A Report on Managing Quality in Health and Social Care Contexts

This report delves into the critical aspects of quality management within the health and social care sector. It begins by identifying key stakeholders, including patients, caretakers, and regulatory bodies, and analyzes their diverse perspectives on quality. The report then examines the impact of poor service quality on these stakeholders and the role of external agencies, such as the Care Quality Commission (CQC) and the National Institute for Clinical Excellence (NICE), in establishing and enforcing quality standards. It provides a detailed analysis of quality measurement standards, with a specific focus on NICE and CQC guidelines, and explores various approaches to implementing quality improvements, particularly in diabetes care. The report further analyzes the barriers encountered in achieving quality in health and social care settings, including external factors like inter-agency interactions and internal challenges such as resource limitations. The effectiveness of systems and policies adopted by St. Thomas and Guy's Hospital is evaluated, along with the influence of other factors. The report concludes by discussing ways to improve quality, including the application of the SERVQUAL instrument for evaluating service quality and the importance of involving service users in the evaluation process. The report offers a thorough overview of quality management in healthcare and provides insights into enhancing service delivery.

MANAGING QUALITY IN
HEALTH AND SOCIAL
CARE

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
TASK1.............................................................................................................................................3
1.1 Stakeholders and their types and perspectives regarding quality in Health and Social Care
................................................................................................................................................3
1.2 Impact of poor service quality on stakeholders................................................................5
1.3 Analysis of role of external agencies in establishing standards.......................................6
TASK 2............................................................................................................................................7
2.1 Standards for quality measurement with special reference to NICE and CQC................7
2.2 Different approaches to be used while implementation of quality in diabetes.................8
2.3 Analysis of barriers in achieving quality in health and social care..................................9
TASK 3..........................................................................................................................................10
3.1 Effectiveness of system and policies adopted by St. Thomas and Guy's Hospital in
achieving quality..................................................................................................................10
3.2 Analysing influence of other factors..............................................................................10
3.3 Ways in which quality can be improved........................................................................11
TASK 4..........................................................................................................................................12
4.1 SERVQUAL instrument as a method for evaluating service quality.............................12
4.2 Impact involving users of service on the quality in evaluation process.........................13
CONCLUSION..............................................................................................................................13
REFERENCES..............................................................................................................................14

INTRODUCTION
Quality is a very important aspect in the healthcare sector because here, a life is at stake
and therefore no compromise can be made with respect to quality. This report will discuss the
variety of stakeholders and their perspectives regarding quality along with the standards set by
various institutes and how they can be achieved. This report will also highlight which techniques
can be adopted by healthcare units which will improve their system and procedures adopted for
improving quality and lastly, this report will discus the impact of users of services and the
importance of SERVQUAL as a method for evaluating quality.
MAIN BODY
TASK1
1.1 Stakeholders and their types and perspectives regarding quality in Health and Social Care
Stakeholders can be defined as those parties who are directly or indirectly interested in
the business activities (Cooper & et.al., 2018). In healthcare sector, the relevant stakeholders are
patients, caretakers, employers, external agencies like Care Quality Commission etc. In St.
Thomas and Guy's hospital there are three major stakeholders classified as Caretakers i.e. the
doctors and other professionals who take care of the patients and other activities that need to be
performed in a healthcare unit; Patients who are concerned with the efficiency of the technology
used for treating the diseased person, the quality of the methods adopted, the effectiveness of
results etc. and the third main party is the external agency i.e. the regulatory bodies like Care
Quality Commission, Local Authorities, National Institute for Clinical Excellence which ensure
that the methods and technologies adopted by the unit are ethical and do not harm the society or
patients. They also ensure that the treatment fee charged is minimal (Maybin, Charles &
Honeyman, 2016).
Perspective Regarding Quality:- In healthcare sector, the importance of quality is
extremely high but every stakeholders formulates a different aspect, for e.g. Caretakers perceive
quality as the level of service provided, skilled doctors and professionals hired communication
systems etc. while for patients the quality is related to the quickness and efficiency of the
treatments provided and the environment of the healthcare unit along with behaviour of the staff
working there towards patient (Waring & et.al., 2016). And, the regulatory bodies perceive
quality as accountability along with responsiveness of caretakers and the practices implemented.
3

