Managing Quality in Health and Social Care


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Managing Quality in Health and Social Care

  1. 1. NQF level 5: BTEC Higher National — H1 HND Health and Social Care (Management & Care Practice) In Course Completion ofUNIT 28: MANAGING QUALITY IN HEALTH AND SOCIAL CARE Submitted this ___ Submitted to: Submitted by: 1
  2. 2. Contents:Answer to Question 1 - 1.1 3Answer to Question 1 - 1.1 4Answer to Question 1 - 1.2 4Answer to Question 1 - 1.2 5Answer to Question 1 - 1.3 5Answer to Question 1 - 1.3 6Answer to Question 1 - 1.4 6Answer to Question 1 – 1.4 7Answer to Question 2 – 2.1 7Answer to Question 2 - 2.1 8Answer to Question 2 - 2.2 8Answer to Question 2 - 2.2 9Answer to Question 2 - 2.3 9Answer to Question 2 - 2.3 10Answer to Question 2 - 2.4 10Answer to Question 2 - 2.411Answer to Question 2 - 2.5 11Answer to Question 2 - 2.512Answer to Question 3 – 3.112Answer to Question 3 – 3.113Answer to Question 3 – 3.213Answer to Question 3 – 3.214Answer to Question 3 – 3.3 14Answer to Question 3 – 3.3 15References 16Bibliography 17Appendix 18 2
  3. 3. Answer to question 1 – 1.1The concepts of quality vary depending on every user‟s perspective. It varies depending on thelikes, opinions, and ideas of how each person looks at it. One certain study regarding the user‟sperspective on pharmaceutical proved the same thing, Traulsen (2002) states: [t]he lay perspective emphasizes a definite split between lay and expert views on the value and quality of pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk.An elderly client may not always approve of what his relatives or care worker‟s likes regardingthe quality of the care home or the care given to him because each of them has his ownpreferences when it comes to quality in relation to nursing care.Whenever an elderly is admitted in a hospital, he is expecting to be treated in a pleasant andsubtle way. He wants to be taken care of and yet the nurses tending to him should also listen towhat he wants. Senior citizens may be old and yet they are also filled with pride. They don‟twant to be always accompanied or assisted whenever they want to go to the restroom becausethey want to prove to everybody that they still can do things by themselves even if they‟re not asstrong as they used to. They want to feel independent. Their perspective of quality care is whenthey still have the freedom to do some of the things they want without a lot of restrictions whilefeeling “at home” even if they‟re lying in the hospital bed. Elder people mostly get scared orspooked by “high tech” gadgets and prefer being treated the conventional way with conventionalgadgets like the stethoscope. These are the areas where the elderly rates the quality of care in anursing home or hospital, whichever will make them feel “at home” and “independent”.If you are a relative of an elderly client, your concept of quality in relation to nursing care maydiffer from that of a client or the care worker. What keeps you satisfied with regards to quality iswhen you see that your sick relative is always being tended and taken care of. We like to see thenurse always checking how your sick grandmother is doing and always assisting her whenevershe wants to go to the restroom or if she wants to have a walk.The concept of quality from a care worker‟s standpoint is mostly having a good nurse-patientrelationship. The care worker and patient should establish this certain mutual trust and respect. 3
  4. 4. Some patients especially in my country, they treat caregivers as if they‟re servants. Somepatients also are afraid of the nurse or doctor because of the lack of trust. The caregivers wanttheir patient to trust them and for that to be possible, both parties should establish a certain bondso that they will understand each others‟ roles for everything to be delivered effectively. For me,that is how health care professionals see good quality.Word count: 500Answer to question 1 - 1.2There are a lot of models of quality so let me enumerate to you and explain further how to usethese models in nursing care.First of all, let us start with what W. Edwards Deming‟s model or more known as The DemingWheel: PDCA Cycle which means plan, do, check, and then act. Please refer to the Appendix[page 18] section of the paper for the specific chart sample. This model is very basic and yet ifexpounded and understood can be very helpful when applied to nursing care. Let me tell youhow it works; the nurse plans for a certain intervention although the nurse isn‟t sure howeffective it will be. The nurse shows the patient the plan and the patient tries to do it. After acertain trial period, the nurse will assess how the patient is doing, make a few tweaks and fixsome things to improve, and then that‟s the time they both act or come into a conclusion of whatregimen to finally follow, an improvised and revolutionized intervention resulting to quality care.Another model as popular as The Deming Wheel is Joseph M. Juran‟s Quality Trilogy. HisQuality Trilogy is composed of quality planning, quality control, and quality improvement. Thiscycle can be done in a lot ofareas especially in health care.A belief by Juran (1967cited inSwinton 2004 ) states that: [t]he key steps in implementing company-wide strategic goals are: Identify customers and their needs – both internal and external – and work to meet those needs Create measures of quality, establish optimal quality goals and organise to meet them. Create processes capable of meeting quality goals in “real” operating conditions. 4
