Analysis of Service Quality at Royal United Hospital Bath NHS Trust

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MANAGING QUALITY IN HEALTH AND SOCIAL CARE
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Executive summary
The researcher in this study is intending to analyse a range of perspective of service quality in
different perspective within health care service. Internal as well as external stakeholders are there
to be affected by these factors. Moreover, we are aiming to highlight the ways through which the
health care sector Royal United Hospital can improve its service quality. The development issues
in some fields identified by CQC are aiming to highlight in this report. Various approaches are
there to follow by this healthcare sector in order to improve their service. The methodology of
evaluation includes survey and questionnaire as well as review assessment. Impact of users on
the service quality is also intending to highlight in this report.
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Table of Contents
Introduction......................................................................................................................................3
LO1. Various perspective of quality related to health and social care service................................3
1.1 Stakeholder's perspective regarding quality of health and social care service......................3
1.2 Way of external agency can set standard...............................................................................5
1.3 effect of poor service quality on stakeholders of health and social care service...................5
LO2. Way to achieve service quality in health and social care service...........................................6
2.1 standard of measuring quality in health and social care service............................................6
2.2 approaches in implementing the quality system....................................................................6
2.3 Hinder in quality deliver in health and social care service....................................................7
LO3. Evaluation of system, policies, and procedures in health and social care service..................8
3.1 Effectiveness of system, policies, and procedures.................................................................8
3.2 Influential factors in achievement of quality.........................................................................9
3.3 Ways to improve the quality of health and social care service..............................................9
LO4. Methodology to evaluate the quality of health and social care service................................10
4.1 Internal and external perspective to improve quality...........................................................10
4.2 Impact of involving users in evaluation process of service quality.....................................11
Conclusion.....................................................................................................................................12
Reference list.................................................................................................................................13
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Introduction
This study is based on an assessment of treatment and cares within a health care sector Royal
United Hospital Bath NHS that covers around 5.00.00 people. The locality named as Western
Wiltshire and North East Somerset is covered by this sector. A regulatory body CQC has been
identified some issues related to inappropriate care and unsafe. The staffs of this sector have also
failed to maintain the records of hydration and the fluid level of their service users. A range of
functions is necessary to take by this sector. We are intending to analyse various perspective of
service quality based on healthcare. There are some influential factors in this organisation in
standard quality management; we are aiming to highlight those. Internal and external
perspectives are needed to evaluate for making action plan.
LO1. Various perspective of quality related to health and social care service
1.1 Stakeholder's perspective regarding quality of health and social care service
Improvement of service aspects can be identified in various ways within a health and social care
service. This can be identified that the level of quality is now developing for the population
consistently through professional knowledge. The stakeholders of health and social care are
those, who have an intrinsic power on the organisation. They may be internal as well as external
as per their involvement. In the context of this case scenario, some of the stakeholders of Royal
United Hospital Bath NHS Trust are service users, service providers, nursing staffs as well as
CQC and professionals. There is various perspectives of stakeholders in this sector depending on
quality.
Perspective to the service users: The individual people have various perspectives regarding the
service quality of the health care sector. For this reason, the level of this service needs to achieve
the essential factors of service users. However, they need not meet the requirement of different
people; they just have to maintain the standard service quality of service users. As stated by
Bokberg et al. 2017, the cause for this is, individual service users may not have the same concept
in all time or they may not agree or satisfied with the existing quality. The quality of service may
be determined by quality of drug, data protection as well as waiting time and support along with
the hygiene. Moreover, the related cost of service also included in quality service.
Perspective of service providers: The professionals, as well as health service practitioners, have a
primary duty to maintain and monitor the quality of service in Royal United Hospital Bath NHS
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Trust. This can be influenced by efficient and effective home care practices. Moreover, not only
the monetary but also a non-monetary reward can be helpful on this ground.
Perspective of technology service: According to the technical service of Royal United Hospital
Bath NHS Trust, their quality of health care performance can vary. One of the effective systems
through which all the staffs will continue high-quality service in home care is known as Total
Quality management. As mentioned by Boundaoni (2015), besides this, some monetary qualities
such as recording data as well as supervision and auditing are necessary to be monitored in
health care sector. Moreover, document maintenance and gathering feedback from service users
is essential. In order to provide vital information, these are helpful.
