MANAGING QUALITY IN HEALTH AND SOCIAL CARE SETTING

Introduction
There are direct and proportional relations between the quality of care services provided and the health and wellbeing of individual. Quality care services lead to improved health and wellbeing of servicer user. Unfortunately, not all healthcare organization is able to provide quality care services. In this report, I explain how quality can be effectively managed in health and social care setting using RUH bath as the case scenario.
1.1 Perspectives that stakeholder in health and social care has regarding quality
Every healthcare provider has its own stakeholder. These are people who are interested in the operation of the organization. Each group of stakeholder have different interest in the operation of the healthcare provider and as such their perception of quality care is influence by their interest. According to a study by Papp et al (2014) which was conducted to find out the perspective of patient and that of health care professional in relation to quality care, found out that, although the two groups define quality care using similar criteria, some criteria varied with each group. Patient define quality based on criteria such as appropriateness of the services, clinical outcome, humanity of the healthcare staffs, communication, accessibility , fair treatment, and affordability. On the hand, health care staffs give more weight to technical quality such as appropriateness o procedure, tests, appropriateness of facilities and equipment.
Regulators also do have their own perspective of quality based on their interest. For instance, according to RUH bath NHS trust quality report (2014), it is evidence that Care quality commission defines quality in term of how well the care provider is in compliance with the national standards applicable in healthcare sector.
These differing perspectives of quality held by different stakeholders pose a challenge when it comes to management of quality in healthcare. However, since all the stakeholders are of greater importance to RUTH bath hospital it is important that a balance is found in their perspectives. The care service should be designed in a way that addresses all the perspective of the entire stakeholder. However, where a conflict of perspective occurs, the perspective held by statutory body such as CQC should always be considered.
1.2 The role of external agencies in setting standards
There are several strategies of healthcare that RUTH bath hospital must comply with. These standards are sets by different agencies which include the National institute for health and social care excellence (NICE), the care quality commission (CQC), among other
The national institute for health and social care excellences was formed by the government to be the industry agencies responsible for setting evidence-based guideline and standards that guide operation of health care provider (NICE 2015). To improve the quality of care, Ruth bath hospital need to know all the relevant guideline and standards as developed by NICE and apply them in it operation.
The care quality commission has special role in setting standard of the industry. The commission is responsible for overseeing the implementation NICE’s guideline and standards as well as the essential standard that was established by the health and social care act 2012 and 2008(Royal college of nursing 2015).
The faculty of public health also has important role in setting standards for health and social care setting. This agent is responsible for setting standard relating to staff qualification and training. The aim of standard set by faculty public health is to ensure that the staffs that works in health care setting has the right qualification (FHP 2015). The competency of health and social care staffs is important in management of quality. Competent staffs are associated with quality care. Ruth bath trust hospital should therefore ensure all it have the right qualification as per the standards s4et by the faculty of public health
1.3 Assess the impact of poor service quality on health and social care stakeholders
Poor health care services result to poor health and wellbeing of patient and service user. According to care quality report (2014), RUH bath lacked an effective system to assess the needs the care need of patients. As a result the healthcare needs of the patients are not met. CQC (2014) also noted that during busy time the needs of the servicer user were not always met. Failure to met servicer user needs increase risks to their health and safety.
Another case of poor service in RUH bath is demonstrated in Recovery unit. Before implementation of the communication system patient had to wait in the recovery unit until bed was available in the ward (CQC 2014). This was a bad practice, which increases the risks to their health and safety
2.1Explain the standards that exist in health and social care for measuring quality
Several standards exists which RUH bath can use to measure and improve the quality of care. These standards includes
CQC standards-These is a set of 16 standard that are basic and statutory that must be met by hospital, dentist, care home, domiciliary services, clinics among other health and social care provider. RUH bath is under legal duties to comply with all the CQC standards.
NICE Guideline and standards- NICE set various guideline and standards of care that help care organization adopt evidenced –based approach in services delivery. The basic guidelines and s6tandard from nice include
• Clinical guideline and standards- these guideline and standard recommend how care must be provided to individual with different condition such as dementia, learning disability, cancer among other (NICE 2015)
• Public health guideline- these provide recommendation of intervention that need to be applied locally fro preventing and managing diseases (NICE 2015)
• Social care guideline – they are standard and guideline meant to ensures social care intervention used are effective and cost-effective (NICE 2015)
• Medicine practice guideline-these are meant to improve the practice of commissioning, prescription and decision making relating to medicine (2015)
• Safe staffing guideline-these are established standards that recommend the best practice in staffing capacity and capability in NHS (NICE 2015)
2.2 Different approaches to implementing quality systems
Implementing quality system is not easer. Fortunately there are a number of approaches that provide clear guidance on how to implement quality system. These approach are many and includes quality improvement, SWOT analysis, benchmarking among other

Quality improvement is an approach that focuses on the process of care and it emphasis on standardization of the processes. This approach is based on the notion that, if people are working using the same standardised method or process, errors can be easily detected and corrected. It becomes extremely hard to detect error when individual work using their own ways. These methods however have some limitation especially when used to improve the care of older people. Older people normally have multiple conditions and the severity of such condition keep changing due to ageing. This becomes extremely hard to standardize the process for care for such group of patient/servicer user (Reuben 2007).