The different parties have different viewpoint regarding quality i.e. technical quality or
functional quality etc. because the interest level of these parties differentiate and while caretakers
i.e. mangers are more focused on the profit and returns aspect i.e. functional quality, patients
are focused on the quickness of treatment i.e. technological quality and regulatory body is
focused on quality of the treatments provided.
4

1.2 Impact of poor service quality on stakeholders.
In healthcare sector, compromising with the quality of the treatments provided or
practices adopted at the unit can lead to disastrous effects as the efficiency of the entire unit is
dependent on the single factor of quality (Sukumar, Natarajan, & Ferrell, 2015). At St. Thomas
and Guy's Hospital, the relevant stakeholders are severely affected by any deficiency in quality
standards in the operating activities of the hospital.
Caretakers at this hospital get affected in an economical manner as compromise in
quality implies reduced revenues which is a financial loss for the management as well as the
professionals working there as the number of patients getting admitted will decline drastically
and hence the management will not be able to pay these professionals who would then seek
opportunities at another hospital thus causing employee turnover as well.
Patients, in case of decrease in quality would simply switch-over to another hospital
whose quality of treatment is reliable and good (Nelson & Staggers, 2016). However, they might
have to pay higher to other hospital or the commutation time may increase but for St. Thomas
and Guy's hospital, the number of patients getting admitted would immediately fall in case of
shortage in meeting quality standards.
Regulatory Bodies might take some severe steps in order to control the activities as well
as quality of the services provided at St. Thomas and Guy's hospital by Implementing
regulations. The severity of their actions depends on the seriousness of consequences that the
hospitals might face due to such compromise in the quality. It might even lead to shutting down
of the hospital in case of loss of lives of the patients that were treated. Thus regulatory body
takes strict actions in case of compromise with quality.
The major factors that might cause decline in quality at St. Thomas and Guy's hospital
are mismanagement in the funds i.e. in finance department; improvement in the orientation of
patient i.e. in the environment and their surroundings and lack of training of the support staff in
adopting cordial and cheery behaviour towards the patients (Maybin, Charles & Honeyman,
2016). This can be improved only when the practices are regularly evaluated and monitored
through quality audit, quality assurance etc. and can be improved whenever the need arises.
SERVQUAL is another instrument which helps in matching the expectations of the consumer
with the service that is actually provided and helps in bridging the gap between wants and the
service actually provided.
5

1.3 Analysis of role of external agencies in establishing standards.
External agencies includes different monitoring facilities which are formulated with the
purpose of keeping an eye on the health standards that are implemented by different hospitals
and units along with St. Thomas and Guy's Hospital. There are many external agencies and their
impact on formulating and implementing standards can be evaluated in following manner:-
Care Quality Control (CQC):- It is an independent regulator which monitors the activities of
various healthcare units based in England (Ellner & et.al., 2015). Their major aspect is ensuring
that the environment of healthcare units is stress free, relaxed and happy and the services
provided to the patients are high in respect to quality standards and they formulated five basic
principles upon which their evaluation of any unit is based.
National Institute for Clinical Wellness (NICE):- Nice is a non-departmental public body and
their major role is to provide guidance and advise to all the healthcare units in England regarding
the policies and practices they can adopt in order to improve the health and social care that is
provided to the patients. They usually operate for organizations like NHS etc. focusing on
improvement in the outcomes for patients (Cooper & et.al., 2018).
Health Service Commissioners :- Health Commissioners are employed by the government
where they are tasked with developing those programmes that will help the communities in
developing healthier lifestyle and implementing it. They basically operate in England and Wales
and are concerned with their public health.
Therefore, apart form these bodies, there are many other bodies working towards
improvement of the healthcare and social practices so that quality can be improved regarding
healthcare.
6

