Assignment title | Managing Quality in Health and Social Care |
-------------------------------------------------

Introduction..................................................................................................................6

Executive Summary
This report has been produced to show how RUH have developed a number of mechanisms to overcome the notices placed by CQC. The hospital itself became a trust in June 2012. It is located in West Wilshire, outskirt of Gloucestershire and Bath with over 4500 staff a budget of 230 million, 4600 staff and delivering a number of complex and acute services the hospital has the opportunity through work with it Human resource and quality team to address the 5 action points given to the hospital after the February 2013 inspection.

Introduction
This report will show how RUH are using different techniques to address gaps in their service of delivery, it will discuss the tactics being used and how they are being evaluated, policies procedures being in place the impact it has left the organisation in terms of remaining competitive. And avoid any re-buff from CQC .Quality can be described as the standards of measuring something set against a criteria this statement is supported by Geynt (1995). For health and social care it is about improving knowledge and techniques to deliver high quality services .Quality management is essential within the sector as it will help to engage staff reduce wastage and be part way to fulfilling customer expectations.
LO1
1, 1
For RUH perspective there are a lot of stakeholders from ranging from professionals, managers shareholders to families that have a concern with the trust. According to TQM quality is defined as meeting the customers expectations and also delivering high quality services using a range of mechanisms such as communication and transparent decision making Ellis and Whittingham (1993) describe it also as reaching for a goal there are a number of stakeholders with the main purpose is ensure that internal and external interests are met. At ruh it is doctors nurses ,families and service users as well as management ,and also cqc who have asked them to address five issues using the 9 cs commissioners collaborators, customers as well as other formats using th 9 c’s will enable RUH to approach this area properly. Service users and family satisfaction will enable them to remain competitive.
Service users perspectives is about ensuring that people are the perspectives in which they feel stratified with the quality of delivery that has been given to them . it also includes giving them the opportunity to feel free and have autonomy to be involved in decision making. one of the main issues that RUH faced was not giving patients dignity and respect. As described in the CQC page 14. 1. The professional perspective was to ensure that quality of services and delivery of quality care was person centred care to ensure that each family were ensuring that quality systems are in place and recording methods are in place.Above all it needs to co-ordinated in a consistent way. The care quality commission role is to ensure that care homes gp surgeries and other to ensure that there i9s safe and secure services are maintained and improved ,there role also monitor inspect and regulate the services and to ensure that quakity safety and maintaining standards is evident.
The report shows that there were concerns regarding the RUH bath nhs trust and that best practice wa not being observed many of the patients complained about poor service. The trust response was that they were short staffed .national guidelines show that best practice has to be in place and that poor care and loss of dignity cause emotional responses to quality and a cause for concern.

In addition Employees should be given clear perspective on patients needs been met continuous training and development leading to first rate qualifications and above all meeting patients satisfaction the report highlighted the need for providing training for new staff and guidance and supervision for those who were new .Leebov and ersoz (2003) also expresses the need to be in a clean environment and also self esteem can be raised with the hospital having a good reputation.
Management perspective as described by Wenglar 2007 express the need to achieve the organisations goals. Have a budget to update things such as equipment something that came out of the quality review to enhance their business reputation and continually finding ways of promoting customer satisfaction.

.
.

