. Service providers are required to have written policies and procedures in place, covering various aspects of their activities to ensure that this is observed. Patient-centred treatment and care. Treatment that the patients receive is compliant with clinical guidelines. There is an assurance to the patients that monitoring of the correct standards of treatment and care occurs. Sensitivity and appropriate handling of dying patients and the death of patients is done. The establishment obtains the views of the patient and these views inform treatment and care provision of prospective patients. There are policies and procedures of an appropriate nature in place to ensure that standards of quality in service and treatment are maintained. The establishment or agency should be run by a person or organisation that is reputably fit to do so; with a clear hierarchy of accountability to ensure and assure delivery of services to the patients. The staff is well trained, recruited and qualified. The professional codes of practice of the various Health care professionals who treat the patients are adhered to and complied with. The equipment used to treat patients is in good working order and safe to use. (DOH, 2002) While these minimum standards provide a benchmark at which to start, they are by no means the goal to which care aspires. New standard to improve the quality of health and social services were incepted in 2006. These standards encompassed Corporate leadership and accountability of organisations; Safe and effective care; Accessible, flexible and responsive services; Promoting, protecting and improving health and social well-being; Effective communication and information. While announcing the publication of these standards, Health Minister Shaun Woodward said, “People want to be able to access services easily and when they need them and to receive a high standard of service regardless of where they live.”The HPSS and other organisations will now be able to measure themselves against these Standards and demonstrate how improvement in the quality of service provision is being made." (HPSS, 2006). Between July and October 2009, a questionnaire was sent to patients who had recently attended an outpatient department appointment for each trust in England. There were 392 respondents from patients at Guy's and St Thomas' NHS Foundation Trust. The survey focused on how the new regulations were impacting patients’ perception of healthcare provision. Participants were surveyed as to their thoughts on different aspects of the care and treatment they received. Each healthcare organisation received scores out of 10, based on the responses given by their patients. The results from each trust take into account the age and sex of respondents, and whether their admission to hospital was planned or an emergency, compared with the age, sex and method of admission (planned or emergency) of all people across England that returned the questionnaire. The majority of parameters were found not to have changed much, but the survey found that provision of information by staff had improved (CQC, 2010). A CRITICAL EVALUATION OF THE SYSTEMS POLICIES AND PROCEDURES IN A SPECIFIC HEALTH OR SOCIAL CARE SERVICE IN RELATION TO ACHIEVING QUALITY SYSTEMS Maternity Care within the NHS According to the NHS Next Stage Review (England), a number of initiatives designed to improve the measurement and monitoring of quality within the NHS have been outlined. As health and social care quality is multi-factorial and broad ranging, definition, measurement and communication of quality involves many stakeholders. This can, however, lead to discrepant views as observed earlier. Priorities and definition of quality for different groups, that is, the end-users (the public, patients and carers), the service givers (nurses, allied health professionals and clinicians) and commissioners of health and social care may diverge. (Leatherman and Sutherland, 2008)(Campbell et al., 2002). It is therefore important to take all this into account when coming up with variables of assessment. Engaging with multiple stakeholders to identify core elements of health and social care quality is essential to this process. Measurement of effectiveness of these systems is important for various reasons. Due to increase in public expenditure in the NHS delivery of value for money and increased productivity is essential to justify its continuation. Public accountability and service quality also improves. Of course, with the nature of the economy, efficiency savings are key. According to the Maternity Services survey of 2010, majority of women are positive about the services they have received. 25,000 women, who had given birth between January and February 2010, responded to the survey, which came to 52% of participants. All the women were aged 16 years of age and over. All women who had received care from one of the 144 NHS trusts in England, and had given birth in a hospital, birth centre, and maternity unit or at home, were eligible to take part. All aspects of the maternity care process were covered including their first visit to a clinician and what the quality of care was like at their home in the weeks following the birth of their baby. The aim of the survey is to aid service improvement in the NHS. The findings of the survey were that women were generally positive about maternity services in the NHS. Many reported improvements in access and a sense of involvement throughout their care. There was a general increase in the percentage of women who were seen by a midwife rather than GP or other member of staff, who had dating scans before nine weeks, were offered a choice in location of birth, three quarters being offered home births, and also involved in decisions about their care and feeling confidence and trust in the staff caring for them. Only 7% felt they were mistreated after the birth of their baby, and 79% were given consistent advice on feeding by midwives. 