  5. 5. Applying this model in the field of nursing care, quality must start with the care workersthemselves. Quality should start with them and they should think strategically and plan ahead inorder to achieve it. They should identify the needs of everybody such as their clients and theirstaff and they work to meet such needs. After all the planning is done, they set certain standardsof what to follow such as realistically benchmarking almost everything in providing goodservice. When everything has fallen into place, we measure everything then we should maintainthe things that are giving us good quality while trying to improve steadily from these things.The last but not the least and my most favorite quality model of all is Philip Crosby‟s “Do it rightfirst time”, “Zero defects”. I think that this model is brilliant because as you know, most ofevery hospital‟s income losses are spent on errors. If we care workers try to do everything aserror-free as possible, then we will be giving quality care to patients without risking time,money, and effort. This may sound impossible because mistakes are bound to happen but if wetry our hardest then we care workers could get it right the first time.Word count: 490Answer to question 1 – 1.3The principles of nursing care in relationship to quality is mutual because when you talk aboutthe profession “Nursing” and what it is about, it goes back to providing patients with qualitycare. Every nurse‟s goal is to satisfy their client so that they can feel good that they‟re doinggreat in their line of work which is to give care. If it is the nurse‟s goal is to give satisfaction to aclient then we are talking about quality here. Even in research studies, the inclusion of clients assubjects will always remain in accordance to the rights and welfare of the patients. This viewhas been supported in the entry coming from Connelly (2009). Quality after all is about how theoutlook of others on what we are trying to sell or serve to our clients or patients.In this line of work in health care in which we are dealing mainly with people, it is so fulfillingto see even a single expression of satisfaction from our client‟s face. If our way of doing ourwork which is giving care to our clients makes our clients happy then we are happy. That is whywe try to provide the best nursing care possible instinctively without being reminded or told 5
  6. 6. because we want to provide our clients the best quality care as possible. That is why therelationship of the principles of nursing care is always going to be connected with qualitybecause this is a profession where we always try to serve with quality.I have been studying nursing for the past 5 years or so since I was in the Philippines and now thatI‟m studying health care here in the UK, there‟s still no difference when talking about theprinciples of nursing care. What I have learned a lot when I hear the lines “to nurse” is to givecare which means prioritizing others before oneself. Judging just by that principle, there‟s noother quality more noble than that and that is sacrificing our own welfare in order to serve ourclients.Word count: 347Answer to question 1 – 1.4In setting the standards of nursing care, the role of external agencies play a very vital part. Theseexternal agencies set the standards in which every clinic, care home, or hospital follow. They setthe benchmark of the standards these hospitals will try to achieve. They conduct regularinspections and tests like sanitization, safety, equipments, nursing care, and almost everythingthat‟s happening inside the hospitals and they make sure to it that these health establishmentsandtheir systems of nursing care are passing their quality standards or else they have to take certainactions in guiding them. Outcomes identification and planning in the nursing standards of carehas been said to be greatly influenced by external agencies according to „Winter Haven Hospital‟(n.d).Aside from setting the standards of nursing care, these external agencies also provide someadequate and useful training to health care professionals such as nurses, doctors, radiologists, andscientists. They keep everything innovative by always making sure that the system of care inevery hospital or care home are up to date to the latest trends in health care. These externalagencies also provide some integrated approach to protecting public health by supporting andgiving advice to other external sectors and health organizations. Most of these external agencies 6