Figure 1: Represents internal and external stakeholders
(Source: Li et al. 2018)
The perspective of ethical system: There is a range of legal bodies such as CQC of Royal United
Hospital Bath NHS Trust, are involved in setting the benchmark of this sector. In case of any
malfunction, this body acts as a supporter within the service boundary. As influenced by
Bröchner et al. (2016), this body covers its activity on maintaining regular meals, dressing or
bathing or any others. This health care sector needs to maintain a symbiotic working approach to
achieve success. Moreover, this body helps to improve the skill of home care practitioners for
service users. The concern of this body is mainly on the quality of service.
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This can be identified that Royal United Hospital Bath NHS Trust is now offering near about 5,
00,000 population in their sector. They additionally maintain a positive environment in service
that can be observed from customers.
1.2 Way of external agency can set standard
Some external body of Royal United Hospital Bath NHS Trust is ministerial department as well
as governmental system has a crucial role in this context. There are two primary external
agencies that are involved in positioning the standard of health care service.
Care Quality Commission: This is a private and non-departmental system in the UK. The
company, as well as service and authorities, are supervised and governed by this body. Their
concern is to improve the protection of service users in all aspects. Moreover, this establishes an
excellent practice and dynamic workforce in home and health care sector along with improving
the quality of service. As per the suggestion of Hillen et al. (2015), additionally, another field of
this system is to ensure an individual's right about vulnerability. In case of service providers do
not achieve the standards, this agency takes necessary action.
National Institution of Clinical Excellence: This body is involved in providing various
suggestions related to health care services to Royal United Hospital Bath NHS Trust.
This creates primary guidelines and advice about service, as well as maintains the basic standard.
Moreover, this provides various instructions to this sector.
Social Care Institute for Excellence: This identifies as well as recognizes effective practices in
various healthcare sector and spread the service. Moreover, this helps to improve as well as
modify the health care service of Royal United Hospital Bath NHS Trust.
1.3 effect of poor service quality on stakeholders of health and social care service
As quality of service in healthcare sector is one of the essential components, low service quality
may significantly affect both internal and external stakeholders. Basic criteria in this sector such
as management system service user's experience can be impacted by this factor. As per the
notation of Hsieh (2017), the field of impact can be categorized by two factors as mentioned
below.
Organisation: The organisation Royal United Hospital Bath NHS Trust and its management
body can be affected by poor service quality. This leads to decrease the productivity along with
its profit margin. Additionally, this can be the cause of reduction of customer satisfaction. For
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this reason, the legal body of this sector will identify the malfunction and take necessary action.
This attribute is a driver of damage to brand reputation.
Service seekers: The loyalty of customers as well as publicity of NHS may be impacted for this
reason. As stated by Huotari and Havrdová (2016), poor technical equipment can lead to poor
quality of home care service. For this reason, a hazardous environment can be created within the
organisation.
Internal stakeholders including staffs: The poor capability in meeting the emergency care can
be the reason to damage the reputation. Moreover, low paid workers and inadequate equipment
can drive service user complains, long waiting time, bad surgery. As opined by Jolanki et al.
(2017), these are the indicators of health care standards.
LO2. Way to achieve service quality in health and social care service
2.1 standard of measuring quality in health and social care service
The aspiration of quality standards of health care sector is to improve the service to be provided
to service users. This organisation is intending to ensure a service of a basic standard. Various
measuring standards are there for determining the quality. The case scenario discussed that
quality standards are not achieved by Royal United Healthcare. Some of the issues warned by
CQC, needed to met this sector. According to the benchmarking of CQC, the organisation had
not controlled the rate of infection. Some of them are discussed as follows.
 The stage of culture of an organisation can be determined by identifying it’s all over
performance. This provides necessary support to service users of this sector.
 The quality standards of this health care sector can authorize some formal appraisals.
 Safety factors are legalized by these standards.
 This also makes the service users understand about the service.
 There is another standard named HSMR of this sector. This observes the count of death
within the service. As per this standard, this factor is noticeably less than the other
sectors. This checks medical records of individuals and assesses those.
2.2 approaches in implementing the quality system
A range of approaches is there to implement the quality system management of the healthcare
sector. Name of some of this body is CQI, TQM as well as CQC. Moreover, an effective quality
management system is benchmarking. This body is involved in observing the performance of
Royal United Hospital Bath NHS Trust. Tools of measurement are internal as well as external.
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Khan et al. (2017) noted that the methods can be used to identify the quality management are
mentioned below.
Target skilling: For the reason of getting the service sector more and more complicated, this
attribute needs to be adopted. Through target setting, this is necessary to work in integrating
approach within organisation.
