Context of Care by Edward Deming - Essay Example

Context of Care Introduction Asking a group of healthcare professionals today to define quality, there would be as many answers as the number of the persons consulted. Edward Deming-a fellow highly associated with quality revolution in both America and Japan once said that “a product or a service possess quality if it helps somebody and enjoys a good and sustainable market” (Deming, 1994, p. 5-7). He never defined quality directly but linked the aspect of quality product or service to helping the consumer and marketability. Quality has in the past years been perceived to be one of the most diverse concepts in the health care sector with a number of scholars developing varied definitions. According to the Institute of Medicine (2001, p. 1), quality “is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Buttel l et.al (2007, p. 62) further expanded on the definition of quality developed by the Institute of Medicine and arrived at “quality consists of the degree of desired health outcomes (quality principles), are consistent with current professional knowledge (professional practitioner skill), and meet the expectations of health users (the marketplace).” In this regard, the public has continued to become more and more aware of the role of quality in health care and even though the definition continues to remain the same, the level of quality awareness has significantly changed (Buttel l et.al (2007, p.62-63). Quality in a healthcare setting is therefore vital for the patient’s experience. Improving children and young people’s experience of healthcare In the recent past, the health outcomes for children and young people in the UK have been observed to be poor and many people around the world have attributed this to failures of care (Clements, 2013, p5). Fuller (2011, p. 4-6) observed that despite the major improvements achieved in reduction in the number of teenagers and involved in smoking and early pregnancies and prominent areas of special care, the deaths of children and young people of below 14 years in UK is larger than any other European country in both in Western and Northern Europe. Cheung (2012, p. 12) indicated that within the European healthcare setting, there are enormous and unexplained variations in almost all of healthcare aspects related to children and young people. In this case, the UK has been observed to be worse in children and young people care than all the other European nations and leading in aspects of childhood accidents, infant mortality, obesity, inequality and teenage pregnancies largely attributable to the disadvantaged families and communities (Marmot, 2010, p. 14). This has engineered far much worse social problems in the country such as increased number of high school dropouts (UNESCO, 2011, p. 8-9). Clements (2013, p. 5) further revealed how the children of below 6 years have a disadvantage of being excluded in the national health survey conducted in UK with the surveys mostly concentrating on the individuals of ages 18 and above. In this case, the troubles of the children and young people within the health care environment are only reflected on small surveys and qualitative research conducted by researchers and different scholars. However, these sources have been enough evidence that children and young men especially the vulnerable groups struggle to get good health care service (Office of the Children’s Commissioner for England, 2012, p. 84). Amongst the different children and young men interviewed on their views of the general service care in the UK, over a third of the total number of young people and children rated their encounters as poor or average (Office of the Children’s Commissioner for England, 2012, p. 84-85). In a research survey conducted on young people of ages of 1 to 19 years by NCB in conjunction with b-LLve a popular young people’s website, less than a half of the respondents suggested that they were worried of their health and a quarter of them suggested that they were not comfortable with the health services offered I the local hospitals (NCB, 2012, p. 4-6). Further, recent rapid reviews by several researchers and medical experts have identified and highlighted several key challenges faced by the young people and children in the health care setting. According to Lavalle et al (2012, p.23), young people were critical of the health services offered to them and they felt like the medical practitioners lacked proper social skills and acted medically incompetent. Further, the young people suggested that they were never listened to by the medical practitioners who always chose to follow their own agendas and ends up giving them treatment which they did not want or need (Lavalle et al (2012, p.23). In a similar context, young people and children with mental disabilities indicated that they were not feeling like talking to the doctors about their mental illnesses for they never trusted the doctors or felt that the doctors would be less concerned about their mental conditions (Cameron, 2007, p. 22-25). On the other hand, there were also criticisms about the conduct of the receptionists who the young people and children claimed were over inquisitive and hostile and really delayed them before allowing them to see the doctor or practice nurse (Clements, 2013, p. 5). In a qualitative study for young people of ages between 12 to 23 years seeking asylum established that the health care experience of the young people with the primary care was a mix up of positive and negative experiences (Chase et.al, 2008, p. 24). In this case, the young people expressed frustrations in trying to register to see the doctor or the practice nurses and once they had a chance to talk to them they were further frustrated since the doctors or the practice nurses failed to listen to them (Chase et.al, 2008, p. 24). In this occasion, they were frightened and never able to talk to the doctors or the practice