  7. 7. are working in partnership with one another to make sure that everything is aligned and balancedwhen it comes to the standards of nursing care. These agencies also assist health managers andemployees with regards to the responsibilities on occupational health issues and these agenciesalso help in the research of finding new ways to resolve some problems of today‟s diseaseswhether communicable or not and this is helping the standards of nursing care by taking thingsand expectations to higher levels.Care Quality Commission – This is the independent regulator of health and social care inEngland. They regulate care provided by the NHS, authorities, companies, and voluntaryorganizations. They also protect interests of people with rights restricted under the Mental HealthAct.Social Care Institute for Excellence (SCIE) – They identify and spread knowledge about goodpractice to the social care workforce and support the delivery of transformed, personalized socialcare services.The National Institute for Health and Clinical Excellence (NICE) – They provide guidance, setquality standards and manages a national database to improve health care for the people.Word count: 390Answer to question 2 – 2.1There are lots of standards for measuring quality and these could also be used in measuringquality of care. To name a few; there‟s the ISO 9000/14000, Federal standard 1037C, GoodManufacturing Practice (GMP), BS 5400, PS 9000, AS 9000, TL 9000, and many more. Thesestandards for measuring quality are very important because they make sure that the users ofhealth care sectors meet those standards and maintain them in order to give quality and efficientservice to their clients.ISO standards make sure that the supply and manufacture of all products and services areefficient, safer, and cleaner so that the consumers will get quality of products with satisfactionand everything will be worth it. They also are setting examples by giving governments somebases for health, safety, and environmental legislation and transfer technologies to developing 7
  8. 8. countries. The role of ISO also safeguards consumers and buyers of products and services. Theymake sure to it that the customers are guaranteed satisfaction plus some never endingimprovement of its performance in pursuit of all of these objectives so the health and social careconsumers are guaranteed that everything they invest on is worth every penny and are satisfiedby its standards of quality.BS 5400 is a British Standard for designs and construction of steel, concrete and compositebridges. This quality standard is useful whenever hospitals, care homes, or other healthestablishments are being constructed because this ensures that these designated buildings forgiving health care services are safe and should pass this standard and guaranteeing saferstrongholds for health care consumers.PS 9000 is an application of the standard for Pharmaceutical Packaging Materials. The PS 9000makes sure that all pharmaceutical materials are safe for the consumers. It ensures that risks areavoided in purchasing pharmaceutics and drugs and users are guaranteed only genuine materialsused.TL 9000 ensures global telecommunications quality and industry-wide performance excellencebecause in our growing health and social care world, telecommunications are widely used.Word count: 331Answer to question 2 – 2.2First of all, a need for improving quality and increased concern about costs and appropriatenessof health and social care in every nursing home has led to some implementation of qualitysystems in health care establishment. Quality systems are the organizational structures andprocesses for implementing quality in a nursing home. It is controlled mostly by documentationand stakeholders should follow these by heart so that everyone in the nursing home will achievepositive results. 8
  9. 9. To implement different approaches to having quality systems in a nursing home, everythingstarts from the health care employer. You should have the right group of people or staff fit fortheir designated jobs. You must make sure that the people you are getting are suitable to enter thesocial care workforce and must understand their roles and responsibilities. Your staff should bediverse and flexible because we are dealing with different kinds of patients here. The morequality employees you recruit, the more quality your care home will be.Now if you‟re part of the staff, you should understand your role and responsibilities. You shouldknow the basic and the most complicated processes of your job and you should have somecertain know-how in dealing with different clients. As a health care provider, you should followthe quality systems and your codes of your own profession by heart.Quality systems are composed of philosophies, principles and strategies, practices, and proof ofevery outcome. For these quality systems to be implemented in every nursing or care home,everybody should follow them. Just by following these guidelines religiously goes a long way insuccessfully producing quality service to every client there is. Giving some training andguidelines could also influence some results to the patient level. Everyone should also providefeedback