1. Perspectives of Royal United Hospital Bath NHS Trust’s Stakeholders regarding quality?
2. Standards that exist in health and social care for measuring quality?
3. Evaluation of effectiveness of systems, policies and procedures used in achieving quality?
4. Methods for evaluating health and social care service quality with regard to external and internal perspectives?
Effective quality management is essential for every health and social care sector in terms of providing best care to the service users. In order to improve productivity and efficiency of services they deliver the health and social care organization should focus on quality maintenance. And it has been evidenced that to improve services to users’ health care sector must follow proper principle, guidelines and procedures set by government or industry authorities. Though having legislation and care standards for health care industry, long term commitments, communications and facilities including all stakeholders are required. Quality standards are set for health and social care and purpose behind it is to increase quality of the sector which providing care to the community throughout responsibility.
In light of all these facts this report is made up on Royal United Hospital Bath NHS Trust’s to assess its quality standards and principles, discuss the perspective of stakeholders working there and will evaluate different approaches for the particular health care to implement quality standard. This report will explain the systems, policies and actions the hospital can take to tackle the determined shortfalls.
Every stakeholder associated with the health and social care services has their own opinion and perspective about the quality provided and standard maintained by the health care home. Any service which offer satisfaction to stakeholder means quality for them.
Service users perspectives of quality is depend upon their way of thinking, their values and experience they got from particular health care. For patients’ measurement of quality is about the treatment they get, responsiveness of hospital staff, how their dignity be respected, confidentiality and safety. If hospital fulfill all these measures then perspective of patient about hospital quality standard is good. In the case of Royal United Hospital it had been seen that patient safety indicators decreased. Patients had to wait more for surgery and elective surgical procedures were also being cancelled (ARAH, WESTERT, HURST & KLAZINGA, 2006). Such incidents tend to create negative perspective of service users. Another instance we can take which shows that the Royal Hospital have not been able to met personal needs of service users. Lack of facilities like shortage of beds and availability of staff create discomfort among service users.
Other stakeholder is health care professionals include senior nurses and doctors. According to them quality is the outcomes of services user’s and result of care taken by them, positive result of their treatment. There perspective about quality is adopting adequate skills to provide proper care and treatment, taking right decisions for their patients, availability of instrument and all media of treatment in hospital define high quality (BALDOCK, 1997). The way and ability to conduct their duties to promote quality of services depend on commitment and effort of healthcare professionals. Case study of Royal United Hospital shows that Health professionals did not understand much about record systems importance which promotes quality of service. Senior nurses and some doctors are not serious about implementation of policies and procedures which essential to fulfill service users’ needs.
Another stakeholder is Care Quality Commission (CQC) whose perspective is very important regarding to the hospital. CQC’s view of looking towards hospital issues can make difference is obtaining quality of care, because they have the responsibility monitoring GP surgeries, hospital facilities and all practices conducted by hospital (BAMFORD, QURESHI, NICHOLAS, & VERNON, 1999). They need to ensure about safety, effectiveness, and availability of services and care with high quality (The Royal United Hospital page 29).
Royal United Hospital Bath NHS Trust’s CQC perspective initiates measures through putting service users on the centre of care; they were in the favor of promoting independence and equality. Always try to improve performance of hospital to achieve standard. Inspection and regulation of hospital helps to maintain quality is the opinion of CQC which is stated in the given case. CQC also understands the need of updating standard continuously to meet needs and satisfaction of service user’s at NHS trust.
External agencies plays important role in order to provide good quality of services and setting standard of care for health sector. Plenty of external agencies work for it such as National institute for clinical excellence, Care Quality Commission, Health Service Commissioners and local authorities. Role of each agency is important in setting standards and achieving quality outcome for health and social care sector.
National Institute for Clinical Excellence: This independent organization provides guidance in terms of promoting good health which prevent and treat ill health. In Royal United Nursing home professionals reassured before giving prescriptions to the service users having problem of anxiety and panic attacks and require regular sedatives for sleeping. For this case if required professionals also ask review and advice of government practitioner. Service providers and professionals take training of National Institute of Clinical Excellence guidelines for treating different medical conditions. As compare to CQC NICE guidance mostly used to assure about quality of services and NICE also make sure that value for money are maintained.