nurse about their difficulties, anxieties or other distressing feelings for they felt that they would not help them anyway (Chase et.al, 2008, p. 24). Further, the research review on young people with mental health problems revealed that the young people felt that the respective medical practitioners lacked quality awareness, empathy, interest, and understanding and were reluctant to provide support (Clements, 2013, p. 7). A GP patient survey in the year 2011 on the young age children may give clues to the older children’s experience. In this regard, the 2011 patient’s GP survey revealed high poor satisfaction rate on the quality of the healthcare practices (Lavis, and Hewson, 2010, p. 30-31). Strategies to improve on the standard of the practice The UN Convention on the Human Rights of a Child Article 12 declares that young people and children have to have their view considered in all health issues touching them, Article 2 stipulates that the children should never be discriminated in the matters of health care while Article 3 indicate that the medical practitioners should act to the best interest of the child (Department of Health, 2013, p. 9). In this regard, the UK government has pledged to place, children, young people and their families at the heart of its initiatives in improving the health outcomes since positive patient experience is a major aspect of quality health care (NHS Confederation, 2012, p. 23). In this a number of strategies have been undertaken by the respective health organizations especially the local based health organizations to ensure that the children and young people’s experience of health care is improved. Several of these strategies in this regard adequately touch on the community nursing and how young people and children’s health care experience can be improved in this particular field. One of such strategies is implementation of the ‘You’re Welcome’ quality framework implemented by the NHS to ensure that health services to the young people are made friendlier. In this regard, the healthcare service offered by the community healthcare assistant has remarkably improved since the relationship between the respective healthcare assistants and the young people and children has significantly improved. The NHS has been working on more such strategies to ensure that the health assistants are able to reach out to most vulnerable groups of the community to enhance patient’s healthcare experience. However, it has been impossible to reach out to some children and young people from the disadvantaged communities and families. The NHS has also been on the verge of developing a platform where the patients are able to freely express their views and concerns on their experiences and the services they receive from the different healthcare practitioners through technologies such as phone, email, web or even social media (Department of Health, 2013, p. 8-9). In this case, significant improvements service delivery by the community health assistants has been observed since the health assistant’s carefully monitor the feedback given by the patients. This strategy is significant in this field of community service for it first of all pressure the various health assistants in meeting their objectives and also can adequately be used as way to pressurize the government and health organizations increase the number of healthcare assistants attending to the health needs of the respective groups of the community what would further enhance the children and young people’s health experience. However, this strategy is inadequate for some groups of the society especially children and young people from low income families who in this case lack access to the various technologies: phone and an access to the internet. The development of the Care Quality Commission (CQC) is seen as one of the boldest steps made by the Department of Health in promoting equality in distribution of health care in the different regions in UK (NHS England, 2013). The main purpose of the CQC is to drive the improvements in quality of health care services by monitoring and regulating the services rendered by the respective medical practitioners and health providers (Department of Health, 2013, p. 9). The CQC has been observed to achieve its objectives by putting the people’s experiences and views at the heart of its activities, drawing on relevant intelligence and insight to have an authoritative voice on the underlying state of care (Department of Health, 2013, p. 9). Further, the CQC works closely with other strategic partners across the healthcare system including the local health providers to ensure that quality care is the objective of every single healthcare provider and medical practitioner. The health assistants are basically in charge of the community health services hence answerable for the state of community health including the quality of patient’s outcome. The CQC has been a constant pressure for the different health assistants to enhance the children and young people’s health experience at the grass root levels. The greatest significance of this particular strategy is the fact that there is no way that the community health assistants can evade supervision in their line of duty hence they are forced to deliver. On the other hand, the biggest challenge undermining this strategy is that it is sometimes difficult for the CQC to conduct follow ups in all regions in UK. Previously, CQC has also developed an approach that involves the children and the young people in an inspection exercise (Department of Health, 2013, p. 9-10). In this regard, the young people and children are involved in the CQC inspection exercises as ‘experts by experience’ when the CQC inspects the various registered health providers both locally and nationally (Department of Health, 2013, p. 10). The various community healthcare assistant are part of the registered health institutions in the UK. Therefore, inspection of