on the outcomes to assess which areas to improve inside the nursing home to make surethat these quality systems are really implemented.Word count: 318Answer to question 2 – 2.3The value of established quality systems in a nursing home is vital because this is where wemeasure the consistency of quality inside the establishment. As we already know, qualitysystems are processes, guidelines, and policies which everyone should follow. If an alreadyestablished nursing home has been following quality systems over the years, then the only thingthat this health establishment needs to do is be more consistent and to further find ways toimprove from what they have already been practicing and should always continue to seekperfection in providing good quality service for all their stakeholders. 9
  10. 10. The tricky part is when you‟re a nursing home that is still trying to develop and establish someeffective quality systems to follow. You must identify some needs and which areas you need tofocus on improving or fixing, strategically plan, implement some changes and fix some minorbugs within the nursing home. Next, we should keep records so that we can evaluate theoutcomes if we had positive results or not. The administrators and supervisors must plan or makesome certain guidelines in dealing with the staff. If your nursing home can establish someeffective quality systems and practice these systems, processes, and policies consistently thenthere should be never ending improved health care delivery within the nursing home. If weaddress the needs of every patient including their families and commit ourselves to improvingthe nursing home environment and establish good quality systems then our environment withinthe nursing home will have effective qualities. If we can establish good quality systems withinthe nursing home then that‟s the time the quality of the nursing home will quantify resulting tosome more improved products and services offered and then more stakeholders will be willing toinvest in it. With these established quality systems followed by every user in the nursing home,the admission of patients will increase significantly.Word count: 318Answer to question 2 – 2.4The impacts of quality systems on every client, care worker, health care supervisor,administrator, or any other stakeholder are beneficial. No matter which area you are assigned in,as long as these quality systems are present, then your environment inside the nursing home willbe optimal.If you are a client, the first thing you look first when looking for a care home to be admitted isthat they are providing really good service and you get the quality‟s worth of your money and themost effective care you deserve. A care home with effective quality systems can guarantee youas a client some satisfaction not only in the latest equipment and good aesthetics within the carehome but also some very efficient service in providing care. 10
  11. 11. The impact of quality systems on care workers are far more important because if you are a healthcare provider looking to improve on your practice or profession, you need to be guided byeffective quality systems. The numerous processes and policies you should follow are substantialin guiding you on what to do to ensure that you are giving good service to clients. Yourconfidence in your own practice of profession will rise resulting to your productivity levels goingup because you are practicing the right methodologies in doing your profession.If you belong to any group of stakeholders then the impact of quality systems should also bebeneficial for you. If you are an investor who is thinking of buying a share or investing in someequipments or service in health care then you will also reap the rewards. Let me tell you howthese quality systems could also impact you. I shall state this again that these quality systemsdefine processes which will result in a more streamlined production of quality products andservices. Quality systems eliminate wastage of products or services just because you just foundout that they are defective right after they have been produced. These quality systems will notonly benefit the customers or partners but will also benefit the whole organization. This is a win-win situation where nobody has to lose.Word count: 356Answer to question 2 – 2.5There are some barriers to the delivery of quality nursing care services. Let me tell you whythese common barriers get in the way to the provision of quality nursing care services.Apathy –According to Marshal (1999) from his research results regarding the barriers inimproving quality practice, „ authority described an effective working relationship withonly a small minority of doctors but a high degree of apathy among the majority.‟ This studythus confirms such existence of a barrier in the field of health care.The staff may feel that it isunnecessary to change or improve something because he or she feels contented about the service.He/she may think that it is useless to exert some effort in order to change things and when asked 11