Care Quality Commission:
The care provided by local authorities, NHS, private companies and voluntary organization are regulated by CQC. They always aim to provide quality and better health care to each service user. In Royal United Hospital CQC makes minimum three inspections yearly on the measure of cleanliness, care quality and so on. CQC has the power to take action on the behalf of service user if the care and quality provided by health care is not acceptable. CQC perspective initiates measures through putting service users on the centre of care; they were in the favour of promoting independence and equality. Always try to improve performance of their hospital to achieve standard.
1.2 Impact of poor service quality on Royal United Hospital Bath NHS Trust’s stakeholders:
If health care sector not providing sufficient and effective service quality it leaves negative impact on its stakeholders. Stakeholder temperament seems to be changed in some cases due to the poor quality of services provided by health care. Service users complaining about getting poor service continuously and more over that no one is taking accountability that means change should be needed. Solution over it is every service user should get consultant in charge for the sake of services they are receiving.
In order to maintain stability in stakeholders perspective quality measuring is required in hospital industry. Every stakeholder has their opinion about quality standard which no one can change, but coordination and same indicator of quality among stakeholder is essential. The case study about Royal United Hospital shows that lack of coordination and lack of similar opinion is main among stakeholders is main reason of poor quality services (BENZEVAL, & JUDGE, 2001). Level of poor quality will be reduced with the help of monitoring and measuring quality because health care service very is complex. For instance take an example from case study which determine that service users affected due to the poor quality of care, as the record shows dehydration complaint is found in many patients due to lack of fluid intake (The Royal United Hospital CQC report 2013).
Standard is level of quality against which performance of health care can be measured. Having standard is essential and requires ensuring and measuring safe and effective practice. It designed in order to encourage and support a better practice environment in health care. Due to implementing standard individual would be able to receive right care within health and social care. Person-centered approach can be facilitated through quality standards. Due to implementing specific standards in health care sector error will be reduced and quality will be increased (Department of Health, Social Services and Public Safety 2006).
Care Quality Commission introduces many quality and safety standards and record keeping is one of them. Record keeping standard ensures that patients do not get unsafe and incorrect treatment and care standard in any manner (Care Quality Commission, 2010). In record keeping it is initiated that patient’s treatment, medical condition and other important information related to care should be recorded by service provider on regular basis. The maintained records have been assessable whenever it will be required. Service users experience and trust improve due to keeping such relevant record. Level of health professional’s practice can raised. As far as our case concern it is found that record keeping system did not implemented by the RUH bath and hence the fail to meet CQC standard of record keeping. Though RUH Bath maintained some records but when CQC requested to look those records they were not easily assessed (The Royal United Hospital CQC report 2013).
Another standard incorporated by CQC to maintain high quality of care is respecting dignity and rights of individual’s (Care Quality Commission, 2014). It is important to increase satisfaction level of service user’s and their experience that their dignity should be maintained. Dignity is related with individual’s feeling and behaviour. But contrast is experienced in RUH Bath as per the case study which evidenced that some of the times patient’s dignity was not respected.
Safeguarding people who use services from abuse is also the essential standard quality and safety of CQC. It simply required that people should be protected from abuse and staff should respect their human rights.
In above section the important of providing quality care to the service users is discussed. Now it is also essential to understand and evaluate the approaches that are very crucial for implementation of quality system. The quality management systems are important and focused towards patient’s satisfaction and derive value for their money.
First quality management system we discuss here is Total Quality Management (TQM) system. The application of quality management processes throughout the organization. This includes working on problems and strengthening areas that cross departmental lines. This quality management system is person focused and it aims to increase satisfaction and care standard of service users and provide value for their money.
Another quality system is benchmarking which work on compare and implement basis. It is required to compare your organization quality and care with other competitive organization. Through this comparison best and different trends are discovered and projected into our organization practices. It will help to improve and meet the expectation of people working in and getting served through the organization. It adopt the process which compares current data of the health care organization with its old records and compare the performance which helps to determine difference between current and past performance. The variation determined alert the manager to implement changes.
Approaches to implement quality system:
Policies and procedures: These are outlines in various government document and these guidelines can also set things informed through regulations. Different policies and procedures are implemented for different situations in health care such as in accidental case hospital first file a report of resident accident, after that their family members are being informed about accident (BOYNE, 2002). The patient is treated and then precautions are put to avoid future consequences. Policy of infection control helps to prevent spread of infection within health care. All the protective measures have to be followed while handling the infectious wastes and treated residents.
