Royal United Hospital: A Reflective Quality Management Workshop

This report presents a reflective workshop on managing quality within Health and Social Care (HSC) organizations, using Royal United Hospital as a case study. It examines different stakeholder perspectives on quality, the impact of poor service, and the role of external agencies like the Care Quality Commission (CQC) and NICE. The report details strategies for achieving quality, including CQC standards, implementation approaches, and potential barriers. It further analyzes the effectiveness of systems, policies, and procedures, recommending improvements for service quality. The report also covers methodologies for evaluating service quality, both internally and externally, and the impact of service users in the evaluation process. The conclusion summarizes the key findings and emphasizes the importance of continuous quality improvement in the HSC sector.

A REFLECTIVE
WORKSHOP ON
MANAGING QUALITY IN
HSC ORGANISATION

Table of Contents
INTRODUCTION...........................................................................................................................1
PART 1............................................................................................................................................1
Different perspective of quality.................................................................................................1
1.1 Explain the perspective of stakeholders in health and social care organisation....................1
1.2 Impact of poor quality service on stakeholders.....................................................................2
1.3 Role of external agencies......................................................................................................2
PART 2............................................................................................................................................3
Strategies for achieving quality...................................................................................................3
2.1 Standards that exist for measuring quality............................................................................3
2.2 Approaches in implementation of quality systems...............................................................3
2.3 Potential barriers in deliverance of quality health and social care services..........................4
PART 3............................................................................................................................................5
Evaluating systems, policies and procedures related to quality..................................................5
3.1 Analysing the effectiveness of systems, policies and procedures used in health and social
care setting..................................................................................................................................5
3.2 Factors that influence the achievement of quality in health and social care service.............5
3.3 Recommendations to improve service quality......................................................................6
PART 4............................................................................................................................................7
Understanding methodologies involved in evaluating quality of services..................................7
4.1 Evaluating service quality methods internally and externally..............................................7
4.2 Impact of service seekers in the evaluation process of service quality.................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Quality matters a lot in every sector especially in the Health and social care organisation.
Health and Social Care organisation include the different regulatory agencies such as Care
Quality Commission (CQC).This report talks about a case study regarding Royal United Hospital
and its inspection carried out by CQC. Also, a detailed discussion about stakeholders, their
perception regarding poor quality, role of external bodies or agencies in the health and social
care sector is accounted for. It also describes different standards, implementing quality service
approaches and the barriers relating to it. A discussion about the policies, implementation and the
methodology used by the Royal United Hospital has been explained below.
PART 1
Different perspective of quality
1.1 Explain the perspective of stakeholders in health and social care organisation
Stakeholders are persons who affect the organisation through their actions and ARE also
affected by their activities (Allen and et.al, 2014). It includes owner of the health care service,
legal bodies, government agencies, staff, supplier, service seekers, technical service provider
etc. Objective and goals of the health care sector influence the stakeholders. The staff members
include the employees of the Royal United Hospital who provide health care services to the
service seekers (patients). They are always expected to provide good service to their patients as
quality matters a lot in this profession. Patients have their own perspective towards quality of
service. If these expectations are not met then service seeker is not happy with the quality and
RUH has to find out the reason behind the dissatisfaction. Legal bodies includes the external or
legal bodies. Such as Central Quality Commission (CQC) and National institute for clinical
excellence (NICE). These organisation set a benchmark for the health care sector. If RUH does
not meet these standards then these legal bodies can take action against it as it is directly attached
with human health and life which is inexpensive. According to stakeholders perspective, service
seeker want a good quality service which make them healthier. Staff member always wanted to
provide best services to their patients which make them happy and create trust.
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1.2 Impact of poor quality service on stakeholders
Service seeker are hugely affected by Royal United's service quality. If any individual is
not satisfied with the service then it will create a negative image of the organisation. It is like a
negative promotion through word-of-mouth which will reduce the trust of patient in RUH. If the
trust provides bad quality service or uses poor quality equipment for treatment, it may prove to
be harmful for the patient's health. People are very emotional in context of health so organisation
need to provide good service to the patient. For example: - Any patient comes with the issue of
skin problem to RUH but they are not able to satisfied his/her problem and prescribe high dosage
medicines to the patient without knowing any past allergies or health issues. In that case these
medicines would increase the problem for the patient rather than resolving. Due to this, patient
will never come for the treatment induced with fear regarding treatment and discourage others
too thus breaking the trust of patient from the RUH.