  12. 12. to change, his or her reaction would be “why would I do it if there‟s no problem with our oldroutines?” This type of approach to ideas of improvising to deliver quality nursing service is abig hindrance because how can we innovate? I am sure that with what they‟re currently doing isfine but there may be some room for improvement but because of the lack of interest or concern,then how can we improve our services to provide a more qualitative manner of giving care?Cynicism –This type of approach when it comes to change for some better quality nursingservice is also widely normal as a hindrance or barrier. Even if everybody involved wants thepositive need for change or reconstruct things, the deviant persons who just wish to antagonizemay have a different outlook of the idea. This are usually caused by mistrust about his/her co-workers or managers. They see this as just excuses or unnecessary changes that are tooextravagant and may only benefit the managers and not them.Lack of resources – To rebuild, innovate, and improve things isn‟t always easy especially whenyou have this kind of barrier which is lack of resources. This needs time, money, personnel, ortraining of producing quality care services. There‟s always the excuse of “we are too busy tochange things” or “we don‟t have enough money” or “why would we spend more to do that?” Ifthe management or the staff is hesitant because of the lack of resources then we cannot doanything to boost our quality and this always takes effect in the near future when you‟re puttingyour quality at risk.Word count: 404Answer to question 3 – 3.1The effectiveness of systems, policies and procedures used in a nursing home in achievingquality in the nursing care service offered is substantial because with following these guidelines,we are ensured good results in achieving quality in the nursing home. These said systems,policies, and procedures are being implemented because they have been there for quite sometime and they are tested by experience whether trial and error or because they have always 12
  13. 13. resulted to positive results in producing valid quality nursing care services in every nursinghome.It is really important to establish good systems, policies, and procedures in a nursing home andimplement all of these to every member of the staff so that they will know which things topractice. These practices should be instilled upon them so that they will get some ideas of how toreally provide good service to the patients that are admitted in the nursing home so that theclients will be ensured of getting quality service in care from this nursing home.These systems, policies, and procedures should focus around innovation within the nursinghome, erasing or minimizing errors, getting feedbacks from clients and every other stakeholder,and a good quality management of time and work load. These systems, policies, and proceduresshould always be ever-changing or innovative in which the managers should always find newways to improve their quality of service. They should also try to minimize mistakes and nearmisses so that the quality of service will be more efficient and there will be less monetary losses.Doing a survey from everybody in the nursing home should also help because it is important tohear what every stakeholder wants especially in those areas which need improvement the most.If you listen to the people then most likely, you will know which areas you need to focus themost in. Time and task management is also very important because with this, we could maximizeeverything and this will most likely result to achieving quality in providing nursing care services.Word count: 340Answer to question 3 – 3.2There are a lot of other factors that influence the achievement of quality in nursing care. Thereare the external agencies, the quality systems to be followed, and the willingness of all themanagement and staff to provide better services in every hospital and nursing home.External agencies are important because they assist the health care sectors in a lot of things. Theyalso set standards and do the benchmarking for every health care professional and health care 13
  14. 14. organization to follow. They also find ways to improve things and then train health careprofessionals in workshops or seminars and equipping them with more knowledge in providingbetter quality care. These external agencies also inspect those health care establishments likenursing homes and hospitals and really test them to make sure that they are really following theright systems and procedures in providing care. With this, those health care professionals in allhealth care establishments are more motivated and obliged to do their best providing quality careservices to every client.Quality systems are equally important in influencing the achievement of quality in nursing carebecause these quality systems are guidelines for everybody to follow. These quality systems areguidelines which are already tested and proven and they‟re like laws which govern every healthcare establishment in providing the right procedural methods in giving care which