Managing Quality in Health and Social Care - Essay Example

St. Patricks College London Managing Quality in Health and Social Care LECTURER: DAREN KANNAYYASTUDENT: ANETA WADAS P1002473 GROUP 3A Table of Contents Summary………………………………………………………………………………………….3 Table of Contents 1 Summary 2 Introduction 3 1.2 Analyse the role of external agencies in setting standards of health and social care 6 1.3 Impact of Poor Service Quality on Health and Social Care Stakeholders 7 2.1 Explain the standards that exist in social and health care for measuring quality. 8 2.2 Evaluate of different approaches to implementing quality systems 10 2.3 Analyse potential barriers to delivery quality health and social care services 11 3.1 Evaluate the effectiveness of systems, policies and procedures used in a health and social care setting in achieving quality in the service(s) offered 12 3.2 Analyse other factors that influence the achievement of quality in the health and social care service 14 3.3 Recommendation regarding health and social care service for improving the quality 15 4.1 Evaluate methods for evaluating health and social care service quality with regard to external and internal perspectives 16 4.2 Discuss the impact that involving users of services in the evaluation process has on service quality 17 5.0 Conclusion 19 6.0 References 20 7.0 Bibliography 23 Summary The inspection on Care Quality Commission was done in The Royal United Hospital Bath on June 2013. This inspection and report by the Care Quality Commission realised that most of the hospitals have not taken in consideration meeting the important standards set by the Care Quality Commission. It deliberates on the significance of efficient and effective quality management in the general healthcare fraternity, the effects of service delivery and the views of stake holders regarding the healthcare quality. The report scrutinizes on the various factors affecting the quality delivery of healthcare and also to look at the possible ways in eradicating the vices and also approaches to gauging and enforcing quality systems and standards. The report also discusses the delivery of quality service by involving the service users and how this will help in promoting quality and effective delivery at The Royal United Hospital Bath. The primary aim of this report is recommend and facilitate the ways of improving quality in healthcare and social organizations through monitoring, regulating, and implementing every aspect of service delivery. In addition, the report recommends various means of improving quality at The Royal United Hospital Bath by classifying factors influencing quality and the areas of improvement. Finally, the report also targets to evaluate different structured approaches to achieve high quality of health care deliver by providing evidence in order to define the essentiality of adequate quality management. Introduction Quality of health care and social care aspects has become a serious concern for healthcare settings. In health care and social care, quality is the most fundamental aspect being considered in improving the productivity and efficiency of service delivery. As a matter of fact, quality is defined in a number of ways and literally as the degree of excellence in doing something. In healthcare and social care sectors, quality management is very important in providing the best care for services uses and to achieve high quality outcome. It is extremely important for the within health and social sectors to work efficiently together in order to help them implement appropriate approaches and strategies in increasing the quality of services. In health and social care sector the NHS Outcomes Framework has illustrated five domains of quality as follow; enable people to recover effectives from period of illness or injury, promoting quality of life for individuals diagnosed with long-term condition, avoiding early dead, treating and caring for service users in safe environment by protecting them from abuse and ensuring that individuals experience positive care. In this regard, several countries have developed policies and procedures of health care services with the aim of enhancing the quality of medical science and social care. Therefore, in this report I will be making an effort to answer the learning outcomes and provide evidence based on my understanding of differing perspectives of quality, strategies for achieving quality, evaluating systems, policies and procedures, and also showing comprehension of methodologies for evaluating quality in The Wexham Trust. 1.1 Stakeholders Perspective Regarding the Quality of Health and Social Care Quality is one of the fundamental aspects in case of health and social care services. Within Royal Trust hospital, stakeholders include external and internal partners holding their own views on quality. Quality attribution may vary from person to person depending on the considerations they put into considerations. The three important stakeholders of RUH Bath NHS include CQC team, nurses and patients. CQC team has been identified to be conducting survey in RUH Bath NHS Trust with the aim of ascertaining patients’ experiences and core services provided. The overall health and social care standard is an important consideration for ensuring that the operations of RUH Bath NHS Trust are conducted in accordance with the needs and requirements