1.3 Role of external agencies
There are three major external agencies in the Health and Social Care Act 2008 and it
include Care quality commission regulation 2009 (CQC), National institute for clinical
excellence (NICE) and SCIT. Care quality commission is the regulatory body of health and
social care in England. It sets the standard for the Royal united hospital which provide them set
of regulations to be followed. They ensure that quality and safety can meet with the standard and
these things expected by the service seeker. CQC does inspection of all the home care hospitals
in England annually (Boudreaux and et.al, 2014). There is no necessity to pass the judgement
just to check whether standards are met or not. CQC has 16 standards grouped into five areas and
are directly related to the health and safety. These organisation observe the hospital staff and
check how they care of patients. When treatment is done, CQC takes feedback directly from the
clients of RUH. There are also some agencies who provide some standard and advice them
(Chassin and Loeb, 2013). Such as NICE and SCIT, it provide the advices to the National Health
Services (NHS). Basically these agencies build some standards which is followed by the health
care organisation. So similarly Royal United Hospital follow the CQC regulation and this agency
continuously keep their eyes of the health care activities. Inspect the staff as well as service
seeker so they can find out that organisation follow these standards or not.
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PART 2
Strategies for achieving quality
2.1 Standards that exist for measuring quality
Quality is a subjective element in health and social care (HSC) organisations which
differs from individual to individual. Therefore it is important to set a specific benchmark that is
applicable to every receiver of services to ensure that quality of service provided does not falter
or degrade (Cherry and Jacob, 2016). There are important standards set by Care Quality
Commission (CQC) to evaluate quality across all HSC organisations. Among them the most
important standards are Care and Welfare (Regulation 9), Respecting people (Regulation 17),
Consent to care (Regulation 18), cooperation (Regulation 24), safeguarding people from abuse
(Regulation 11), assessing and monitoring the quality of service provision (Regulation 10) and
records (Regulation 20). These standards ensure that there is no gap in services provided by
organizations and customer expectations. To verify that these standards are met with, regular
inspections are carried out by CQC for continuous appraisal, maintenance and improvements of
quality across all healthcare organisations (Goodwin, 2013). Royal united hospital had two
inspections, one in February 2013 and one in June 2013 of which the latter was unannounced and
was carried out to ensure whether the hospital had implemented changes recommended from
former inspection or not. This latest inspection concluded that apart from meeting the
requirement of cooperation (Regulation 24) Royal united had failed at every other standard. They
have been warned by CQC to implement required changes between October to November 2013.
It also suggested that a proper record system be enforced in the hospital to maintain medical
records on a daily basis.
2.2 Approaches in implementation of quality systems
Quality systems refer to the frameworks and guidelines that have been incorporated in an
organisation's management system to ensure that the quality of services provided is maintained at
every stage of the process (Lee, Lee, and Kang, 2012).To maintain this quality, every health and
social care organisation has their own quality systems. Royal United Hospital uses a quality
system that helped in the identification, assessment, risk management to health, safety and
welfare of people. This also included a quality assurance programme for conducting audits. The
NHS has incorporated Quality and Outcomes Framework (QOF) as a voluntary reward and
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incentive programme in England that includes three main components called domains: Public
Health, Clinical and Public Health-Additional Services. These domains consist of a set of
achievement measures known as Indicators that help in benchmarking the level of achievement
while quality check by assigning score points against each of them(Pulvirenti, McMillan and
Lawn, 2014).
The Public Health Domain consists of seven indicators across four clinical areas worth 97
points. Clinical Domain consists of sixty five indicators across nineteen clinical areas worth 435
points and lastly, Public Health-Additional Services Domain comprises five indicators across
two service areas worth 27 points. National Institute of Health and Care Excellence (NICE) is
one of the organizations that aims to provide standards and indicators for those who want to
improve quality mainly in health and social care organisations. These organisations employ audit
and governance reports to exhibit the quality of care in a proper manner. As per the inspection
outcome at Royal United Hospital it was observed that there was no record kept for the
monitoring of balance and hydration checks as they were carried out informally.
Thus, it is important that the staff members comply with the code of conduct of the health
care as these standards assist service seekers to ensure timely and effective deliverance of
services.
2.3 Potential barriers in deliverance of quality health and social care services
Since quality is a subjective element when it comes to health and social care services it is
difficult to assign a certain unit of measure to it. Thus, an organisation may face difficulties
while delivering these services to the service seekers (patients). In the case of Royal United
hospital the trust faced situations of confusion in case of recording hydration checks as there
were more than one system in effect to record and manage fluid intake which included fluid
charts, hydration charts and comfort rounds. One of the major barriers faced by health and social
care institutions is lack of financial resources that ultimately result in degradation of quality of
types of equipments used, human resources at large (Slater and et.al, 2013). Apart from this, the
trust exhibited no proper communication network among the employees as meetings were held in
a very vague and irregular manner, especially for older people's unit. The trust faced gaps in
implementation of most of the quality systems in place such as electronic tagging devices for
patients at risk of wandering was not followed completely as per Mental Capacity Act 2005, the
risk assessment action plan was not reviewed regularly. This shows that employees were not
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prudent while delivering the expected quality to the service seekers. In addition to this, legal
restrictions and lack of power available with care homes also impose as barriers in deliverance of
quality services.