Resources: Adequate and efficient amount of staff help to provide highest quality of services and most importantly services are provided on time and quality of those services maintained. If hospital have appropriate resources then total quality management will be easy to manage.
Benefits of applying resources:
Consequences:
Best Approach for RUH is increasing the resources. Because it is found at various situation that patients had to wait more for surgery and elective surgical procedures were also being cancelled. Such incidents tend to create negative perspective of service users. Another instance we can take which shows that the Royal Hospital have not been able to met personal needs of service users. Lack of facilities like shortage of beds and availability of staff create discomfort among service users.
External barrier:
Barrier created due to external factors in front of the RUH prevent the hospital from achieving quality standards and are given as below:
Legislation: In certain cases it is found that RUH has to face certain legal issue. This type of controversies effect on hospital’s image and quality of care was affected. Warning notice from the CQC standard had also been issued after the inspection of their team.
Social policy: In terms of ensuring the experience of service user at the highest quality level, safety has to be promoted and value for money in place of health is required. In lack of social setting staff do not able to empower with the right skills and training in quality improvement and measuring techniques.
Internal barrier:
Interaction between people: Having right staff and correct attitude towards quality is basic criteria for maintaining good practice in healthcare. But it is not being practices in RUH identified in case study. This attitude and less interaction create potential barrier in front of hospital.
Organizational structure: RUH need to make changes in structure of its organization in order to gain quality standard. Value, ethics and believes of staff should be improves and for this proper training is required to be arranged.
Impact of the barriers are quite obvious, as staff does not feel motivated and satisfied while working in the hospital and providing services to the patient’s. As it is known less satisfied and motivated staff cannot be committed towards their organization which will impact through their services provided. If service user get less quality service they got dissatisfied and such dissatisfaction chain lead RUH towards less quality and service provider organizations category.
The first policy RUH used as specified in case scenario was safe wandering policy. This has implemented occur need of attaching bracelets to the wrists of some people with dementia and had at the risk of wandering off the ward. These would only be attached on the recommendation of the consultant for the ward.
Another policy identified is trust policy. This policy had been detailed that when and how the bracelets could be used. It was also emphasized that Deprivation of Liberty Safeguards had to follow (CHALLIS, CLARKSON & WARBURTON, 2006).
Different procedures are implemented for different situations in health care such as in accidental case hospital first file a report of resident accident, after that their family members are being informed about accident. The patient is treated and then precautions are put to avoid future consequences.
The escalation procedures are used in RUH in order to manage the waiting times. It is being told by senior staff and surgical outpatients that if due to new referrals impact on appointment waiting time had been occurring then it is the right of service user to notify it to lead consultant who should provide other doctor or additional clinics to complete the service.
The quality systems identified in scenario was Total Quality Management (TQM) system. The application of quality management processes throughout the organization. This includes working on problems and strengthening areas that cross departmental lines. This quality management system is person focused and it aims to increase satisfaction and care standard of service users and provide value for their money.
Benchmarking work is to compare and implement facts. It is required to compare your organization quality and care with other competitive organization. Through this comparison best and different trends are discovered and projected into our organization practices. It will help to improve and meet the expectation of people working in and getting served through the organization. It adopt the process which compares current data of the health care organization with its old records and compare the performance which helps to determine difference between current and past performance (DAVIES & CHALLIS, 1986). The variation determined alert the manager to implement changes.
In order to get success in any work it is important to have any support along with the hard work. The same thing goes correct about RUH there are various factor which influence the health care organization to achieve quality of services and getting positive feedback from service user.
Funding:
In order to perform service, provide facility and having sufficient resource it is important to have sufficient funding. This is the factor which goes correct for RUH that they got proper funding the trust received £2.35 million of NHS funding which promote it towards improvement of services. This was increased trust confidence and it leads significant change effectively. The funding had been used by RUH to support the innovative changes and new ideas would help to improve the quality.
User of service expectation:
When someone expect from you more you automatically starts to improve yourself in order to meet their expectation. Same thing happen with RUH, it got large amount of funding which means people want to see them working more quality work and serve people with excellence. This pressure automatically leads the hospital towards improvisation in its working practices and its service providers working with more discipline.