Social approach: This is consisted of coaching as well as mentoring along with sharing good
practices.
Personal development: Through this approach, organisation can guide its staffs. This also
includes skill development and other influential factors.
Applying internal resources: The application of adequate resources within the healthcare sector
may lead to provide a good quality service to patient. Moreover, this increases the chance of on
time and effective service. In order to implement quality management, Royal United Hospital
Bath NHS Trust needs to utilize its resources, which has a great influence.
● Legal outcomes can be prevented by using regulation and policies of the healthcare
sector.
● Proper followed procedure can drive to establish a positive environment in organisation
(O'neil et al. 2017).
● For maintaining a standard, RUH needs to prevent the service users from various
infections and diseases through applying quality control management (Kurpas et al.
2018).
● Utilize of internal resources ensures the proper maintenance of equipment, for this, the
providers can monitor machinery and tools for treatment on a regular basis. This can
prevent long waiting time and failure of emergency operation (Lora et al. 2017).
Increment of resources: This has been observed that, in a traumatic situation, service users had to
wait for a long time in RUH. Moreover, hydration records, as well as fluid balance, has not
maintained formally in this sector. They failed to ensure the health of patients of Western
Wilshire and Northern Somerset. As these events can create a negative image in locality, the
increment of resources is necessary.
2.3 Hinder in quality deliver in health and social care service
Some external, as well as internal barriers are there in delivery of healthcare service (Rand et al.
2015).
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External factors
Social regulations: The value of money is essential for quality of service. In order to ensure the
highest quality healthcare service, service providers need to provide safety and security.
Legislation: One of the vital external factors is CQC warning notice for improper treatment and
system. After a formal inspection, this has been reported.
Internal issues
Inadequate resources: The organization is suffering from lack of skill of employees, money as
well as technical equipment. For this reason, Royal United Hospital could not achieve the need
for service users.
Communication with customers: Well attitude as well as efficient nursing staffs, are the
building blocks of the healthcare sector. For the lack of communication, they failed to manage
risk and maintain data recording.
Organisational structure: RUH has failed to keep the records of hydration and fluid balance. In
ensuring patient's health and managing risk, they show huge informality.
LO3. Evaluation of system, policies, and procedures in health and social care service
3.1 Effectiveness of system, policies, and procedures
This is vital to have significant support and integrated work to achieve success. There is a range
of influential issues in the healthcare sector. As mentioned by Small et al. (2017), in order to gain
positive feedback, as well as quality service, hard work is necessary.
Action plan based on service: This is a system in which effective plan, assessment is necessary.
The clerk and other staffs have the responsibility to maintain proper documentation. According
to the system, the coordinator of shifts needs to ensure relevant treatment and their assessment.
Through evaluating various risk factors, they can mitigate those. An effective investigation may
consequence a standard quality.
Determining quality control: This system helps to determine as well as monitor the service
quality in RUH. This also can operate the balance between all section of service. As per the
opinion of Steketee et al. (2017), employee’s wellbeing can be observed by “Comfort Round
Record”, which is a tool to monitor.
Assessment along with treatment: This is a formal way to keep the records of treatment, cure
as well as the appraisal. As appropriate treatment and providing safety has not done by this
organisation as per the CQC report, this system failed.
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National Institute for Health and Clinical Healthcare Excellence: This body reported that
hydration level as along with the nutrition and fluid balance maintenance had not maintained
properly. This identified the necessities of service users in all aspects (Tod et al. 2016).
Record keeping procedures: This can be evaluated by the Nursing and Midway Council. This
measures all the issues of treatment and cares within the sector. Moreover, this helps to record all
the determinations followed by CQC report.
Hydration Bundle policy: This is a record-keeping table, which is consisted of intake as well as
output of fluid of a patient. In the healthcare sector RUH, this has not done in proper way.
3.2 Influential factors in achievement of quality
For quality improvement, this is necessary to find out the internal problem is necessary
according to the case scenario. Some of the influential factors are mentioned below.
● In some occasions, this has been observed that service providers failed to ensure the
health of patients; also they have been provided improper treatment or care. Therefore,
this is important to manage health risk and ensure the safety and welfare of service users
(Apostolos et al. 2018).
● As per the report of CQC, some of the hospital issues have done inappropriately. Through
inspecting and monitoring, CQC has been reported that staffs were failed to manage risks
and traumatic situation. The body has the responsibility to provide hospital facilities,
RUH needs to evaluate its risk mitigations.
