Managing Quality in Bath Royal United Hospital - Case Study Example

REPORT Managing Quality in Health and Social Care Title: Case study of Bath Royal United Hospital – perspectives of quality, strategies and systems for achieving quality, and methods for evaluating quality Contents EXECUTIVE SUMMARY 2 STAKEHOLDER PERSPECTIVES ON QUALITY 2 Stakeholder identification and analysis 3 9 Cs analysis of RUH Bath 3 Explanation / comparison of key stakeholder perspectives at RUH Bath 6 Role of peripheral agencies in setting values and explanation of existing standards relating to RUH Bath 7 Impact of poor quality on key stakeholders relating to RUH Bath 8 QUALITY SYSTEMS, POLICIES & PROCESSES 9 Evaluation of the clinical governance framework and a clinical audit process at RUH Bath, and discussion of how these are implemented 9 Evaluation of the effectiveness of policies, methods or systems supporting quality and quality improvement at RUH Bath 9 Analysis of barriers and other factors influencing delivery of quality and implementation of quality at RUH Bath 10 EVALUATING SERVICE QUALITY 11 Methods for collecting information on (measuring) service quality at RUH Bath 11 Methods for involving service users in the quality evaluation process, and the impact it would have at RUH Bath 12 CONCLUSIONS & RECOMMENDATIONS 13 REFERENCES 14 EXECUTIVE SUMMARY Royal United Hospital, Bath as a nationally accredited hospital remains focused in offering the best practice, maintaining highest standards of clinical, and customer care to the patients. The facility treats tens of thousands of patients annually. However, in the past years, the facility faced remarkable challenges in offering quality improvement in the service and care to the customers. However, with recent developments as reports such as the CQC indicate that there is an improvement in the quality of care. This report evaluates the perspectives of various stakeholders in RUH bath, assessing their views in depth over the quality of service within the facility. It also evaluates the procedures applied in the context of the facility in measuring the quality of service and procedures for improving quality care by the facility. Further, it also evaluates the procedures of gathering information used in assessing the level of performance of the hospital as well as the performance assessment techniques. Further, it evaluates the limitations and challenges to the implementation of change strategies that focus of initiating quality involvement at RUH Bath. STAKEHOLDER PERSPECTIVES ON QUALITY The health care subject remains critical in addressing the health concerns of the communities near these social amenities. In the case of Royal United Hospital, in Bath City, there are several areas of concern regarding the quality management of the care and services provided by this facility. Despite the facility being among the few under the support of the national government in offering services within the city, the subject of quality of service remains key. There are several stakeholders within this facility, and whose perspective on the quality of care and service of the hospital is essential. These stakeholders include the governance board, the health professionals, and staff of the facility, the neighbouring hospitals that compete with the facility and the patients. Additionally, other stakeholders include the community, the quality inspection agencies, financiers, and partners of the hospital. Stakeholder identification and analysis 9 Cs analysis of RUH Bath Type of stakeholder Identified stakeholder Perspective on quality at RUH Bath Consumers/ Customers Patients of the facility and the community around the hospital Initially, before the execution of the first report of the Care Quality Commission, the patients in the hospital complained of prevalent cases of negligence and poor service. The staff showed an attitude of being carless for some sections, especially the A&E department as well as the surgery section. However, with the recent developments, the patients and community of RUH, Bath report improved quality service, with limited cases of negligence and delay in attending to the patients on part of the nursing staff. Contributors The health professionals and staff of RUH Bath The professionals in the hospital complain of under staffing as a contributing factor to the inefficient quality of service. Further, professional development programs for the staff, including workshops and other necessary training also affect the quality of care. Moreover, the staff and health professionals also cite inadequate resources such as accommodation facilities and medical supplies as affecting the quality of care in the facility. Therefore, they cite these as key concerns in providing quality care in the hospital. Commentators Care Quality Commission and the auditing agency According to the CQC chief inspector, the RUH faced significant challenges from 2012 to mid 2013 due to the high demand for its services. The capacity of the hospital could not accommodate the emergency and admissions cases. However, in the recent reports, the CQC reports that RUH is improving the quality of its service significantly. The audits office states that the hospital is open with its use of funding in seeking alternative solutions to improve the flaws in the in and out sections of the hospital. Thus, with these developments, the quality of care in the hospital is improving, although at limited pace. Collaborators The partners such as the community, the university of Bath, the Council BaNES The partners of the RUH are a significant