TASK 2
2.1 Standards for quality measurement with special reference to NICE and CQC.
Quality Standards help in categorize and defining those areas in which improvement is
required under health and social care. Every standard has a different set of statement addressing
various aspects of quality improvement.
With regards to NICE, the quality standards formulated by them have been grouped in
seven different categories which are prevention of Type 2 diabetes, different educational
programmes for adult with type 2 and type 1 diabetes, and also provides a description of diabetes
related to foot care and helps in highlighting those areas through which the patient's condition
can be improved (Kawata & et.al., 2016). These standards were made applicable over all the
branches of NHS operating in entire England but these standards did not cover areas for
improvement in pregnant women or children. For this purpose, a separate standard has been
published and implemented by them. These standards basically target four major groups i.e.
patients, healthcare professionals, organizations in health and social care like NHS and
commissioning groups so that appropriate regulations can be implemented regarding quality
improvement for patients suffering with Type A and Type B diabetes.
However, CQC is a regulatory body which ensures that the standards that NICE has
formulated are implemented and monitors different activities of hospitals (Shabbir, Malik, &
Malik,2016). CQC specifies various guidelines and evaluates the impact of implementation of
such standards like effect of educational programmes in educating patients about the precautions
and practices that they should follow. Basically while NICE deals with setting up relevant
standards, CQC ensures that by implementation of these standards, quality of the outcomes is
improved.
7

2.2 Different approaches to be used while implementation of quality in diabetes.
For increasing the quality in Healthcare unit, it is essential to implement proper systems
and strategies. There are various aspects involved but some of them can be highlighted as
follows:-
Continuous Quality Improvement:- CQI is used in healthcare settings interchangeably with
TQM as CQI helps in implementation of quality assurance programmes in such healthcare units
which helps them in regulating, documenting, monitoring and evaluating all the practices
implemented and these clinical practices are continuously improved and care processes are
regularly reviewed which helps in continuous upgrading of quality (Al-Damen, 2017).
Communication:- This involves clearly and precisely conveying to the patient which problem he
is exactly facing, what do the symptoms mean, how it can be treated, medications required to be
used etc. which will help the patients in clearly understanding what disease are they suffering
form and consequently adopt relevant quality standards.
Information:- Information includes correctly analysing the symptoms and identifying the
diseases that the patient is facing on behalf of the caretaker or professional so that the patient can
be treated accordingly. The caretaker also need to acquire and remember complete knowledge
about the patient regarding the past treatments taken, medical history etc. so the treatment can be
devised after keeping in mind all the relevant aspects (Cucciniello, Lapsley & Nasi, 2016).
Resources Utilized:- Resources involve financial aspect, equipments used i.e. they are sterilized
properly before use, personnel employed i.e. the staff, caretakers, professionals hired have
adequate and expertise knowledge and lastly accommodation facilities for patients i.e. they are
clean, properly sanitized etc. so that appropriate quality can be maintained in hospitals and
healthcare units like St. Thomas and Guy's hospital.
All these factors collectively help in implementing and successfully achieving the quality
standards so that all the practices are extremely quality efficient in the unit.
8