SWOT analysis is an approach which focuses on identifying the strength weakness, opportunity and threat of an organization. Once the SWOT analysis is fully understood, the organization then set goal to take advantage of it strength and the opportunity. At the same time, the organization set goals and strategies of addressing the weakness and the threat. This approach help identify the internal factor as well as external factor that may be negatively affecting the quality of care and developed goals and strategy to deal with them leading to improved quality of care. The approach does however suffer from some limitation. The external as well as internal environment of health and social care organization keep on changing rapidly. It may change even before the goals set are realised or the strategies bear fruit.
Total quality management is an approach of implementing quality system that focus on continuous improvement of customer satisfaction by addressing the gaining commitment and participation of all employees (Patel 2008). They key component of total quality management are participation and commitment, focus on customer needs, continuous improvement, flexible plans and goal (Roey 1992)
In case of RUH bath, total quality management would be the most appropriate approach to improve the quality of care. Staffs commitment and participation is very much needed in the organization. According to CQC (2014), staffs motivation level was very low and this would negatively affect any attempt to improve quality of care. Additionally, the quality report by CQG (2014) also noted that servicer user needs was not met during busy time. The hospital also lacked an effective system of assessing the health and welfare needs of the servicer user. Total quality management focus more on meeting the services user needs making it most appropriate for RUH bath where need are not always met.
2.3 Analyze potential barriers to delivery of quality health and social care services
Several factors exist which has the potential of hindering RUH bath from offering quality care. According to a study by Gordon et al (2013) on factor that facilitate and hinder quality care services, staffs were the major facilitator of delivery healthcare. At the same time they also hinder delivery of healthcare. The motivation of workers as well as their capability determines the ability of a health care organization delivering high quality services. The care quality commission identified sevela issue with staffs at RUH bath hospital. It identified inadequate staffing, identified skill and knowledge gap and also low motivation among worker. These have the potential of hindering RUH bath hospital from offering quality services in long run and therefore the needs to address them.
According to Gordon et al (2013), the complex health care needs and the unpredictability of illness and diseases in community are also affecting the organization ability to plan and deliver quality care services. This factor together with the facts that RUH bath lack an effective system of assessing the health and welfare needs of individual may act as barrier to delivery of health and social care. However, this barrier can be dealt with by establishing a system to monitor diseases and health need of the community where RUH bath serve.
According to a study by chartered quality institute of London, leadership is the second largest barrier to delivery of quality care in health and social care setting. The study found out, leader of HSC lack proper understanding of what quality is, approach to implement quality system and how to continuously improve quality in their organization (Feary 2012). Delivery of healthcare services at RUH bath Depend on how well the leadership of the trust understand the concept of quality management and their commitment to quality.
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
RUH bath has implemented several systems, Policy and procedure in an attempt to improve the quality of care to meet the standards requirement. Some of them have proved to be effective in improving quality while others are totally ineffective.
During the black alert in 2012, RUH bath hospital experienced situation whereby patient had to wait in the recovery until bed is available in the ward. RUH bath was able to deal with this unfavourable situation which increased Risk for patient. A communication system was established alerted the theatre personnel of the bed capacity situation at the ward. An electronic risk management was also used to alert when patient stay at recovery unit was extend. These communication systems improved the situation in the recovery unit and patient only stay there for the appropriate time after which they were transferred to ward immediately they were medically fit for transfer.
According to a guideline by NICE (2012), the care providers are required to assess the physical and psychological needs of the patient include hydration, pain relief and nutrition. To comply with these requirements, RUH bath hospital had established the hydration bundle policy which aims to monitor fluid intake and output. The aim of the policy is to ensure patient were well hydrated. However, according to an inspection by CQC (2014), the hydration policy was ineffective since 90 percent of the fluid recording chart were not filled as required. RUH bath has also established a “comfort round” procedure which was used to monitor the welfare needs of the patient. This procedure was working for the hospital as patient needs welfare were being assessed and during provided (CQC 2014)
Although RUH bath had in place needs assessment and care and treatment planning systems, the system had not met the standard as required by the care quality commission (2014). The trust had also put in place a strategic framework for risk management. This system had improved the reporting collating and management of incidence and risk across the entire hospital. However, an inspection by CQC found that some aspect of the system was not working effectively. The electronic tagging devices for tracking and monitoring patient at risks of wandering were not being used effectively (CQC 2014)