of the stakeholders for better sustainable performance. In addition, the development and implementation of health and social care related services in RUH Bath NHS Trust that include patient safety, managing risks and medical management among others for fulfilling the expectations as well as perceptions of the stakeholders (Persad & et. al., 2009; Schweppenstedde & et. al., 2004). The Royal United Hospital Bath NHS Trust is involved in ‘Chief Quality Care’ (CQC). This body monitors hospitals, care house, GP surgeries and Dental practice to makes sure that they provide service uses with safety, effectiveness of the services and high quality of care. CQC perspectives on quality are measure through putting service users on the centre of the care, promote independency and equality and improving the performance of health and social care organisations (Park, 2014; Persad & et. al., 2009). The organisation has been performing operations in a transparent as well as open manner, so that the stakeholders have adequate information relating to the challenges along with funds invested for the development of the same. In this respect, Patients expect quality of care in the guise of a robust professional service that ensures optional care planning and delivery that is tailored for their specific status, when accessing services from the RUT and the organisation has been identified to be performing operations on the basis of needs of the stakeholders, Duke University: Department of Community and Family Medicine, (2011). 1.2 Analyse the role of external agencies in setting standards of health and social care External agencies includes Care Quality Commission group, Emergency Care Intensive Support Team (ECIST) among others have been engaged with RUH Bath NHS Trust for developing service and care provisions, whose primary functions are to monitor standards is crucial in health and social care setting in order to achieve good quality of the services. Therefore it facilitates health and social organisations to deliver safe and effective services. CQC as an eternal agency ascertains that health and social services provided to individuals is effective, safe, sympathetic and high-quality treatment and care (Schweppenstedde & et. al. 2014). It also prompts health and social organisations to improve and update their serves. CQC sets standards and monitors their implication within health and social sector (Schweppenstedde & et. al., 2004; Walshe & et. al., 2001). When CQC reviews the performance of providers they focus on one or more of 28 essential sets standards such as meeting nutritional needs and records. For instance, those two standards have not been met in The Royal United Hospital (The Royal United Hospital CQC report 2013). It has been identified that CQC has played a crucial role for promoting leadership and culture of health and social care services by maintaining the quality and performance. At the same time, it is also recognised that external agency has tried to build trust and transparency among the stakeholders with the intention of improving the services of medical science. Moreover, CQC has established a strong relationship standard with the patients for improving the patients care performance. In regards to the RUT, standards should have been part of a structured framework, translated through company policies and procedures to meet the relevant standards. As regulators, the CQC works in partnership with other agencies such as the ISO, SCIE, NICE and the Health and Wellbeing Board. This collaboration ensures there are no gaps of disparity or discord, threatening the aims and objectives of local and national policies. Inspections are carried out unannounced and announced at least once a year on registered organisations to establish whether or not health care services meet the required standards. On the other hand, ECIST has tried to build strong engagement with the valuable staff for providing higher quality healthcare services, which can enhance the leadership opportunity for the organisation. In this regard, ECIST would be facilitated in developing standard relating to admission as well as discharge of patients (Park, 2014). 1.3 Impact of Poor Service Quality on Health and Social Care Stakeholders Poor and ineffective service delivery has greatly impacted on stakeholders in several ways. For this reason, quality measuring is requires in any health and social sector for the maintenance of stability of stakeholders perspectives. In addition, different stakeholders have diverse view of quality, that why is important in one organisation stakeholders to have the same indicator of quality. Referring to the case study, The Royal United Hospital CQC report 2013, poor quality of care has vital impact on services uses such as dehydration due to lack of fluid intake record. The health and social care service is complex and it can be absolutely without errors, however monitoring and measuring of quality aim to reduce the level of poor quality (Walshe & et. al. 2001). In order to identify the impact of poor medical services, it is witnessed according to observation of Walshe & et. al. 2001) that lack of health and social care lead high mortality rate among the patients. And for this reason, operating under inadequate governance framework systems can be responsible for the suboptimal cycles that occur through the various stages