2.3 Analysis of barriers in achieving quality in health and social care.
Implementing those standards which will help in achieving quality at any health or social
care unit is not an easy task and there are various internal and external barriers that units like St.
Thomas and Guy's Hospital might face:-
External Barriers:- These involve -
Inter agency Interactions:- In order to imp-rove quality of service delivered, it is extremely
necessary to integrate practices of various agencies associated with healthcare sector which
ultimately improves coordination and encourages innovation (Singh & Prasher, 2019). It also
brings in professional care or expertise form other unit thus improving the quality of care
provided and if the interactions are not good, this might act as a loss for the hospital.
Legislation:- There are various kind of legal barriers that the hospital might face whi9ole
implementing quality standards because although they are supported by the government yet their
implementation requires lot of paperwork and formalities.
Social policy:- The beliefs of society and the practices that are approved in their eyes might be
insufficient in some medical cases or negatively impacting. In such cases, adopting the correct
treatment for the patient might not be approved by the general public and this can lead to
criticism (Gupta, & Rokade, 2016).
Internal Barriers:- these involves :-
Risks:- There are a wide number of risks associated with an healthcare unit and its operations
like the safety of the patient, avoiding any hazardous impact, keeping surroundings clean and
equipments sterilized etc. which the caretakers and professionals need to adopt as there is lives of
patients at stake.
Resources:- It might be possible that in the initial stage of opening, the staff at a healthcare unit
is not adequately trained or the facilities are not clear or adequate. This is resource barrier which
states that insufficient resources can often lead the management of the hospital to compromise
with the quality of the services that they provide.
Organizational Structures:- When the management cannot properly mange or control the staff
hired by them, their can be compromises with the quality sometimes even resulting in loss of life
etc. (Shabbir, Malik, & Malik,2016). Improperly managed employees work carelessly and do not
understand the seriousness of their responsibilities leading to mistakes like using equipments
which are not new or have not been sterilized etc.
9

TASK 3
3.1 Effectiveness of system and policies adopted by St. Thomas and Guy's Hospital in achieving
quality.
At St. Thomas and Guy's Hospital, there are many methods and strategies implemented which
help in maintaining and monitoring the quality levels:-
Total Quality Management:- In St. Thomas and Guy's Hospital, TQM is implemented as it helps
in detailed analysis of the relevant portion of system. It helps in identifying those activities which
will help the unit in achieving competencies and the policies and procedures are further modified
so that the methods adopted at the healthcare unit can be improved extensively.
Quality Control:- This technique will help the management of St. Thomas and Guy's Hospital in
properly planning, formulating, implementing and monitoring the practices implemented so that
the quality of such techniques adopted and implemented can be improved (Healy, 2016). Quality
control ensures that the standards of quality are not compromised with while setting those
policies and standards.
Involvement of People:- It is extremely necessary to involve all the relevant stakeholders in the
decision making process regarding crucial points at the St. Thomas and Guy's Hospital.
Therefore, the management evaluates opinions and view points of everyone like patients,
caretakers, support staff, professionals etc. before finalising any key policy so that when such
policy is actually implemented it is done so after approval of all the interested parties.
Management Leadership:- The management at St. Thomas and Guy's Hospital ensures that the
employees are properly mangled and all their activities are monitored by some person or another
i.e. they inculcate proper authority levels so that employees are accountable for their actions.
Collectively, all these aspects help in maintaining quality standards at St. Thomas and Guy's
Hospital so that the services offered by them are advanced and extremely efficient (Plough,
2015).
3.2 Analysing influence of other factors.
There are various other factors which influence the achievement of quality standards in an health
and social care unit like St. Thomas and Guy's Hospital which are:-
Social Services:- Since St. Thomas and Guy's Hospital works like an NGO but not similar to the
level of NHS, there are certain factors that need to be managed and in case of increase in the
10