3.2 factors that influence the achievement of quality in the health and social care service
Delivery of quality health and social care services is dependent on a number of factors. These factors include availability of resource, availability of appropriate skills needed for quality delivery, perception and expectation of health user.
For successful improvement of quality in Ruth bath, a lot of financial resources are required to see the system, policies and procedures established are working. For instance, financial resources is required to train staffs on how to use some of those training and upgrade their skills as recommended by CQC (2014). The amount of money available or allocated to the trust will therefore greatly determine it ability in improve the quality of services.
The perception the health care staffs has on quality also affect achievement of quality. For achievement of quality services in RUH bath, the healthcare staff at the hospital need to high very positive perception toward improvement of quality. Their perception improves their behaviour and commitment to quality.
The perception and expectation servicer has on the quality of care in RUH bath also have impacts on achievement of quality service The higher the servicer user expectation the more effort will be to improve the quality of care.
3.3 ways in which RUH bath can improve quality of care services
Although RUH bath has recorded a significant achievement in quality improvement, there is a room for further improve. There are several issue that the hospital need to a address which include staffing capacity and capability, supervision and staff monitoring
According to a study by Gordon et al (2013), Staffs are key determinant in delivery of quality care. RUH bath should ensure there is system in place for training it staffs to sharpen their skills and knowledge. By doing so, RUH bath will be addressing a number of issue as identified by CQC in it quality report. It will close the knowledge gap identified, and to some extent the inadequacy in staffing as well skilled individual are able to be more productive.
According to CQC (2014), the staffs were not following some of the policies, system and policy established in the hospital. For instance, CQC found out that the hydration bundle policy was given a wide breath by staffs. The management at the RUH bath hospital need to up their game in supervising and monitoring the work of the staffs.
4.1 methods for evaluating health and social care service quality with regard to external and internal perspectives
Evaluating the quality of care services mean measuring the extent to which the care servicer are meeting the expectation of different stakeholder. For comprehensive evaluation of quality of care in RUH bath hospital, the different expectations of stakeholder need to be taken into account. To do that, the following method of evaluation can be used
Survey-This refers to systematic gathering of information from various individual (Brook et al 2000). Survey can be used to measure quality of care at RUH bath hospital by taking into account the feedbacks and opinion of healthcare staffs, management, servicer user, the local community which the trust serves, clinical quality commission and other relevant stakeholder. This method provides a comprehensive evaluation that incorporates both internal and external perspective of quality as held by various stakeholders. However, the effectiveness of this method depends on how well the survey is designed, planned and data collected (Brook et al 2000).
Evaluating quality against the standard – Another method of evaluating quality of standard is to measures the quality against Standard. In RUH bath hospital the quality of service can be evaluated based on NICE guideline, CQC essential standard and other applicable standards. This method would help RUH bath know how well it is doing in meeting CQC essential Standards of care as well as other applicable standard. However, using this approach, only the perspectives of certain stakeholder are taken into account. The perspective held by other stakeholders especially the internal one will be largely ignored (Donabedian 2005). Despite the limitation the method can be very effective when combined with other method.
Analysis of clinical record- evaluation of quality of care in RUH bath can be done by analysing clinical record. However, this method has several limitations. Inadequacy in record keep may lead to inappropriate evaluation. Additionally, accessing some of clinical records might be restricted (Donabedian 2005).
4.2 The impact that involving users of services in the evaluation process has on service quality

Involving servicer user in evaluation process has several implications. According to Carr (2004) conflict and dissatisfaction are unavoidable when servicer user are involved in health and social care activities. Servicer user and the healthcare personal may fails to agree on the method or criteria used. If conflicts are not properly solved, dissatisfaction with the results is most likely. To ensure conflict and dissatisfaction do not hamper the evaluation process, it is important a common ground is reached where conflict arise. A conflict resolution mechanism should be put in place.
There are some positive impacts of involving servicer user in evaluation of servicer. According to Nilsen et al (2006), involving servicer user improve and encourage individual to get involved in issue that affect them. Additionally, by involve servicer users, RUH bath stand in a better position to improve service since their contribution is very vital in understanding their needs
Conclusion
Managing quality in health and social is a challenging but a necessary function. To manage quality effectively, proper understandings of the national standard of care is required as well as understand the role played by different government agencies ion setting the standard. An understanding of different approach of implementing and evaluating quality system is also required.

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