faction in the facility. The community provides social support to the facility. However, they cry foul of the quality of service they get from the hospital. The University of Bath nursing and medical students do attachment in the hospital and some later get jobs in the facility. With respect to quality, they cite that the facility needs to improve on the quality of service, with respect to resource management and staff attitudes towards quality. Commissioners The governance and leadership of hospital The leadership of the hospital, including the board of trustees and directors of the hospital departments hold that the hospital facilitates quality care. They envision external factors such as adequacy of resources and facilities as the cause of the current state of quality in the hospital. Contributors financiers The hospital receives financial support from the national and local governments as a facility sponsored by these authorities. They insist on the essence of improving the quality of care in the facility. They defend the position that the facility is up to standards and that it offers services accordingly. Table 1: 9Cs stakeholder analysis regarding quality at RUH Bath Explanation / comparison of key stakeholder perspectives at RUH Bath There are three key stakeholders within the operational sections of RUH Bath. These stakeholders include the health professionals and staff of the hospital, the patients and the monitoring bodies. The perspectives of the first two stakeholders that are the health professionals and staff of the hospital versus those of the patients contradict each other. The perspectives of the monitoring bodies present the meeting point, as it is a neutral and external stakeholder in the issues of the hospital. In comparing the perspectives of the two contradicting stakeholders, the first that is the health professionals and staff holds external factors as the causes of the state of quality in the hospital. For instance, they point factors such as the inadequacy of resources and facilities, as well as, inadequate staffing as the cause of the deteriorating quality of service in the facility. However, they hold that the quality is not as poor as other stakeholders envision. However, the patients who are the consumers of the service hold that although there are improvements in the quality of service, there is need for further improvements. The patients hold the internal factors such as the attitudes and inefficiency of skills of the staff as the cause of poor quality of service (The Care Quality Commission (CQC) has expressed concern that staff did not recognize signs of patient abuse at Royal United Hospital’ 2011). These are the perspectives as these stakeholders hold on the quality of care at RUH Bath (Research Data from Royal United Hospital Update Understanding of Angiology, 2013). The monitoring bodies, consisting of the auditing council and CQC hold a neutral ground, evaluating the factors affecting the quality of care and service in the hospital. The CQC reports that both factors as cited by the first two stakeholders affect the quality of care in the hospital. They state that the aspect of resources and facilities for working for the staff affects the quality of service. Similarly, the attitudes and skills of professionals also contribute to the state of quality in the facility. The CQC alongside the auditing council reports that the quality of resource management, service and care delivery is improving but is lacking in earning the status of being satisfactory. Role of peripheral agencies in setting values and explanation of existing standards relating to RUH Bath The Care Quality Commission, CQC holds the sole responsibility of safeguarding the consumers of hospital care services. The process of safeguarding encompasses protecting the health of people, the rights and wellbeing of patients, free from abuse and neglect. The commission executes its duties of gathering information to supervise and account on the quality of service of the health care facilities. It also refers cases, which require further investigations to the relevant offices such as the police and local authorities. The commission also contributes in policymaking and recommendations at the national level of the health ministry. Therefore, with these responsibilities, the CQC is among the notable external agencies that define the standards that RUH uses in operating its facility. In relation to the case study, the principles of CQC are critical in guiding the operations of the facility. RUH uses these principles as standards to define the guidelines and limits of its operations in the endeavour to achieve quality care. The standards include the commitment to being a high-performing organization, promoting equality, diversity and rights of the people. These standards rigorously influence the operations of RUH Bath. The trustee board is another external body that dictates the operations and standards within RUH. The board of trustees incorporates participants from the partners of the facility and members of the community. This body works in conjunction with the managing board and directors of the hospital to establish the standards and regulations on the quality of service in the facility (Hewison, 2013, p 268). Thus, as external participants, the trustees are key in the running of the facility. However, the organizational culture limits the complete execution of the standards and recommendations of various oversight bodies on the facility. Thus, such challenges limit the implementation of the standards as recommended by the