Managing Quality in Health & Social Care - Case Study Example

Introduction: There has been a widespread debate on the definition, measurement and management of ‘quality’ in the healthcare field. Quality has been defined in this area by many authors in many different ways. The measurement of quality and knowledge about the standards of quality is one of the major success factors in service industries like medical and health areas. According to Lee & Jones (1933, p. 6) ‘good medical care is the kind of medicine practices and taught by the recognized leaders of the medical profession at a given time or period of social, cultural, and professional development in a community or population group.’ The institute of medicine (1990, p. 4) describe quality in the healthcare field as ‘Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.’ There are many definitions of quality in healthcare but it depends on the individual what quality means to him as per his implied values and perceptions about the extent of care in healthcare arena. Different Perspectives about ‘Quality’: The standards of quality are different for each group related to the field. The major stakeholders like service users (patients), service providers (hospitals, healthcare agencies etc.) and regulatory bodies (legislators) have different concepts of quality and hence, it is quite difficult to maintain a level of quality which is sufficiently suitable for all of the stakeholders. Quality in healthcare for service providers may be divided into two types practically, which are internal quality and external quality. Internal quality refers to setting standards and meeting them by improving the internal functions of the healthcare organization. However, external quality refers to the expectations and demands of the users (patients) in order to maintain good reputation which is of immense importance for any business. Quality may also be categorized from the users’ perspective into 3 categories which are expected quality, perceived quality and actual quality. The expected quality today, is overwhelmingly high due to the technological advancements and increasing competition in every field. The customers’ expected quality is often too high to leave an expectation gap to be filled in by the management of the healthcare service provider. This expected quality is transformed into perceived quality when the users start using the service. The expectations are then changed as per the conditions of the healthcare organization, the behavior of staff, the nature of services provided, the care given and so on. Actual quality then translates the experience of the user. It represents the final impression or experience of the quality of healthcare identified in the situations that were prevalent that time. Regulators, on the other hand, may give more importance to safety over autonomy. They would set strict rules when it comes to patient care, medications and treatment. The quality is hence, more influenced by the standard of care according to them. The service providers give more importance to interpersonal relationships, qualification of staff and expertise of staff in order to imply that their quality of service is higher and more reliable. Users of such services will be more motivated to assess the quality based on the behaviors, timeliness, medications and proper treatment provided by the healthcare organizations (Noelker & Harel 2001 pp. 101-102). Dimensions of Quality: It is important to understand the dimensions of quality as they relate to the healthcare services. These dimensions help in improving and maintaining the quality of services. The Institute Of Medicine (IOM) has proposed the multidimensional framework for quality assessment and improvement. According to this framework the safety of patients and assistance to them helps in building the quality stronger. The safety of patients is more important than the outlook of the building; hence, more care is the key to the quality of healthcare services. Effectiveness and efficiency are considered as two important dimension of quality care as they direct towards the utilization of resources, knowledge and skills in an appropriate manner. They stop from wastage (either by overuse or deterioration due to underuse) of resources (Shekelle 2008, pp. 16-17). The effective and efficient use of scientific knowledge hence builds and maintains the standard of quality in the long run attaining customer loyalty and trust. Patient-centeredness is also an important factor that deals with focusing on the needs, expectations and values of patients who are the ultimate users of services provided by health care organizations (Shekelle 2008, p. 17). Timeliness is yet another factor which affects the perceptions of quality in the service users mind. Unusual delays may be harmful and unacceptable for the patients who are in distress or have a tight daily life schedule. A quality care is provided on the basis of equitability i.e. without bias on any basis. The equitable provision of health services maintains the same level of care and safety procedures for all clients regardless of their gender, race, social status, educational level and financial background (Anderson, Rice & Kominski 2007, p. 214). Models of Quality: Keeping in view the importance of quality in the healthcare field, it becomes important for individual organizations, healthcare agencies, governments and other concerned organizations to adopt, implement and review policies and regulations to improve the quality of care. Individual hospitals maintain their quality in order to build goodwill and earn business and name. However, international and national laws are designed and implemented to aid the suffering people and provide them with the care appropriate for them in certain circumstances. National Continuous Quality Improvement Tool can be taken as an example of such struggles at national level to aid the mental health service users and provide them with quality care (University of Lincoln 2005). Care Quality Commission (CQC) is also an important individual and autonomous regulator of social and mental care. It has statutory duties to keep reviewing and assessing the performance of Primary Care Trusts (PCTs). The CQC aims