● Some of the satisfactory issues in healthcare service are trust, customer service as well as
technical and housekeeping services (Chandra-Mouli et al. 2016).
3.3 Ways to improve the quality of health and social care service
● Individual service users have different perspectives according to their concept.
Responsiveness of nursing staffs and other staffs is necessary.
● Keeping safe confidential documents and personal records are essential. As RUH made
no records about medical and health, this is necessary to ensure this factor.
● Meeting some personal necessities of individual patients is essential.
● Sufficient staffs, as well as medical instruments, help to reduce waiting time and improve
health outcome in a critical situation.
● Lack of facility can occur in case of shortage of room or bed or hospital staffs. This
creates discomfort among the patients.
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● Besides, maintaining the relevant focus on improvement, the managers of RUH may offer
training to their nursing staffs.
● Healthy communication with service users helps to keep a close relationship with
stakeholders and develop the service. Moreover, this creates a good culture and
collaboration in RUH
● Another approach is to identify as well as fulfill the wants of patients. Collecting
customer’s feedback and assessment those on a regular basis helps to improve this
approach.
● Through recognizing efficient staffs and sharing best treatment practice helps to improve
productivity of RUH.
● From the case scenario, this can be observed that, improvement of staffs in trauma care
along with regular home care.
LO4. Methodology to evaluate the quality of health and social care service
4.1 Internal and external perspective to improve quality
For a formal evaluation of quality service, questionnaire and survey among local patients are
vital. This is helpful to identify the various perspectives of individual patients. For this attribute,
commission and the service providers can get a clear concept about healthcare (Islam et al.
2015).
From survey among patients, the individual's need can be noticed. As this varied according to
experience as well as values and thinking, this approach is responsive in nature. In case of the
sector, RUH can fulfill the raised issues by CQC for the perspective of patients; they can achieve
the standard quality service. From the observation of senior nursing staffs, this can be found that,
recently, safety indicators of nurses are reduced strictly. For this reason, service users had to wait
for a long time. Care in a traumatic situation had not been maintained properly. Moreover, some
elective service prices and surgery had to cancel at a time. These are some factors that can reflect
a negative image to customers.
Besides, lack of service staffs and less availability of rooms and beds are the reason for feeling
discomfort of patients. Thus, quality standard development requires safety and effectiveness of
services (Kellici et al. 2015).
Survey questionnaire with patients can be concerned about some fields of improvement and
resource availability. This helps to determine the satisfactory level of service users. This can
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motivate to fulfill the expectation at all time (Robert et al. 2015). Moreover, in some cases, this
provides vital information. In reduction of errors in treatment and care, this helps advice to
improve operating system.
Review of assessment and quality audits are some of the systematic measurements that involve
in various fields of organisation (Zaga et al. 2018). This identifies performance of hospital staffs.
In external perspective, this collects a range of statistical data that are quantitative in nature. This
also evaluates the link between standards and actual external body.
4.2 Impact of involving users in evaluation process of service quality
Patient-centered services are the chief concern of the recent era in different healthcare
organisations. In addition to this, the management of satisfaction among service users is
regulated by the involvement of the stakeholders. Developing and planning for the intervention
programs must consider the preference of the service users in availing the treatment programs
and facilities. As stated by Bokberg et al. (2017:16), the management of service users and their
involvement in service delivery process help in distinguishing the quality of services effectively.
Integration of service users with appraisal services has advantages and disadvantages regarding
the evaluation processes. With the aid of increased involvement, service users are boosted with
self-esteem and become one of the loyal service users for that institution. However, Boundaoni
(2015:23) commented that involvement of stakeholders in decision-making processes makes it
complex and time-consuming. In addition, loyal service users are often disadvantageous for price
control and evaluating the efficiency of the implemented services quality.
RUH has developed policies to improve services by incorporating the stakeholders in the
management system. In addition, their online forum to provide feedbacks supported in analysing
the service quality by evaluating the feedbacks obtained from service users about the service
quality and maintenance of the intervention environment. Conducting survey over a large
population helps in obtaining knowledge about the perspective of different people about service
quality. However, Bröchner et al. (2016:648) mentioned that the inspection of service users
about the service quality provide specific responses and information that are beneficial to
evaluate the quality of the services. Empathic understanding about the expectation of the service
users and the gap between the provided service quality helps in the management of provided
service quality and developing strategies to improve them.
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