1.2
Within health and social care there are a number of external agencies that support RUH meet the 28 essential standards According to Balgrosky 2014 partnership working and interaction with key players can help them to influence performance and help with standardisation .Monitor are also part of the structure established in 2013 they act as a health watchdog to ensure that legislations legislation such as the mental health capacity acts and health and safety act are met. They also play a key role in supporting organisation to have robust policies and procedures in place and are followed. Other agencies that play a role are the care quality commission, national care standards commission National institute for care and excellence
Care Quality Commission (CQC)
Is one of the most recognised external agencies in Health and social care their role is to monitor ,regulate and ensure that quality is Atkinson et al(2014 )the organisation own their remit for inspecting quality this includes on the spot check , improving standards . They look at every premise that is health related from care homes, dental institutions to general practitioners and surgeries with the overall remit of dealing with complaints. The winterbourne report is flagging up issues and making planned visits. The way the RUH work is under question and as a result 6 action points have been raised this and CQC are keen to see how this will be addressed especially against their standards whilst protecting the rights of vulnerable people
NICE
The case study show that the National institute of excellence provide guidelines whist coca make sure that safety and quality are met in the process. The work collaboratively with these organisation not ensure that clinical standards are met the case study mentioned very small areas of neglect. Patient experience is vital for improving the standards and in particular ensuring that physiocological and physical well being , in addition patients suffering from pain , having hydaration isssues must be addressed by RUH as pointed out in the CQC report Not only do NICE provide guidance but they also work withhealth organisations to ensure that guidance is provided and standards are set ,finally they advice on drugs and devices across the country and help practicioners to give effective treatment where needed.
Medicines and Health Product Regulatory Agency (MHRA)
. In the case of RUH, Medicines were regularly checked and were in date. Medicine administration charts had been suitably completed. Consumable items such as dressings and bandages were easy to get to, appropriate and intact although there were concerns regarding the Hydration and fluid chart there was little evidence of malpractice. these agencies work together and have outlined their specialties to ensure that there a there is little duplication .Mhra concentrate on providing care for the public whilst SCIE share intelligence regarding good practice and service user satisfaction or dissatisfaction. 13.1 Effectiveness of Systems, Policy and Procedure in RUH
Policies are long term, high level management instructions on how organisations is to be run (Tipton and Krause, 2007). Policies reflect on an organisations goals, objectives and cultures and are intended for the general public.

3.1 Effectiveness of systems policies and procedures in the RUH
Policies are to protect people from making mistake while procedure is use to implement system. CQI is a quality tools which for management is crucial to the development of the organisation. And follows the nation al learning consortium guidelines (2013). . This will help to up skill and reskill staff and ensure that the escalation policy becomes effective and fulfils one of the Cqc criteria. (CQC report RUH 2014 p.11).The DSU was identified as one of the areas not working properly and as a result of that the policy the requirement of service users were not been met the strategy of their A@E was in jeopardy (CQC report summary 2013 p.3). Human resource team can assist in developing good systems such as handbooks and policy manuals for alignment with cooperate strategies.
In RUH hydration Bundle policy were not effective because they did not follow and finish the order on their new hydration Bundle policy additionally 90% of the fluid charts are not been use so that evaluation and planning of care as well as how much they drink and output. No evaluation of patient’s daily hydration through calculating the quantity of fluid was present in a 24 hour period. (CQC report summary 2013p.4).Staff should be trained in applying the whistle blowing procedure at least on a regular basis interact with other department more freely and discuss coping mechanisms. (CQC report RUH 2014 P.14).they also need to meet the comfort rounds record standard for nutrition discharge recording and other surgical procedures.

Recommendation * Include good communication manual so that respect and dignity is mutinied. * Involvement in recording keeping techniques * Collaborative working e.g. no decision about me without me.

The Monitoring system that RUH had in place is to assess and monitor quality of the service they provide to ensure full customer satisfaction. However this system had not been fully effective in ensuring quality improvement as there was no record made from these monitor checks. Making it difficult for RUH to know which areas needs improvement. As feedback was carried out, it was clear that the monitoring system was not known by all the staff.
In conclusion the monitoring system identifies, assesses and manages risk relating to patients’ and staffs’ welfare and safety hence important for RUH to accurately continue with the monitoring system for the promotion of quality service. Best practice –best care (2001) describe having a framework that improves quality this is also in line with NICE. This in line with nutrition, hydration and pain relief.it can also have an effect on physical and psychological health.