86% of the respondents were given support and encouragement in how to feed their baby. There were however, areas of concern that still need to be addressed. About a quarter of the women reported that infant feeding was not discussed with them during the antenatal period. They had to wait the same length of time to receive their episiotomy stitches. In the time of antenatal care, about a tenth of the women don’t remember being given contact details of a midwife; or the midwife was not helpful when contacted. The same percentage reported that they failed to receive the pain relief they had asked for (unchanged from 2007). 38% of women who had no complications requiring surgery gave birth in a supine position, with a significant rise in those being supported with stirrups. This could imply that they were not given sufficient encouragement to take more active birthing positions. About a quarter reported not receiving help or advice from health professionals about feeding their baby six weeks after birth and almost one in five felt inadequately informed about their own recovery; 21% feeling they did not get enough information about emotional changes they may undergo. The majority (92%) of women rated the care they received during pregnancy as being ‘Excellent’, ‘very good’ or ‘good’. An even higher proportion (94%) said the same about the care they received during their labour and birth. Women rated their postnatal care least positively, with 89% of women rating it as ‘excellent’, ‘very good’ or ‘good’. These scores however conceal significant differences between various trusts. A matter for concern to policy makers was that while a general satisfaction with their care was reported; there were some major concerns expressed about some aspects of healthcare and these concerns seem not to have been addressed. This implies that many trusts appear to be complaisant about results of previous surveys and the importance of learning lessons from these reviews must be stressed. (NICE, 2008) The improvement in quality of service provision in maternity services in the NHS is self-evident judging by the results of this survey. However there is no room for complaisance and there are still some serious areas that need to be addressed. Considering that the emotional well-being of the mother is essential to the well-being of the baby, more counselling needs to be incorporated into the system so that every woman can feel she received adequate preparation. To achieve this, the staff needs to be adequately trained, both professionally and personally; every health care professional needs training in counselling, public relations, and customer care. Adequate facilities need to be established to cater to the various needs of the society. Health and Social care networks need to be established to work together as an integrated whole. The concept of ‘network’ has grown beyond the model of ‘hub and spoke’ into a growing concept that puts the needs of the ‘network’ comprising of leading organisations in healthcare provision above that of the of the individual hospitals or institutions. (Edwards, 2002). A great advantage to this approach is that it provides for a continuous working relationship between organizations and individuals thus enhancing the quality of care to the patients who require it across many different institutions. Their advantages include; - reducing professional and organisational boundaries; - sharing good practice; - Patient-centred care is the priority and; - Enhancing improved access of the public to care (NHS Confederation, 2002). This year, there is a new law about regulating health and adult social care in England. It becomes the legal responsibility of every health and adult social care service to ensure they meet the new essential standards of quality and safety. This becomes effective from 1 October 2010. This is different from the obsolete system in that it is centred more upon the patient. It concentrates more on the care given than the systems and processes; the patient also has a bigger say in the provision of care given to him; the focus is on how care is adhering to standards at present rather than in the past; there is a wider latitude of power that the care giver has to ensure essential standards of care are adhered to; there is a regular updating of the website in the event of changes or new checks or concerns. Servqual-Zeithmal, Parasuraman and Berry came to the conclusion that customers held two SERVQUAL dimensions in a consistent order of importance; this was done through a qualitative study. Reliability was perceived to be the most important and tangibles to be the least. There was support from clientele on the need for a comprehensive and thorough examination of the needs and quality of service which would lead to an improvement in service quality (Fedoroff, 2010). This can be implemented using Total Quality Management. The concept of total quality management was incepted in the Japanese industry in the 1950’s; it gained popularity in western culture in the 1980’s. It describes the culture, attitude and organisation of a company which consistently and continuously aims to provide quality products and services to its customers; in order to satisfy their needs. Total Quality Management (TQM) requires that all aspects of the company’s operations retain quality standards, and things are done in the right manner the first time round; with defects and wastage kept at a minimum. Surveys have found that many companies find it difficult to implement TQM. Only about 20-36% of those who have undertaken total quality