external agencies. Impact of poor quality on key stakeholders relating to RUH Bath The poor quality of service within the confines of RUH Bath has notable consequences that can ground the operations of the hospital in the future if not addressed. The poor quality on the patients as stakeholders within the facility affects their personal lives as well as their affiliation to the facility. The patients have a right to access quality and effective services from the healthcare facility. Therefore, in the event of deteriorated quality, the patients as stakeholders can instigate legal procedures against the hospital leading to termination of its license. Additionally, the patients withdraw and attend other hospital facilities that offer quality care, leading to disserting of the hospital. In view of the staff and medical professionals, the poor quality of the facility reflects as failure on their responsibilities, leading to questions of their skills and qualifications. The management of the facility also faces the threat of losing their leadership positions when the service under their leadership is of poor quality. The partners and financial supporters withdraw their services when the quality of RUH Bath is poor, a factor that affects operations of the facility. Further, the CQC as a stakeholder may recommend termination of license of operation of the facility when the service is of poor quality. (‘United Kingdom: CQC publishes report from listening activity at Brighton and RUH Bath Hospitals NHS Trust ahead of full trust inspection in May’, 2014,) These consequential actions on the stakeholders and by the stakeholders result from the poor quality of service and care at RUH Bath. QUALITY SYSTEMS, POLICIES & PROCESSES Evaluation of the clinical governance framework and a clinical audit process at RUH Bath, and discussion of how these are implemented The governance framework of RUH incorporates several departmental heads that constitute the organizational structure that ends with the formation of the governing board of the facility. There is the Trust Board, whose responsibility is to facilitate and oversee the policymaking, overall performance and strategic leadership of the facility. The Board consists of non-executive directors who are the people selected from the community and partners, as well as, executive directors who consist of active health professionals within the facility. Within this board, there is equal and sufficient representation of the various stakeholders, leading to the culmination of the stable leadership within the hospital. The audit cycle incorporates an external auditing body whose role is to oversee the utilization of recourse within the hospital. The facility utilizes the recommendations of the audit body to formulate polices and further the changes as expected within the running of the facility. Evaluation of the effectiveness of policies, methods or systems supporting quality and quality improvement at RUH Bath In recommendation, the evaluation of the effectiveness of the policies and systems for supporting quality improvement in the facility should incorporate the following techniques. The first technique is the Continuous Quality Improvement (CQI, which incorporates four basic steps (Bowling & Ebrahim, 2005, p 223). This method for evaluating the effectiveness of policies and systems of supporting quality of service incorporates a plan from evidence. After evaluating the evidence and setting the plan, then the next step is ‘do’, in which the facility provides the service as intended. The following step is to study, in which the facility reviews and analyses the data from the progression of procedures and lastly us the ‘act’ stage, in which there is adjusting of the practices based on findings. This continuous method of evaluating and implementing change will foster the operations of RUH towards quality improvement of the service. The employee Involvement Initiative is another strategic approach to engage all staff in quality improvement and control (Yardley & Marks, 2003, p 121). The employee involvement initiative will incorporate the participation of the medical professional and staff of RUH in extending the quality of service in the facility. The involvement will encourage the staff to accept and support the implementation of changes in the facility towards achieving quality improvement. Analysis of barriers and other factors influencing delivery of quality and implementation of quality at RUH Bath In the processes of engaging the various stakeholders and settings of RH Bath to deliver services and care, several factors present themselves as barriers. These factors include the various perceptions of the initiatives and policies for quality improvement. The staff in the hospital present opposition to implementation of various polices, such as the initiative to incorporate the university nursing and medical students of Bath University in the operations of the hospital. Thus, opposition of the staff and leadership to various initiatives presents barriers to implementation of quality at RUH. Additionally, the clinical staff repels the management methods and strategies, leading to retarding pace of implementing quality improvement strategies within the setting of the hospital. The externally imposed quality standards and policies face opposition from the internal structures and reception by the staff. These affect the improvement of the quality of service for RUH (Listening Events for Royal United Hospital Bath NHS Trust, 2013). The factor of personnel skills and attitudes in leading the change also