3.2 Factors that Influence the Provision of Quality

Factor that influence the achievement of provision in quality is understanding the history of the organisation, and the way it applies it equality and diversity with regards to treatments. stakeholders will want to know if the organisations one that empowers people and apply the PCA of service user involvement for decision regarding provision and delivery, the 3 key things being behaviour ,process and delivery structure factor classification . Patient satisfaction is another areas that has an underlying influence, this include admissions, discharge nursing care food and hygiene and technical services.
One of the key things that cqc were looking for was reliability continuity of care and trust reliability and recruitment procedures.
As mentioned benchmarking skilled leadership and attitudes all have a part to play , a sharing organisation can be an influencing factor in promoting the organisations cultural and diverse delivery .Funding is also an important part of health and social care it will enable them to match fund what they currently get which is 230 million , and enable other training development and hospital activities to be initiated The trust also won funding from health foundation to be use on cultural problems this can be seen on (CQC report RUH 2014 p, 1, 2, 11, 13).
.Communication is the most important in whole world so RUH need to communicate with the staff and service user (CQC report RUH 2014 p. 2). Media and online development is also needed as it can help to promote education for patient family and staff, improve quality encourage professional networking and improve quality provision. If at all possible innovative ideas should be shared with the local television stations, this time for aching a good CQC inspection. There are professional approaches to quality that needs to be adopted include delivering standards to a high quality and of competence. In addition performance measure and individual measurement need to part and parcel of raising the profile of the organization in order to achieve quality. Addressing complaint and ensuring that they are dealt with needs to be embedded into the system. If not delivering homecare will leave doubt in CQC, stakeholders and the public’s mind. This could lead to budget reductions which will affect their efficiency and effectiveness. Service users need be part og the design of services and take part in the evaluation role. Then there needs to be good partnership working between professionals and users groups to ensure that quality defined and agreed and that service users can have bespoke lifestyles.

3.3

Ways of Improving Quality Service
As healthcare sector provides service for individual areas it is important for there to be high quality of care and for people to be safeguarded., improvement can include quality training hiring quality staff continuous training and development , a good communication person and quality leadership someone is not just a leader but skilled in making effective decisions .
Service users will need satisfaction monitoring rounds and will need to be involved in ensuring that their complaints and observations are listened to. Sullivan and Atlas (1998) support the strategy for giving feedback and express the need for survey questionnaires and suggestion boxes. As a result of this 81% of people recommended the service.
. Staff need to be trained on how to record the fluid intake and output as well (CQC report 2014p.7, 14, and 16). In RUH policy it demonstrate that “accurate measurement of intake should be recorded”. But this was not follow less than 10 % of 100 fluid balance chart has was recorded which will not specified if the patient is adequately hydrated it staff should attend training 3 to 6 months to overcome this situation.(CQC report summary 2013 p. 4, 5, 7,8).. The continuous improvement of services adds safety and efficiency to a service and also links tightly with the health and social care 2012. In concluding Simons (2006) expresses the need to follow these guidelines to provide value for money, accountability and effective sharing. The report shows that the hospital staff are providing services that are unlikely to meet patient’s needs, so they need to re-evaluate their approach. And look at a stage intervention to meet the CQC needs and for future sustainability. Sharing information with NICE AND SCIE is a good way of sharing good practice and learning new techniques. Involving policy makers to ensure quality is good and ensure that delivery is of a high standards, using technology is also a useful way of monitoring progress. Using legalization to its fullest potential is also will also maximize how these standards are working with health and social care act (2012) article 8.also the needs for risk management systems are a need for RUH they also have to improve their governance structures. Checking hydration systems, ensuring that patients are in a fit state of mind to feed themselves are key. The inspectors found this to be unsatisfactory.

LO4
Methods for Evaluating Quality Service
To ensure that improvements are made continuous development must take place and good practice models that should be implemented. Internal and external working arrangement needs to be in place. These include quality survey, quality inspection, complaint procedure, quality tour, quality sampling.

A Complaint according Prakash (2007) is a process that shows you how to take complaints to a satisfactory conclusion by following the steps needed. Every good organisation has a complaints procedure. For RUH this is one of the ways to move forward and maintain a good reputation. It also enable trust within the organization and have damage limitation.
External complaints can be dangerous also if they are not dealt with accordingly, patient satisfaction and quality of service provision depends on this and therefore service users must be involved. This process is long and can have an adverse effect on the complainant so it key to have support during the process.
.
Quality Surveys