of care, and can lead to patients be at risk of harm. As per the CQC’s inspection report on the RUT states “patients were not protected from risks concerning the maintenance of accurate and up to date records” (CQC, 2013). This could have an adverse impact on the patient’s treatment, care, safety and welfare as medical errors are imminent under such conditions. Thus, several problems have infused due to poor nursing operations. Moreover, it has raised critical difficulties for the patients, which have discouraged the overall growth of health care and social care industry around the world. Additionally, poor health service quality has instigated challenges for the patients as well as stakeholders. In addition, the community services and General Practitioners failed in integrating their services effectively. In this regard, it is identified from the stated case study that RUH Bath NHS Trust has been focused on having an appropriate evaluation of improving services for better treatment and care services (Park, 2014). 2.1 Explain the standards that exist in social and health care for measuring quality. Standards are measures, regulations and essential elements in health and social care industry put in place to ensure and monitor that an organisation is held responsible for what they do and held responsible in attaining the set benchmarks. Setting standards can ensure that individuals and patients receive quality services within social and health care sectors at any given time they seek the services. As put across by CQC and standards they set in order to develop quality of services, improvement of the set standards can lead to reduction of errors and increases quality of services in health and social care settings Duke University: Department of Community and Family Medicine, (2011). Setting standards involves keeping records within the health and social care to maintain quality and safety standards whose objectives are to ensure that patients are protected and receives safe and correct care and treatment (Care Quality Commission 2010). The patient record involves adequate information about service user’s care, treatment and medical condition. The patient’s record should be done on regular bases and it should be efficiently assessable when it requires. The keeping of relevant record can substantially improve service use’s experience with the care they receive. It also can raise the level of health professional’s practice. Within RUT, health care quality has been maintained on the basis of certain standards of CQC, National Institute for Health and Care Excellence (NICE) and Nursing and Midwifery Council (NMC) for measuring quality. It has been identified that CQC has adopted quality and safety standards in relation to screening, diagnosis and treatment procedures. The NICE quality standard is national guidance based on which clinical practice is improved and accordingly, healthcare provisions are improved. In addition, NMC standard is to provide ethics, conduct and performance based on which the nurses are required to conduct their operations in accordance with the needs of patients. Together they set the backdrop for programmes that help implement quality, regulate and builds measures to quantify performance against given specifications, for instance; the NICE and NSF’s are involved in the development, training and assessing of service providers. The RUT also has got a quality monitoring systems in place, designed for monitoring and controlling potential risks concerning the health, safety and wellbeing of patients, but patients had been failed in a number of areas Respecting individual’s dignity and rights is other essential CQC standard which is at the centre of high quality care. Maintaining dignity is crucial aspect of health and social care in order to increase the service user’s experience and satisfaction (Royal College of Nursing 2014). 2.2 Evaluate of different approaches to implementing quality systems Efficient and effective measuring of quality depends on measuring. There are there approaches involved in implementing quality within the health and social sectors; they include national standards, clinical governance and clinical audit (Park, 2014; Sorenson and Mossialos, 2007). In order to improve the quality of the health care service in RUH Bath NHS Trust as identified from the case study, it is essential to concentrate on the appropriateness of medical treatment through quality control and Total Quality Management (TQM). In this regard, quality control approach focuses on nursing practice. Clinical audit is a method that doctors, nurses and other health professional measure the quality of their performances against set standards to identify areas of improvement and opportunities to overcome those areas. Its main aim to identify and promotes effective practice which increase quality of services provide and rise service user’s satisfaction. Clinical audit project can involve services provides as well as service users. Two of the main approaches of clinical audit are providing training opportunity and carrying out interview with health professionals and patients. Clinical audit has facilitated in having an effective estimate about the performance of RUH Bath NHS Trust, so that appropriate measures are undertaken for better effectiveness. National guideline has been an effective approach with the assistance