to provide improved quality of care to the users of healthcare services. It publishes the results of assessments and reviews to maintain a level of competence by the individual health providers and trusts (Great Britain 2010, pp. 285-286). Ofsted keeps records of the social care providers, track their performance, and inspects their operations in order to ensure that they follow the relevant regulations and national minimum standards. It keeps a check on the quality of services being provided by such organizations and is responsible for their registration (Great Britain 2009, p. 62). These and other organizations and health departments work together, in order to provide better care and quality to the patients. Total Quality Management is one of the crucial models of quality improvement and standardization. The TQM model ensures that the internal functions and operations of the organizations are sufficiently accurate by decreasing or eliminating the chances of errors, improving patient satisfaction level, using up to date technologies, employing well qualified staff and healthcare staff and provide training facilities to staff when needed. Six Sigma model ensures high quality services by identifying and dealing with the issues which end up creating defects or errors. It divides the whole staff in a distinct infrastructure of employees of the healthcare organization (i.e. Black or Green belts etc.). Continuous Quality Improvement emphasizes on both internal and external areas which can be improved to provide a higher quality of care and services to the customers. This approach does not merely depend on the defects to identify the areas which may be removed but instead it approaches the weak areas where improvement is possible whether or not that area results in defective outputs. Continuous Improvement Process (CIP) is the process where businesses aim to identify and improve the areas on the basis of their level of efficiency, effectiveness and flexibility. All these standards and processes are set and reviewed for their outcomes by CQC, ISO, NICE, NHS and other healthcare concerned organizations and departments. The standards are set externally by national and governmental organizations, whereas, internally standards are set and managed by local authorities and by organizations themselves to maintain the quality of their services. The external agencies like Care Standard Commission, Local Authorities and Government departments help in setting the basic standards of quality care for all health organizations. They highlight the major areas of concern and evaluate the actual operations of healthcare organizations to identify any shortcomings. These agencies provide frameworks and guidelines to the healthcare organizations and professionals in maintaining and providing quality care to the patients whose comfort is the main concern for such agencies. Strategies used for achieving quality in health and social care services: “A standard is a level of quality against which performance can be measured” (Northern Ireland 2006, p. 2). It is difficult but not unreachable to achieve quality in health and social care services across the country. The IOM defines 3 key standards of quality to be achieved. These standards may ensure the quality of care to be consistent and reliable. These quality standards of IOM include “(1) Minimum levels of acceptable performance and results, (2) excellent levels of performance or results, or (3) the range of acceptable performance or results” (AHCPR, 1995 p. 14). In the same respect some other terms are also relevant. The Benchmark, for instance, is the level of care which is determined by a suitable criterion and is set as a target to be achieved. A suitable criteria to set the targeted level of care is derived either on the basis of equivalent services provided in an organization in different departments (internal benchmarks) or may be set at a level derived from the best external competitor’s quality standard (competitive benchmarks) and so on. A standard of care is another standard for measuring quality. It is more related to legal proceedings and legal context. The standard of care is determined by the law and a healthcare organization is held liable for the legal proceedings if this level of care is violated. The standard of care is also used as a regulatory measure to register, certify or license only those organizations and professionals who meet the minimal requirements of policy, equipment and capacity. These required levels of resources and care help in reducing the risks of harms and negligence and help in achieving the quality care for people (AHCPR, 1995 pp. 14-18). The standards should be measurable, achievable, Relevant and Timely if they are aimed to be successful for a long run. The implementation of quality systems is a complex method as it requires careful planning, reviewing and measurement of the success of the standards being set. The effective implementation of quality strategies is dependent on the approach being undertaken. A simple approach of planning and carrying on the plans may or may not be successful even if the plan is carefully constructed. The reason behind this uncertainty is the requirement of flexibility to modify, update or alter the plan completely if required. Hence, planning alone does not ensure the success. There is a need to review the plan if the measured progress is below or higher than expected. A vast difference between expectations of a strategy and its actual outcomes often indicate a flawed plan or strategy which further directs towards revising the plan. The policies and procedures should be set out carefully which support the planned outcome and do not contradict with the organizational goals. The target setting process is the key area of concern as it may help in assessing the performance of the organization in terms of quality service provision. Auditing and internal quality checks may help in analyzing any errors, policy or rule violations, variations from the planned strategies etc. Internal auditing helps managers and concerned professional in identifying areas of strategies which are working as planned and areas where there is a need for further improvement. It helps in monitoring