Media: when patient’s dissatisfaction graph goes high and patient started complaining about the services and quality of facilities provided by RUH media builds pressure on the hospital. The pressure of media and media reports lead the hospital to improve its quality of services.
Improving quality required find out problem first and the as per the case scenario RUH having some problems. In some occasion it is found that patients had not been treated with respect by service providers. Their dignity had not been maintained and staff need more training to maintain safety while treating children and in serious situation. According to the CQC’s view of looking towards hospital issues can make difference is obtaining quality of care, because they have the responsibility monitoring GP surgeries, hospital facilities and all practices conducted by hospital. They need to ensure about safety, effectiveness, and availability of services and care with high quality (The Royal United Hospital page 29).
Service users perspectives of quality is depend upon their way of thinking, their values and experience they got from particular health care. For patients’ measurement of quality is about the treatment they get, responsiveness of hospital staff, how their dignity be respected, confidentiality and safety. If hospital fulfill all these measures then perspective of patient about hospital quality standard is good. In the case of Royal United Hospital it had been seen that patient safety indicators decreased. Patients had to wait more for surgery and elective surgical procedures were also being cancelled. Such incidents tend to create negative perspective of service users. Another instance we can take which shows that the Royal Hospital have not been able to met personal needs of service users. Lack of facilities like shortage of beds and availability of staff create discomfort among service users. Hence quality improvement needs effectiveness, safety, and efficiency of services.
In order to evaluate effectiveness of quality of service use of surveys and questionnaires is important. Due to questionnaires uses it perspective of different people from service users to service providers and commission is get clear and hence survey and questionnaires are used.
From the survey it is observed that service users perspectives of quality is depend upon their way of thinking, their values and experience they got from particular health care. For patients’ measurement of quality is about the treatment they get, responsiveness of hospital staff, how their dignity be respected, confidentiality and safety. If hospital fulfill all these measures then perspective of patient about hospital quality standard is good. In the case of Royal United Hospital it had been seen that patient safety indicators decreased. Patients had to wait more for surgery and elective surgical procedures were also being cancelled. Such incidents tend to create negative perspective of service users. Another instance we can take which shows that the Royal Hospital have not been able to met personal needs of service users. Lack of facilities like shortage of beds and availability of staff create discomfort among service users. Hence quality improvement needs effectiveness, safety, and efficiency of services.
Questionnaire help to provide area of improvement, measure level of satisfaction and motivation and also provide information about expectations. This will also be used by hospital authorities in order to reduce errors in hospital facilities and operating systems.
There are advantages and disadvantages of using surveys and questioners. Some of advantages involve real word observation of the service, involvement of many people who can offer huge amount of information and different points of view, and an opportunity to produce a huge amount of data at small format.
As disadvantages could be consider lack of details information, lack of respond, and validity of information produce (Kelley, K. et al 2003).
Today patients are involved in all the aspects of design and delivery and hence their response and advice would be valuable for hospitals. Royal United Hospital Bath NHS Trust’s CQC perspective initiates measures through putting service users on the centre of care; they were in the favor of promoting independence and equality. Always try to improve performance of hospital to achieve standard. Inspection and regulation of hospital helps to maintain quality is the opinion of CQC which is stated in the given case. CQC also understands the need of updating standard continuously to meet needs and satisfaction of service user’s at NHS trust. There perspective about quality is adopting adequate skills to provide proper care and treatment, taking right decisions for their patients, availability of instrument and all media of treatment in hospital define high quality DAVIES, B., FERNÁNDEZ, J. L. & NOMER, B. (2000b). The way and ability to conduct their duties to promote quality of services depend on commitment and effort of healthcare professionals. Case study of Royal United Hospital shows that Health professionals did not understand much about record systems importance which promotes quality of service. Senior nurses and some doctors are not serious about implementation of policies and procedures which essential to fulfill service users’ needs.
Conclusion:
For improving productivity and efficiency of quality and services provided by the health care sector it is important to maintain quality standard. It is concluded through the report that different stakeholders have their different opinion and hence hospital should respect and use their perspective to improve quality of services. And it has been evidenced that to improve services to users’ health care sector must follow proper principle, guidelines and procedures set by government or industry authorities. Though having legislation and care standards for health care industry, long term commitments, communications and facilities including all stakeholders are required.
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