of which the organization is able to conduct operation on the basis of ethical as well as performance consideration (Park, 2014; Sorenson and Mossialos, 2007). On the other hand, Clinical governance is a system by which NHS trusts are obliged for continuously development the quality of their care and treatment Clinical governance aims to assure that all members of health and social organization focus at the quality of services. Clinical governance uses the approach of education where the health professionals are trained appropriately. The trainings facilitate service providers to adapt effectively to the new changes of health system which lead to rise of quality. Regarding RUH Bath, there are trainings provided to health care professional. However, they cannot effectively follow those training which cause poor quality of services. Moreover, overall environment of the medical institute needed to be developed for enhancing the quality of health care and social care services (Park, 2014). According to the viewpoint of Sorenson & Mossialos (2007), medical organisations are needed to establish a positive engagement with the staff for enhancing the quality of medical treatment (Sorenson and Mossialos, 2007). Simultaneously, with regard to TQM, incorporating technology is highly essential, which can improve the overall performance of the health care and social care services. In this regard, the report of World Health Organisation (2006) claimed that healthcare organisations should take decisions considering few factors such through analysing the situation and considering the objective of the treatment. 2.3 Analyse potential barriers to delivery quality health and social care services From the case study, the internal barriers of RUH Bath NHS Trust include patient record and equipment. There are possible barriers which could interfere to the process of delivering quality of care and treatment requires (Care Quality Commission 2014). The internal barriers are faced for lack of technological development owing to which the record keeping service of the organisation was ineffective and inappropriate management of service equipment. According to the viewpoint of Jacobs & et. al. (2011), low income based countries are facing several difficulties in case of maintaining the quality of health care and social care services. In this regard, it is identified that geographical access, adequacy and availability has raised numerous challenges, which hampered the quality of health care services. Lack of innovation and competent staff members have initiated challenges for the developing and underdeveloped countries (Peters & et. al., 2008). Treatment cost is also one of the potential barriers of quality health services. On the other hand, availability of drug, treatment equipment and medical staff such as doctors and nurses are the one of the potential barriers of the health care services, which usually initiates challenges in terms of wages and incompetent staff. At the same time, discrepancy can be observed due to the unstable quality and prices of the medical drug. Simultaneously, efficiency of the medical staff, technological intervention, cost and prices of the health care services are the potential barriers of quality health and social care services (Jacobs & et. al., 2011; Peters & et. al., 2008; Ensor & Cooper, 2004). The external barriers of the organisation are social policy and legislation. The organisation has been identified to be ineffective in adopting effective social policies due to lack of social care agencies. In this respect, the company has been effective in providing different communal services for the development of the community as a whole. Additionally, the organisation is recognised to be ineffective in adopting appropriate legislation in terms of healthcare policy and CQC standard. Subsequently, the company faced challenges in performing operations effectively (Jacobs & et. al., 2011; Peters & et. al., 2008; Ensor & Cooper, 2004). 3.1 Evaluate the effectiveness of systems, policies and procedures used in a health and social care setting in achieving quality in the service(s) offered Based on the case study, RUH Bath NHS Trust, in order to ensure the effectiveness of system, policies and procedures of health care frameworks, it is essential to enhance the quality of medical institutes along with nursing approaches. Implementation of effective system, policies and procedures plays substantial part in realizing quality in the delivery of service. This role is played by Care Quality Improvement (CQI) whose main role is to facilitate all health and social professionals to always maintain quality in health care. Care Quality Improvement works through a particular process which helps to analyse, assess and improve the way in which care and treatment are administered according service user’s needs (Care Quality Commission 2014). Their main aims is to establish culture of improvement within an organisation, which may involve using structured planning approach in order to assess and evaluate the efficacy of the current system and procedure in place. In accordance to Evangelical Community Hospital (2013) CQI give various advantages to the hospital process including increase efficacy of services, improving service users satisfaction, establish close teamwork among different departments, raise time saving, and promote