the performance of the organizations in terms of their quality standardization and improvement strategies. The implementation of quality strategies also need to emphasize on the availability of resources like equipments, personnel, accommodation, medication, professionals etc. If there is an inadequate amount of resources, the inadequacy needs to be filled in first. The communication of organization’s strategy and targets is another important feature of implementation of quality systems. The information about the plans, roles of each employee and targets would be communicated clearly. Training programs and campaigns must be offered for those who are weak or require polishing of their skills to quicken the process of target achievement. The quality systems are of great value to its stakeholders. The quality systems in health & social care setting are of immense importance for the fact that these areas are of particular importance to the government as well as general public. The care required in these areas is higher than other areas like employment, education etc. Those areas are equally important but the sensitivity of healthcare setting requires more carefully planned operations and stricter regulations. Safety is one of the main concerns which are achieved by quality systems. The National Patient Safety Agency (NPSA) aims to help in achieving safer processes in healthcare organizations for patients. This agency collects information of adverse cases and incidents and provides detailed notes, information and relevant data on how to improve a particular situation or avoid harms to the patients (Donaldson & Scally 2009, pp. 246-248). The quality in healthcare is important as reported by Institute of Medicine that more people are killed due to medical errors than by breast cancer, vehicle accidents and AIDs (Rosenbloom 2005, p. 221). The establishment of quality systems in health and social care setting is also important because these strategies will help in reducing the overuse and underuse of health care services. The health regulations and quality assurance strategies will develop an awareness of keeping patient’s safety and health on priority to profit making and business development. The quality systems help the service users in attaining the healthcare services which are appropriate, efficient and reliable. The patients who are the users of healthcare services require accuracy of their health reports like x-rays, blood test reports, ultrasound reports and so on. The quality systems developed within a healthcare organization help in maintaining the up to date resources as well as the expert staff. It ensures that the staff working is competent and the resources are technologically advanced. Hence, patients feel more comfortable with the well-qualified and trained staff treating them. The care workers feel more comfortable with the training facilities, preset goals, and well communicated criteria, quality products and helping staff available to them and so on. Such facilities and guidelines help them in reducing the number of errors. The regulations and laws further motivate them to improve their performance. The regulators and law enforcers are able to review their policies and regulatory programs by assessing the performance of their current laws being implemented in the healthcare organizations. If the policies and laws are not sufficient to achieve the goals of quality they review and revise them. There are a number of barriers in implementing improved quality strategies in healthcare organizations. These include rising expectations, increasing demands due to rising population and immigrants, the continuous improvement and changes in technologies, treatments and disease. The rising costs have been one of the most important issues in implementing these strategies. The costs related to the strategies is higher for the smaller organizations hence, it becomes difficult for them to implement the changes effectively. Evaluation of Quality systems at Workplace: There are a number of procedures, systems and policies which healthcare organizations may adopt to improve the processes, healthcare facilities and profitability of the business. The organization which I work for, has implemented on the most useful tools to evaluate the performance of the healthcare procedures being followed. This tool is widely known as Continuous Quality Improvement (or CQI). This approach is, however, not the sole tool or policy of my workplace but t works in collaboration with other procedures like shared decision making. The need to change or decide between processes and options is important because not all options are equally profitable for the organizations and the users. In order to achieve the quality standards which are not only acceptable but are also given priority by the service users is aimed to be achieved. The goal of the organization, which I work for, is to maintain the quality of services along with maintaining the level of competence in terms of expenses and professional advice for children and young adults’ health related issues. The CQI approach is helpful in stepping forward to act rather than formulating a flawless and perfect plan to work on. This approach led our organization to start up with a plan which was not meant to be the only guide for the success or running of the business but it was set as a starting point. The CQI approach provides a flexibility of changes in the plans and provides the concept of adaptability to changes if required. This approach helped the organization as well as the employees to work in an efficient manner by identifying the weak areas and include them in the revised plan to improve the results or quality of services. Shared Decision making is another process which helped a lot in maintaining the quality of care in health and social organizations. It is a process, whereby, the healthcare or social organization and the user of the service work together in adopting the appropriate method or treatment for their purpose. In our organization it benefitted the issue which was identified as the dissatisfaction between patients due to insufficient information about disease and treatment. The shared decision making process helped in achieving