According to lighter and Fair (2000) quality surveys are useful for extracting information and against performance to regulate activities , and collecting views from communities and patients regrinding their level of satisfaction ,internal data will provide honest answers if the process is transparent but data analyse has to be of the highest standard. External standards also can be of benefit and those involved are happy to give feedback. RUH need to adopt this policy to show how they can improve
Quality inspection this method aimed at testing sampling and assessing the characteristics of a department D Seavor (2003). Discuss the need for inspections to iron out problems and reduce damage caused by shortfall sin service, if this is not done properly CQC can post their findings on line and cause problems for the organisation. RUH have a good reputation as a trust they deliver well with other organisations and have many customers waiting to use their services, however they must update retain and sustain credibility. CQC do not inspect regularly so systems need to be place to be like they are. Internal and external evaluations methods also need to be part of the process and be made user friendly to encourage participation. These should include benchmarking interviews surveys and questionnaires. And enable people to make opinions complaints and observation regarding progress or improvement of the organisation. the management of this process for both quality manager and organisation will help to collate effective. However some of the disadvantages can be that unreliable information peoples attitudes ,values and beliefs may differ and there could be bios. This exercise is time consuming and can work out to be relatively expensive. Observation and behaviour are quite useful and they ensure as described by Rosenham (1973). Disadvantage of observation is that people can pretend to be switched on and clued up to the job or forget they are being monitored and act as they normally do. Focus groups are good as they give people the opportunity to explore discuss and give each other support where by the disadvantage can be that they tend to be dominated by one person For an organisation such as RUH it is useful for them to use observation and questionnaires.

.

4.2 Impacts of Involving Service Users

Health and social care systems involve hundreds of diverse and cultural users thy need to be involved in the evaluation process, this will have numerous positive impacts if this is done properly. the Patients at RUH need to feel that they are been involved and as result of that they decide how to further progress the decisions and comments raised by their involvement of the exercise . In order to have quality improvement is important to reduce complaints, give them autonomy over their feelings and make it possible for them to voice their opinions and contribute ideas. This has to be done in a non-bias way and should also involve their families who can give a true reflection. Staff deviancies in RUH have made this a problem that needs to be looked into by senior management, together with an effective communication strategy this ideology can be realised, become effective and help the hospitals reputation. Evaluation should be an on-going process in which RUH look at professional ways of developing the organisation going through tools that will help to develop the skills of others. Service users should also find the experience helpful to them so that they can help others. Huber (2013).involving them could be useful for research service quality measures and for future planning. Hence the advantages for RUH to overcome shortfalls within the organisation can lead to ultimate quality improvement.to overcome the challenges of service users involve them well in advance find out what their capacity is and enable supervisors to develop their leadership skills.

References: Geyndt,W (1995). Managing the quality of health care in developing countries. Washington, DC: The international Bank for reconstruction and development. p2.
Mclaughlin,C (2004). Continuous quality improvement in health care: Theory, implementation and application. 2nd ed. Canada: Jones and Bartlett Learning. p66-67.
Wentges,P and Gossy,G (2008). A stakeholder rationale for risk management: Implication for corporate finance decision. USA: springer science and business media. p6-7.
Oliver,B and Pitt,B (2013). Engaging Communities and Service users:Context,Themes and Methods. United Kingdom: Palgrave Macmillian. p7-8.
Westert,G et al, (2006). Morbidity, Performance and Quality in Primary Care: Dutch General Practice on Stage. Germany: British Library Cataloging in Publication . p211-212.
Leebov,W and Ersoz,C (2003). The Health Care Manager's Guide to Continuous Quality Improvement. 2nd ed. USA: American Hospital Publishing, Inc. p10-11.
Cooper,P (1994). Health Care Marketing: A Foundation For Managed Quality. 3rd ed. USA: Jones and Bartlett Learning. p30.
Kleinaltenkamp,M and Wengler,S (2007). Key Account Management in Business to Business Markets: An assessment of its Economic Value. Germany: springer science and business media. p36.
Motwani,J and Sower,U (2006). Benchmarking in Service. USA: Emerald Group Publishing Limited. p229.
Unison. (2015). Healthcare Assistance. Available: http://www.unison.org.uk/news/healthcare-assistance. Last accessed 20th May 2015.
CQC. (2015). The Fundamental Standards. Available: http://www.cqc.org.uk/content/fundemental-standards. Last accessed 1st June 2015.
Moschandreas,M (2000). Business Economics. 2nd ed. United Kingdom: Cengae Learning . p22.
Coronel,C and Morris,S (2014). Data Base Systems: Design, Implementation and Management. 11th ed. United Kingdom: Cengage Learning. p682.

4.2

Conclusion
The continued inspection of RUH by CQC despite acknowledgement of weak performance improvement suggests that there is a perception that quality is worth implementing. Performance improvement therefore, should be stretched towards increasing a broader and deeper quality that will promote effectiveness and deliver efficient service to users.

Reference

Angela, B. (2005). Managing Performance: Performance Management in Action, London, chattered Institute of Personnel and