will result insuccess in the areas which you are trying to improve in achieving quality in nursing care.Of course, not only systems and policies are factors to influencing success in reaching qualitynursing care, it also depends on the workforce itself which is the managers, the care workers, andall the staff. These people should have that certain desire in giving good service to the clients byheart and not just by profession. They should be sincere in striving to provide good quality careto patients and they should be driven by passion in doing this. If you‟re a health care providerand you want to give better service to your patient, nothing is impossible if you put your mindand heart into it.Word count: 351Answer to question 3 – 3.3My recommendations for actions to make improvements in the quality of nursing care service isby following all these quality systems, policies, procedures, the right methodologies, and toalways commit finding ways to improve even the smallest detail in giving care so that you canachieve improvements in the quality of nursing care. Doing surveys and asking feedback from 14
  15. 15. others will also help you open your mind on which areas you must improve in order to giveimproved quality nursing care services.These systems, policies, and procedures are very important to effecting improvements in qualitynursing care services. As what I have learned, most of these things are rooted from previousexperiences of negative and positive outcomes. They are tested by trial and errors and they weremade because of previous findings of how to produce good quality service. If you as a healthcare provider will follow these guidelines consistently then there should be no way that you‟renot going to get improvements in providing quality nursing care.As a health care provider, everything starts from you. If you are committed to doing your job andproviding quality service to the patients then the effects will be continuous improvement ingiving quality nursing care services. Let us put it this way, if you do your work sincerely withquality then you will get good quality results.Doing surveys by asking people comments about how you are doing your job in providing careservices and collecting data from previous studies is also helpful in getting improvements inproviding quality nursing care services. Listening to others and asking comments about how youare currently doing your job is like looking at a mirror. By listening to the clients and askingthem, you will know which areas you must improve on and if you are open to these criticismsthen you‟re bound to do some constructive rebuilding in trying to improve your way of givingyour services to the patients.Word count: 328 15
  16. 16. ReferencesTraulsen, JM., Almarsdóttir, AB. & Björnsdóttir, I., 2002. Pharmacy World and Science. Thelay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services--results of focus group discussions [Online]. 24 (5), p.196-200. Available at: [Accessed 24 July 2010]Swinton, L., 2004. Management For The Rest Of Us. Management Gurus – The Quick andEasy Guide [Online]. Available at: [Accessed 24July 2010]Connelly, L.M., 2009. Medsurg Nursing: Official journey of the Academy of Medical-SurgicalNurses. Staff nurses responsibilities when caring for patients in a research study [Online]. 18(6), p.385-6, 388. Available at: [Accessed 24July 2010]„Winter Haven Hospital‟, n.d. Model of Professional Nursing Care Delivery [Online]. p.10.Available at: [Accessed24 July 2010]Marshall, M., 1999. British Medical Journal. Improving quality in general practice: qualitativecase study of barriers faced by health authorities [Online]. 319 (7203), p.164-167. Available at:[Accessed 24 July 2010] 16
  17. 17. BibliographyScott, J., 2001. Removing Barriers to Improved Healthcare Quality - health care managementtheory - Brief Article[Online].Availableat: [Accessed 24 July 2010]O‟Dowd, A., 2010. British Medical Journal. NHS staff numbers begin to fall as fears rise overeffect of efficiency savings[Online]. Available at: [Accessed July 24, 2010] 17
  18. 18. Appendix PDCA CYCLE PLAN DO What factors influenced the Technical maintenance and downfall of service consumer‟s upgrades, skill building rate for this month? Things to do: activities, interpersonal Reassessment of services, relation enhancements, workforce and other general meeting. stakeholders involved. Distribute questionnaires to Perform quality assurance clients, build service monitoring. customer support team. The service consumer‟s rate increased the following month. Level of satisfaction became higher compared to the CHECK previous months. Increase in new health care subscribers. Customer support team documented expressed convenience coming from clients. Revision and creation of new policies and standards. Creation of quality assurance team responsible for standard maintenance, squeezing room forACT improvements, conducting scheduled trainings, seminars and reassessments. Creating a standardized point of hazardous level in terms of service consumer monitoring and establishing planned procedures. 18