patients’ satisfaction level due to enhanced knowledge about treatments, disease and possible outcomes of the medications adopted. The patients also felt more comfortable with this approach because of their own role and choice in adopting a particular treatment. This helped them in accepting the outcomes of the treatment or choice adopted. In case of children and young adults, the parents and guardians take the responsibility on behalf of the patients. The decisions are made by knowledgeable individuals with supporting advice from professionals, hence, the patients and service users feel more comfortable, satisfied and confident about the work of organization and its expertise of dealing with situations under consideration. The shared decision making approach is costly, not only in monetary terms but in other ways as well. This process requires much time of the professionals like doctors, nurses and health advisers to justify their claims, gives reasons for their recommendations, explain the possible effects of the treatment, define other choices and help in identifying the critical risk factors of each choice. This process require an expert with the important information and knowledge which may satisfy the user of the potential outcomes, help in explaining the different procedures and treatments. The cost of professionals’ increases as the time required for their services increases. The need to acquire tools like projectors, computers, pamphlets etc. also arises in order to help the users attain knowledge easily. It is also not certain that every user of the service may be able to understand the matters completely or accurately. Wrong decision making may occur due to miscommunication or misunderstanding of facts. Hence, the attitude, culture and behaviors are all involved in adopting this approach (Earp, French & Gilky 2008, pp. 190-204). The CQI approach needs more efforts from the organizational staff, the weaknesses at the users’ end are biased or wrongful judgments/comments of the users about the quality of services being provided. There are many other factors which need to be considered before adopting an approach for the organization. The size of the business or healthcare organization in our case is an important factor. For a smaller organization, it is often difficult to adopt any policy which requires continuous track of its success. Such organizations observe little changes in the patients’ behaviors or trends in business profitability as the process of development is relatively slow. For our organization, CQI was an appropriate step to move forward in achieving the goals as it helped in retaining the regular users of the service and the technological advancements which were continuously being incorporated within the system helped in maintaining user satisfaction and trust. The Servqual model is recommended to improve the performance of the organization more. This model enables the organization to fill the existing gap between expectations and actual result of the services being offered. The main idea behind this approach is to keep users’ demands on the top of the priority list. This user-focused approach helps in high levels of user satisfaction, lower complaints and high retention rates. The SERVQUAL model enables the management to judge and analyze Service Quality (Sarathy 2006). It helps in identifying the gaps between customers’ perceptions and their observation of the service. This model also encourages the management to identify any gaps between management’s perceptions and customers’ expectations. It opens a widespread debate for organization over the effectiveness of the system being employed. "The gap model is one of the best received and most heuristically valuable contributions to the services literature (Brown and Bond 1995)". This model is helpful for the managers as it identifies the critical improvement areas and the manager may be able to find out the changes which will be more fruitful. This model, hence, works like CQI and provides a continuous basis of improvement to the organization. It helps in maintaining the reputation by changing the facts which may be less beneficial for the healthcare organization. Evaluation of Service Quality: The CQI tools provide a systematic way for evaluating the service quality in health and social care like Pareto charts, probability, histograms, control charts etc. However, the first step in evaluating the performance of any system, policy or plan is to identify the areas which need improvement or procedures which are not working in a proper way. There are several ways to identify the weak areas or to identify the outcomes of the procedures and policies adopted. Customer experiences, surveys, interviews, questionnaires, focus groups, structured and semi-structured interviews, panels, complaints procedures etc. are all helpful in evaluating the weak areas and the actual results of the efforts made. The actual results may then be compared with the expected results to identify the unnecessary or unusual differences that exist. The management may then be able to identify the possible reasons for such variances and try resolving the issues. The method used by my organization was customer complaints and client comment cards to evaluate the weaknesses that existed. It was a successful way of measuring the performance of policies currently used as the main focus was to satisfy the customers with the quality of services being provided. Prioritization of the weak areas helps in identifying the problems which are acting as hurdles in the way of achieving organizational objectives. These problems or issues are then incorporated in the plans quickly to be resolved. The fishbone diagram is another important way of measuring the success of changes made. It helps in identifying the causes and effects of every change or procedure of the policy (Sarathy 2006; Martin & Henderson 2001). The quality evaluation technique was not subject to a single idea or process but different strategies were used to evaluate quality from different perspectives. The customers’ or users’ evaluation or judgment about the quality remains one of the most important indicators of actual quality achieved. Customer surveys, interviews, comment