number of patients visiting, the quality in the services provided to the patients cannot be
compromised with as this is the basic purpose for which the unit was set up.
Quality System:- St. Thomas and Guy's Hospital needs to adopt and implement a robust quality
system which will properly categorize the work completed with regards to the quality standards
that were sufficiently met or not. This helps in identification of flaws if any, in the internal
system of the healthcare unit so that the performance and quality of services provided can be
improved (Quality Systems And Models In Heath And Social Care Sector, 2016).
These factors additionally ensure that quality standards are implemented properly and achieved
thus ensuring safety of the patients at healthcare unit.
3.3 Ways in which quality can be improved.
At present, the St. Thomas and Guy's Hospital is facing quality crisis as their standards of quality
have fallen drastically and the waiting time of the patients has increased causing unnecessary
delay due to shortage of beds etc. Also, there is a shortage of the staff employed at St. Thomas
and Guy's Hospital and this collective deficit of staff as well as equipment is impacting the
operational; activities of the healthcare unit extremely negatively (Artiga, & Hinton, 2018).
These aspects can be sufficiently resolved by implementing some of the following ways:-
Adopting a Holistic and Professional Approach:- St. Thomas and Guy's Hospital can appoint
those individuals whose expertise or knowledge level is skilfully developed so that they can
handle crisis situation extremely well and respond quickly and efficiently to the requirements of
the patients.
Investment in equipment:- The hospital should invest more in the equipments and the
technology of the machineries that is required for operating patients so that they can be provided
treatment quickly and the number of beds at the facility also needs to be increased. This will
reduce the waiting time and help in providing immediate care and treatment to the patients.
Appointing more Caretakers :- The management of the hospital needs to increase the number of
caretakers and support staff that they have hired as there is extreme shortage and no one is there
to attend the patients when they enter the facility. This will increase the effectiveness of the
management at St. Thomas and Guy's Hospital (Kawata & et.al., 2016).
11

TASK 4
4.1 SERVQUAL instrument as a method for evaluating service quality.
SERVQUAL helps in bridging the gap between the expectations and demands of
consumers with the products and services that are provided by the manufacturer. In health care
sector, implementing of this research instrument i.e. SERVQUAL is extremely beneficial; for the
management as it helps them in identifying the flaws in their processes and remove such flaws. It
can be implemented in following ways:-
Questionnaire:- Distributing a particular set of questions amongst the patients and then getting it
filled in order to understand their needs. This helps the management in collecting the much
important feedback which provides them an insight in the practices that are actually being
implemented at the facility and whether they are as per the standards set or are lacking.
Focussed Group Interviews:- Under this, the management gather 5-10 patients together and
their feedback is collected regarding the quality of service i.e. treatment provided at the facility
so that during the exchange of conversation, the interviewer can silently observe which parts of
service have caused resentment and which have been satisfactory (Franco. Haase & Barbeira,
2015).
Structured and semi-structured interviews :- Structured interview helps in obtaining answers to
fixed set of questions which are not modified or changed whatever the situation maybe and semi-
structured interview gives basic guidelines regarding the questions that need to be addressed and
are modified as per the situation by the interviewer. These help in adopting and implementing an
informal approach so that the management can get familiarized with the practices that are
adopted by the caretakers at the facilities.
These techniques help in correctly evaluating the services provided like palliative care
which is given to the patients who cannot be cured but can be cared for. By implementing the
technique of focus group interview, the management of St. Thomas and Guy's Hospital was able
to identify that there is a broad category of treatment options available for such type of patients
and their staff required more training and developed treatments to address these patients
carefully and gently.
12

4.2 Impact involving users of service on the quality in evaluation process.
There are various categories of users of the services in a healthcare unit like patients,
support staff, family of he patients etc. and these need to be involved in the evaluation procedure
at any healthcare unit as these are those parties which provide a true image of the actual quality
standards that have been implemented. If the procedures are implemented at the unit without any
consultation or referral to the parties who are actually consuming those services, then it might
cause redundancy in the practices implemented (Adhvaryu, & Nyshadham, 2015). The impact
that this involvement has can be internal or external; internal i.e. the various standards set up by
the healthcare unit will be achieved and they will be able to inculcate continuous development
and improvement in St. Thomas and Guy's Hospital and external aspect involves meeting to the
requirements of agencies and other regulatory bodies so that the minimum standards can be met
and achieved.
There are various bodies like consultation panel etc. who have a direct impact in
determining the levels of quality implemented in the healthcare unit. The approval of these
bodies is extremely important and without these, unit cannot achieve the quality standards set by
regulatory bodies like NICE and CQC. Therefore, it is very important to formulate those
strategies which will help in achieving and further increasing the quality standards in the
practices implemented at St. Thomas and Guy's Hospital.
CONCLUSION
After going through the research conducted in this report it can be concluded that
implementing quality standards is extremely essential in any health and social care unit. Through
this report, it could be identified that there are various stakeholders having varied perspectives
regarding implementation of quality based on their interests. This report also concluded that
there are various standards set up by bodies like NICE and monitoring practices of CQC which
help in implementation and achievement of such standards. This report also discussed various
tools like TQM, CQI etc. which can be implemented in order to regularly improve quality.
Lastly, this report concluded that SERVQUAL is the most important instrument in assessing the
quality and evaluating it.
13