management have achieved success. The more successful the company though, the higher the percentage of those who have succeeded with TQM Stark (1998). In healthcare, the concept of quality is usually understood in a clinical context and there is a distinct separation of managerial and clinical activity. This causes bottlenecks in the implementation of TQM as the following example shows; The outpatient services manager of a NHS clinic is allocated the duty to meet the ‘patients’ charter’ requirement that no more than 30 minutes should pass between patient appointment and the time they actually see a physician. In this surgical clinic, there has been up to two-hour waits to see the surgeon. When the manager sends the results of his survey to the consultant surgeon, he reiterates in an irritated tone, that if management would like him to see more patients, he would be in need of another registrar. CONCLUSION What is it that is required by the general populace from social and health care services? They want high standards in the workforce; they want services to be responsive, fast and convenient. They would prefer services that are tailored to individual users’ needs with respect to culture and lifestyle. They also want social services that build on people’s abilities and enable them to be full participants in society. Lastly, but certainly not least, they want coherent, integrated services that can respond to a range of health and social care needs holistically. (DOH, 2000b) Indeed, the centre of quality improvement is the patient. The aim is to be able to improve service provision and quality to the end user; the person in need. It requires continuous monitoring and evaluation of systems, processes and personnel to ensure that they are up-to-date. Ongoing training of personnel and upgrade of equipment needs to be part of policy making at every level. Regulation and registration of licensed facilities should follow laid down guidelines in order to maintain and improve quality in the industry. It is crucial that these records are available for public scrutiny. Regulatory bodies should make it easier for the public to interact with them using technology, while ensuring adequate response time so that the public feels its needs are addressed. BIBLIOGRAPHY. Care and Quality Commission (CQC). 2010. The essential standards of quality and Safety you can expect. Retrieved 23rd December, 2010 from http://www.cqc.org.uk/usingcareservices/essentialstandardsofqualityandsafety.cfm Care and Quality Commission (CQC). 2010. Guy's and St Thomas' NHS Foundation Trust. Retrieved 23rd December, 2010 from http://caredirectory.cqc.org.uk/caredirectory/searchthecaredirectory.cfm?cit_id=RJ1&widCall1=customWidgets.content_view_1&element= Care and Quality Commission (CQC). 2010. Maternity services 2010. Retrieved 23rd December, 2010 from http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/maternityservices.cfm Campbell S.M., Braspenning, J. Hutchinson, A. and Marshall, M. (2002). Research Methods used in developing and applying quality indicators in primary care. Quality and Safety in Health Care, Vol 11 (4), pp.358-364. Department of Health. (2002). Independent Health Care. Retrieved 23rd December, 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4078367.pdf Department of Health. (2000). A Quality Strategy for Social Care. Retrieved 22nd December, 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082040.pdf Edwards, N. (2002). Clinical networks. Advantages include flexibility, strength, Speed, and focus on clinical issues. BMJ, Vol 324: 7329, p. 63 Fedoroff, P. (2010). SERVQUAL (Zeithmal Parasuraman Berry). Retrieved 23rd December, 2010 from http://www.12manage.com/methods_zeithaml_servqual.html Leatherman, S. and Sutherland, K. (2003). The quest for quality: a mid-term Evaluation of the ten-year quality agenda. London: The Nuffield Trust. McGregor, K. (2010). Manager who made racist comments on blog struck of. Retrieved 23rd December, 2010 from http://www.communitycare.co.uk/Articles/2010/12/02/115938/Manager-who-made-racist-comments-on-blog-struck-off.htm McGregor, K. (2010). Social worker struck off for defrauding service use. Retrieved 23rd December, 2010 from http://www.communitycare.co.uk/Articles/2010/12/21/116044/social-worker-struck-off-for-defrauding-service-user.htm National Institute for Health and Clinical Evidence. (2010). QIPP - Quality, Innovation, Productivity and Prevention. Retrieved 23rd December, 2010 from http://www.nice.org.uk/nhsevidence/ National Institute for Health and Clinical Evidence. (2010). NICE quality standards. Retrieved 23rd December, 2010 from http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp National Institute for Health and Clinical Excellence. 2003. Antenatal care: Routine Care for the healthy pregnant woman, guideline CG6. NHS Confederation. (2002). Clinical Networks: Acute Services Review Report. Retrieved 23rd December, 2010 from www.scotland.gov.uk/library/documents5/acute-00.htm Henwood, M., Lewis, H. & Waddington E. (1998). Listening to Users of Domiciliary Care Services. Quality in Ageing, Vol 2 (3), pp 15-24. Stark, J. (1998). A Few Words About TQM retrieved from http://www.johnstark.com/fwtqm.html The Department of Health, Social Services and Public Safety. (2006). New Standards to Improve Quality of Health and Social Care Services Retrieved 23rd December, 2010 from http://archive.nics.gov.uk/hss/140301a-hss.htm Organisation for Economic Cooperation and Development (2010). Better Regulation in Europe: United Kingdom. OECD publishing. 1st Edition pp. 114. Waine, Tunstill, J and Meadows, P. (2005). Developing social care: values and Principles First Edition. Retrieved 23rd December, 2010 from http://www.scie.org.uk/publications/positionpapers/pp04/values.pdf Read More