high patient’s experience. Implementation of Care Quality Improvement in RUH Bath would facilitate the hospital to build up a strong ground of improving the quality of care provides (Park, 2014; Sorenson & Mossialos, 2007; Walshe & et. al., 2001). Employees can also be involved in maximizing quality of services. The involvement of staff could increase commitments of health professionals and patients satisfaction through motivating the staff by engaging them in decisions making regarding service users’ needs. Health and social organizations should focus on employee engagement within all aspect of care as the staff work directly with service users. Involving staff with developing health care service would motivate them to increase service user’s experience (Park, 2014; Sorenson & Mossialos, 2007; Walshe & et. al., 2001). Involving employees facilitates effective record keeping which has become one of the impediments to achieving quality improvement in RUH Bath. In addition, it has been identified from the case that waiting times for patients is long owing to which it has been ineffective in conducting operations successfully in terms of assistance and medical aid. Contextually, the organisation has adopted plans for reducing waiting times by providing care services on the basis of need or urgency. In addition, the organisation is identified to develop an emergency surgical ambulatory clinic based on which the organisation is able to provide care services to patients with urgency (Park, 2014). In this regard, quality of health care services of RUH Bath NHS Trust would be improved by increasing the medical accuracy of medical practice 3.2 Analyse other factors that influence the achievement of quality in the health and social care service From the case study, it has been recognised that there are certain other factors that have influenced the achievement of quality in case of RUH Bath NHS Trust. These factors have varied effects, either positive or negative, depending on how the health and social sectors reacts to them (Schweppenstedde & et. al., (2014). Constant changes which takes place within the health and social industry in meeting the changes within the sector is proving to be one of the impediments. These social, technological and economic changes require different approaches to develop which may take some times to adapt to. Effective communication and sharing of information is also one of the main factors which can prevent the health and social sectors reaching the required quality they are supposed to attain. Through record keeping as one of the ways to effective communication and information sharing, ensure that service user’s information is kept in appropriate manner and it can be use sufficiently when is require. Patients report should be sensitive to their needs and respectful of their preferences and choices. It also important that service user is provided with clear and understandable information regarding their treatment and care (Care Quality Commission 2014). At the same time, it is also essential for the medical staff to concentrate on the long-term care with the intention of enhancing the quality of clinical care. Moreover, it is highly essential to focus on fund distribution for enhancing the opportunity of increasing the quality. Improvements of health care services are not only relied on policies or system, rather it is also essential to concentrate on the workforce for attaining growth in case of health and social care services. In this context, it can claimed that RUH Bath NHS trust should concentrate on these above mentioned factors, which can influence the quality in terms of health and social care services for users of service expectations (RUH Bath NHS Trust, 2014; Schweppenstedde & et. al., 2014; Francis & Netten, 2004). 3.3 Recommendation regarding health and social care service for improving the quality It has been identified that RUH Bath NHS Trust has been facing certain challenges in terms of patient record, waiting times and emergency equipment. RUH Bath NHS trust should focus on few factors for improving the quality of health care services. In this regard, Schweppenstedde & et. al., (2014) claimed that RUH Bath NHS trust need to incorporate evident based practice approach for enhancing the overall quality of health care and medical services. At the same time, it is also highly essential to concentrate on the audit and evaluation procedure for enhancing the quality of services. Apart from this, RUH Bath NHS trust should promote research culture with aim of enhancing the quality of clinical as well as medication department. Simultaneously, the organisation should encourage researchers for increasing the appropriateness of the medial research and record keeping. Besides, RUH Bath NHS trust should create awareness for its own medical services along with that it is also highly essential for the medical staff to create an environment for the working protocols to minimise waiting times. The organisation is also needed to adopt innovation, so that effective emergency equipment should be accomplished as well as managed through regular review (Park, 2014; Schweppenstedde & et. al., 2014; Francis & Netten, 2004). Respect is also another fundamental factor which needs to be put into consideration. Heath professionals should show respect to their patients in order to uphold their dignity and