REFERENCES
Books and Journals
Adhvaryu, A., & Nyshadham, A. (2015). Return to treatment in the formal health care sector:
Evidence from Tanzania. American Economic Journal: Economic Policy. 7(3). 29-57.
Al-Damen, R., 2017. Health Care Service Quality and Its Impact on Patient Satisfaction “Case of
Al-Bashir Hospital”.
Artiga, S., & Hinton, E. (2018). Beyond health care: the role of social determinants in promoting
health and health equity. Health. 20. 1-10.
Cooper, C. & et.al., (2018). Relationship between speaking English as a second language and
agitation in people with dementia living in care homes: Results from the MARQUE
(Managing Agitation and Raising Quality of life) English national care home
survey. International journal of geriatric psychiatry. 33(3). 504-509.
Cucciniello, M., Lapsley, I., & Nasi, G. (2016). Managing health care in the digital world: A
comparative analysis. Health Services Management Research. 29(4) 132-142.
Ellner, A. L. & et.al., (2015). Health systems innovation at academic health centers: leading in a
new era of health care delivery. Academic Medicine. 90(7). 872-880.
Franco, M., Haase, H. & Barbeira, M., (2015). Measuring knowledge sharing in inter-
organisational networks: Evidence from the healthcare sector. International Journal of
Knowledge Management Studies. 6(2). pp.101-122.
Gupta, K. S., & Rokade, V. (2016). Importance of quality in health care sector: A
review. Journal of Health Management. 18(1). 84-94.
Healy, J., 2016. Improving health care safety and quality: reluctant regulators. Routledge.
Kawata, Y. & et.al., (2016). U.S. Patent Application No. 15/114,764.
Maybin, J., Charles, A., & Honeyman, M. (2016). Understanding quality in district nursing
services. London: Kings Fund.
Nelson, R., & Staggers, N. (2016). Health Informatics-E-Book: An Interprofessional Approach.
Elsevier Health Sciences.
Plough, A. L., 2015. Building a culture of health: a critical role for public health services and
systems research.
14

Shabbir, A., Malik, S. A., & Malik, S. A. (2016). Measuring patients’ healthcare service quality
perceptions, satisfaction, and loyalty in public and private sector hospitals in
Pakistan. International Journal of Quality & Reliability Management. 33(5). 538-557.
Singh, A., & Prasher, A. (2019). Measuring healthcare service quality from patients’ perspective:
using Fuzzy AHP application. Total Quality Management & Business Excellence. 30(3-
4). 284-300.
Sukumar, S. R., Natarajan, R., & Ferrell, R. K. (2015). Quality of Big Data in health care.
International journal of health care quality assurance. 28(6). 621-634.
Waring, J. & et.al., (2016). Healthcare quality and safety: a review of policy, practice and
research. Sociology of Health & Illness. 38(2). 198-215.
Online
Quality Systems And Models In Heath And Social Care Sector. 2016 .[ONLINE]. Available
through
<https://www.researchgate.net/publication/329092690_QUALITY_MANAGEMENT_I
N_HEALTH_CARE_CONCEPTS_PRINCIPLES_AND_STANDARDS>.
15

16

17