cards and complaints were all used in order to identify the areas which are the most problematic to customers, evaluate the areas which remain the most important factors for customer retention and trust and identify the changes which customers want or expect. The users interview, surveys and comments were valuable as well as the complaints they made. These helped in identifying the areas of success which involved professional staff, medication and technologically rich environment. However, the concern of the users of the service was the lack of maintenance of rooms, cleanliness and space. When investigated further, it was identified that users’ expectations were high due to the reputation of the organization and maintenance and space needed careful attention by the management. Moreover, the attitude of lower level staff also counted towards negative attitudes of the users. The training and educational programs were helpful in overcoming these limitations. The use of CQI helped in overcoming many such problems as identified and the reputation of my workplace is still maintained. The SERVQUAL model is recommended to answer the gaps between expectations of users, management and other stakeholders (Sarathy 2006). The control of processes, involvement of staff, patients and professionals and management leadership also helped in evaluating service quality in health and social care in my workplace. Data collection is another way through which quality can be analyzed an evaluated. Indicators are being used at my workplace to evaluate the services. Data collection is a complex process which involves the collaboration of information into the standard indicators. This complex process is tackled such in our company that everyone in our workplace takes enough responsibility that the burden is decreased. Nurses at our workplace have the specific role of determining which data has to be entered and which not. This helps to manage the data properly so that it can be evaluated easily. Quality of healthcare can be maintained through these processes if one notices any distortion in the results of these data collection methods. Electronic sources these days are very important in evaluating service quality as hand written data collection methods are quite difficult to evaluate. Electronic sources prove to be an important source of data evaluation in our company as they help to manage the records of the patients in the healthcare field. Teamwork is an important factor at our workplace which helps in determining the quality of healthcare. Hence our workplace follows the role of team work and divides the labor accordingly so that the individuals do not have a workload which may distort the results. These results can then be compared to the standards to check as to if our quality is satisfactory or not (RCN 003 535; Martin & Henderson 2001). The key to our evaluation techniques is awareness amongst our members. Membership at our workplace is organized in meetings such that all the members are told about the happenings at the workplace. This helps to inform every member about the possible problems that our workplace would be facing. The shareholders define the set of goals at our workplace so that everyone has to work in collaboration to achieve these goals. Research methods are also important in governing our quality care. These research methods are adopted by individuals to check the satisfaction of the patients that visit our workplace. These research methods help to identify the problems and hurdles that our company is currently facing and provides us with challenges which can try and overcome. In other words research allows us to carry out our tasks in accordance to the need of time. Healthcare society is a broad society which needs to be looked upon with the help of different methods. All these methods are then analyzed together by different teams to see how our workplace is progressing with the need of the society. Evaluation is then done at separate levels of hierarchy so that everyone plays a role in evaluating quality care. Quality care is a part of the system which should be looked upon properly by every company and different methods adopted by our company which ensure that quality is maintained throughout our course. Moreover electronic sources are very important in completing these tasks of evaluation (RCN 003 535). Conclusion The quality is given an important place in the healthcare field for the fact that it helps in maintaining the level of care for the patients and suffering people. The standardized care and treatment maintains a level of justice for all on one hand and helps in building users’ trust on the other. The principles of care are not violated if the quality models or standards are implemented and followed appropriately. The quality models are designed by a patient-centred attitude which focuses on higher level of satisfaction of patients. This satisfaction is only possible by true care, proper treatment and appropriate medications which answer the principles of care. Our organization is working with all the relevant evaluation methods so that we do not encounter any problems in the future. Any problem that we face is tackled together by everyone in the organization with the help of teamwork. The methods of evaluating quality in our organization have been quite successful up till now and it is possible that they would be successful even in the future (Anderson, Rice & Kominski 2007; Sarathy 2006). Bibliography: INSTITUTE OF MEDICINE (U.S.), & LOHR, K. N. (1990).Medicare: a strategy for quality assurance. Washington, D.C., National Academy Press. LEE, R. I., JONES, L. W., & JONES, B. (1933). The fundamentals of good medical care. Publications of the Committee on the costs of medical care, no. 22. ANDERSEN, R. M., RICE, T. H., & KOMINSKI, G. F. (2007). Changing the U.S. health care system: key issues in health services policy and management. San Francisco, Jossey-Bass. SHEKELLE, P. G. (2008). Does public release of performance results improve quality of care?: a systematic review. London, Health Foundation. GREAT BRITAIN. (2010). Commissioning: written evidence. London, Stationery Office. UNIVERSITY OF LINCOLN. 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