wishes. When patients feel respected, they are being valued as an individual that may lead to rise of their level satisfaction 4.1 Evaluate methods for evaluating health and social care service quality with regard to external and internal perspectives It is highly essential to evaluate the effectiveness of health and social care service quality with the aim of improving overall performance of healthcare organisations. For this reason, there are several ways of evaluating quality of service which may include the use of survey, questionnaires, complaint procedures and the clinical audit. Survey and questionnaires are used among the health professionals and service users to evaluate the quality of service. These will help to identify areas of improvement, measure level of satisfaction and provide information about patient’s expectations. The useful survey should be valid which could be achieved be focusing on currant problem and reducing errors. Clinical audit plays a fundamental role in evaluating quality as it identifies areas of improvement, supplies health and social settings with relevant information in order to prove the effectiveness of services, provides appropriate training opportunities, facilitate organisation to effectively use the available recourses, and it could improve the relationship between patients and health professionals Based on the case study, conducting a qualitative survey based on audit reports and company reports would ascertain in having suitable information about the performance and quality standards. In a qualitative survey, the results lack reliability to a certain extent due to lack of in-depth analysis (Park, 2014; Malley & Fernández, 2012). In this regard, the best method to be adopted by the organisation is questionnaire and survey, as these two methods would ensure in having appropriate understanding about the quality and care services offered. 4.2 Discuss the impact that involving users of services in the evaluation process has on service quality From the case study, it can be claimed that with the assistance of evaluation process, it would be possible to determine the quality and the effectiveness of RUH Bath NHS trust in terms of health and medical care services (Care Quality Commission 2014). Apart from this, the evaluation process would also help to determine the appropriate execution and implementation of the clinical care on the basis of evident based approach. In this regard, the organisation with the involvement of service users in the evaluation process is facilitated with the opportunity of having an in-depth understanding about service quality offered. In addition, the involvement of service users is recognised to be ineffective for the risk of obtaining bias feedback. In the evaluation process, the service users are able to offer appropriate information in relation to the services provided. On the other hand, evaluation will also be liable for consultation and empowerment. Evaluation based on service users will be less time consuming, but the findings generated may lack validity (Park, 2014; Schweppenstedde & et. al., 2014. With the assistance of appropriate evaluation process execution, it would be possible to identify the efforts of RUH Bath NHS trust to improve the quality of the health care in terms of reducing health risk and diseases among the population. Moreover, it would also define the procedure based on which RUH Bath NHS trust has benefitted the patients through the quality of the health and social care services. Apart from this, it can be also claimed that with the assistance of evaluation process, it would be possible to identifying the aid and quality of RUH Bath NHS trust along with its target area where the medical organisation has concentrated its utmost effort for enhancing the quality of clinical services. 5.0 Conclusion Based on the above discussion, it can be comprehended that the primary aims of enhancing the quality of health and social care services to protect the life of people and to ensure safety and security for patients. Moreover, it is identified that medical organisations need to adopt certain measures to improve the quality of health and social care services. In this regard, it can be identified from the case study that RUH Bath NHS trust has faced certain challenges owing to which the performance of the company was affected largely. Thus, it can be recommended that the company needs to use internal and external analysing measures for having effective information about medical needs of patients for enhancing the quality of health and social care services. 6.0 References Sussex, F., Frances, S. & Herne, D., 2008. The value base of health and social care. In: L. M. Nicholson, ed. Advanced Health and Social Care for nvq/svq level 4 and foundation degrees. Edinburgh Gate: Heinemann, p. 79. Ensor, T. & Cooper. S., 2004. Overcoming Barriers to Health Service Access: Influencing the Demand Side. Health Policy Planning, Vol. 19, pp. 69–79. Adams, S., 2012. Hospital closures inevitable and NHS operation rationing will continue, warns think-tank. [Online] Available at: http://www.telegraph.co.uk/health/healthnews/9365881/Hospital-closures-inevitable-and-NHS-operation-rationing-will-continue-warns-think-tank.html [Accessed 20 02 2014]. Care Qualty Commission, 2014. The essential standards. 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