the local health providers includes the inspection of the activities of the community health care assistants. In this case, a major significance of this strategy is improvement in the quality of service and efficiency of service delivery. A major obstacle to the particular strategy is that it may be hard to involve the children from the disadvantaged families and communities. Further, CQC has developed a joint approach with Ofsted where the different health institutions in UK are expected to: reveal how they will fulfill the need and cater for the responsibilities of the young people and children and prove their accountability to the exercise at every level and demonstrate that they have really listened to the voice the patients and particularly the children and the young people (Department of Health, 2013, p. 10). This strategy is an adequate contributor to the best practices integration by the healthcare assistants in their day to day community service particularly in the areas involving children and the young people. However, some of the local and national healthcare institutions have been observed to focus more on ‘talk’ rather than action. In a survey conducted by the NHS England in the year 2013, the challenge of talk rather than act was imminent. Tertiary centers and children hospitals such as Birmingham Children’s Hospital and Manchester Children’s Hospital were observed to have excellent best practices and so were their health assistants (NHS Confederation, 2012, p. 22-23). Nevertheless, most of the local and national health institutions were observed to have focused on ‘talk’ rather than actions (NHS England, 2013, p. 10-12). Also, local health policy makers have designed programs where the health assistants engage in ‘pressure area monitoring’ and frequent visits to certain areas. This strategy has so far been one of the greatest factors increasing the patient’s health care experience. In this case, increased presence of the healthcare assistants in the community as a result of double handed visit and pressure area monitoring has also enhanced the children and young people‘s health experience. However, it has also been observed that in most institutions the leadership is not always for such initiatives and strategies to improve on the children and young people health care experience (NHS England, 2013, p. 10-12). This has made the respective health assistants reactive other than proactive and in this case responding to ‘a bad thing happening on the ground’ rather than prevent it from happening. Today, research institutions based in the UK have devoted their attention on issues relating to young people and children health care outcomes and activities of the healthcare assistants at grassroots levels. A previous research study by Clements (2013, p. 5) had indicated that young people and children are never mostly included in the healthcare related surveys conducted in UK. Inclusion of the children and young people in the recent surveys by the UK based research institutions has ensured that the development work has been centered on the view of children and young people rather than the adults. Additionally, better complaints processes for the young people and children have been developed. It is now possible to better address complains raised by children and young people. This has further enhanced the bonding of the respective health assistants and children and young people in a community set up and significantly improving on the children and young people health care experience. The aspect of ‘happy staff= happy patient’ may be perceived by many to as a cliché but there exist adequate evidence linking better patient’s experience to the staff experience (NHS England, 2013, p. 10-12). Dissatisfied medical staff renders low quality health services. In this regard, the respective medical institutions are working on better remuneration strategies for the respective medical practitioners especially the health assistant involved in the pressure area monitoring and double handed visits. In the recent past, the UK government has been observed to work on budget reduction strategies to cut down the spending of the public institutions and increase the budget on both local education and local health care (UNESCO, 2011, p. 8-9). In this case, pressure area monitoring and double handed visits strategies have been observed to enhance the community health care awareness and further help the medical practitioners penetrate even the remote area and reach out to the children and young people from the less disadvantaged and marginalized communities. However, inadequate budget allocated to the healthcare institutions continues to be a challenge to adoption of better remuneration strategies. Conclusion Quality is in this case one of the most important factor in community health services and development of children and young people’s experience of healthcare. Quality assurance on the other hand is vital in ensuring that the health assistants reach out to each and every individual in the community especially the vulnerable and marginalized community members. In this case, it is only through quality assurance that the health assistants can achieve their main goals and objectives in community healthcare services. Bibliography Buttell, Phil, Hendler, Robert and Daley, Jennifer. 2007. CHAPTER 3: Quality in Healthcare: Concepts and Practice. Pdf]. Available at http://healthcarecollaboration.typepad.com/healthcare_collaboration_/files/quality_buttell.pdf Cameron, C. 2007. Access to health services: Care leavers and young people in difficulty’. Child Right 238: 22-25 Chase, E., A. Knight, et al. 2008, The emotional well-being of unaccompanied young people seeking asylum in the UK. 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EFA Global Monitoring Report 2010:Reaching the Marginalized. Paris: UNESCO Publishing. Available at http://unesdoc.unesco.org/images/0019/001907/190771e.pdf Read More