affects the implementation of quality development initiatives in the facility. For instance, there are scenarios where the suggested initiative or a passed policy lacks a skilled leader to initiate the change. This limits the establishment of quality service and care. Further, the structure of the organization and its culture affects the implementation of quality improvement initiatives (Bowling & Ebrahim, 2005, p 56). The organizational culture and structure present a bureaucratic administration, hindering the implementation process of the changes projected to initiate quality in the facility (Clarke, 2013, p 21). The organizational culture lacks the motivation and readiness to accept change, learn and share new information in accommodating the changes in RUH. Thus, these happenings hinder the process of achieving quality improvement in the service and care of RUH Bath. Further, as the staff and professionals in the facility cited technical challenges, human and financial resources challenging in implementing quality, these are notable barriers in advancing the quality of service in the hospital. The current communication systems for instance continue to hinder the progression of quality due to factors of file management and communication of critical information within the facility. EVALUATING SERVICE QUALITY Methods for collecting information on (measuring) service quality at RUH Bath The facility engages several procedures and processes in collecting information to establish the quality of care that it offers to the community. As many organizations incorporate statistical approaches to information gathering and performance measurement techniques, RUH is not exceptional, as it applies these procedures to assess the quality of service it facilitates. The information gathering procedures include surveys and questionnaires distributed to the medical professionals and staff of the facility, the community around the facility and the patients within the facility. Additionally, observation as a traditional information gathering technique is extensively applicable in the case of RUH. Further, the information gathering process also incorporates interviews with the various stakeholders, including the clinical and care professionals, the patients and community, as well as, the other stakeholders. Moreover, the focus groups, which comprise of the community, customers and professionals and staff of the facility, are an essential faction of establishing the performance level of the hospital in quality care. Moreover, the procedures of the clinical audit process helps gather critical information on efficiency on utilization of the resources, determining the quality of care in the facility. There are panels consisting of the trustees, the directors and external panels such as the CQC, which also contribute significantly in evaluating the quality of care of the facility. Thus, with evaluation of the information gathered through these procedures and techniques, the facility measures the quality of care and service as it provides to the consumers and from perspectives of all stakeholders. Methods for involving service users in the quality evaluation process, and the impact it would have at RUH Bath The process of establishing quality in the care facilities is a responsibility of all the stakeholders involved directly with the operations of the facility. The service consumers that are the community and patients of RUH Bath remain key in the quality evaluation process as they constitute the larger source of information for the assessment process. However, their role in the achievement of quality care at RUH Bath remains important. Currently, the community participates in boards and committees that discuss the operations of the facility. However, there is need for further involvement of the consumers and customers of the facility in the consultations and panels that govern the processes of the facility. There is community empowerment procedures initiated by RUH Bath to incorporate the community and service users in achieving the objectives of the care facility. However, there is need for further involvement and expansion of these empowerment plans and programs to improve the quality of service of these facilities (Carter & Jarman, 2013, p 16). Incorporating the service users in these technical areas of operation will foster the success of the hospital towards achieving excellent quality of care and service. CONCLUSIONS & RECOMMENDATIONS Royal United Hospital holds the ambitions of establishing dedicated excellent care, which demonstrates respect and equality for all. Additionally, the facility holds a united approach to care, in which they encourage learning, developing and improving continuously in the process of offering services. The hospital remains committed to improving the quality of care as it facilitates to the various stakeholders. However, there are several limitations to the achievement of quality care and service. Therefore, the facility ought to establish procedural approaches to the examining the quality of service as it offers to the consumers. Further, despite the reports by various external evaluation agencies stating improved quality, it is essential to incorporate quality evaluation and improvement strategies such as the Continuous Quality Improvement and Employee Improvement Initiatives in achieving quality improvement in service and care delivery. 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Yardley, L., & Marks, D. F 2003, Research methods for clinical and health psychology, Sage publications, London Read More