PART 3
Evaluating systems, policies and procedures related to quality
3.1 Analysing the effectiveness of systems, policies and procedures used in health and social care
setting
In order to assure proper framework of an organisation it is important that defined
standards, policies and procedures are followed effectively and strictly adhered to by the
management. In context of health and social care sector, the policies and standards are
formulated by both National Health Services (NHS). For Royal United, the most prominent
policies followed by the trust are wandering policy and trust policy (Stoto, 2013). In accordance
with Mental Capacity Act (2005), the wandering policy requires attaching of electronic tagging
devices to the wrist of patients suffering with dementia to avoid the risk of wandering off the
ward on recommendations of consultants assigned to the concerned ward. Additionally, the trust
policy explained the circumstances under which these devices were to be used.
Apart from these policies, RUH also implemented escalation procedures to manage
waiting time for appointments with a right to notify lead consultants in case a service seeker's
appointment time was impacted due to new referrals. Also, Total Quality Management System
(TQM) has been followed to increase customer satisfaction and service quality provided.
Benchmarking has been implemented to ensure standard quality of the service is maintained at
all levels with easily comparable measures. These methodologies ensure that the services
provided by health and social care homes is reviewed and improved regularly(Tew and et.al,
2012).
3.2 Factors that influence the achievement of quality in health and social care service
For achieving maximum quality of service provided, a health care service should be
effective and time managed in order to serve more in less time. In order to achieve this goal, the
hospital should focus on improving survival rates, treatment, safety of users and environment,
welfare as well as recording and reporting of any errors or unfavourable situations.
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In context of the given case scenario, the following factors influence the achievement of
quality in a healthcare organisation:
 Resource availability: Resources form the crux of any organisation, if the resources are
easily available to the organisation it can secure more at lesser costs thus providing
services at cheaper rates and higher quality. Thus, all health and social care institutions
should ensure that they are able to create availability of their services to everyone without
any financial barriers.
 Services provided: It is important that the services provided are efficient and in line with
the needs of their seekers (West and Lyubovnikova, 2013). This includes engaging in
responsive services that provide value for money, proper allocation of resources, cost and
time effectiveness, patient-centric facilities and due diligence.
 Service Expectations: A service user in any organisation derives satisfaction when the
provider is able to meet his/her expectations completely(Berwick, 2016). In case of RUH,
the trust accumulated a large pool of funds that could be applied to various areas for
improvement. If the expectations are high, the trust would need to perform better by
delivering premium quality services at affordable rates to their patients.
3.3 Recommendations to improve service quality
To ensure improvement in service quality, it is recommended that the employees remain
updated with the ongoing changes in legal as well as internal systems that affect the activity of a
healthcare organisation. As observed in the inspection report of CQC in the given case scenario,
the employees were not adhering to regular communication and follow up procedures regarding
review and monitoring standards. The last review of risk assessment plan was carried on 21
January 2010, three years prior to the inspection under question. This created a gap between the
quality of services and the risk associated with it as the staff members had no idea how to
develop proper procedures to avoid such risks.
Thus, it is recommended that a proper maintenance of health records and review in
management policy is made that accurately reflect the documentation system in the trust as well
as in each ward. Along with that, a new system must be put into effect to ensure that any
hydration, balance and fluid check is carried out with proper procedure and the staff members
engaged in such checks are fully aware of its mechanisms, impacts and consequences.
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PART 4
Understanding methodologies involved in evaluating quality of services
4.1 Evaluating service quality methods internally and externally
A service quality method is said to be successful if it is able to deliver a service
completely in terms with the intention with which the organisation implemented it in the first
place. These methods can be measured both internally as well as externally. Internal evaluation
generally includes surveys, interviews and questionnaires to seek effectiveness of a quality
method. These instruments provide fresh insights in relation to service expectations, perceived
and delivered as well as areas that need improvement. For a care home, a patient would expect
treatment, staff responsiveness,safety and confidentiality.
If the care home is able to satisfy these expectations successfully, it can be said that the
quality methods applied by the entity are in fact up to par and effective. Regular review of wards,
reports and internal control as well as management systems to check whether the set quality
standards and methods also play an important role. This can be achieved by holding continuous
follow up meetings among the wards and the trust's management on yearly, quarterly or monthly
basis. Externally, a proper patient/client relation must be maintained by reviewing appointment
waiting time on a monthly or weekly basis to see how the relationship between the trust and their
patients can be improved by making sure the quality methods set in motion are client-centric and
affordable in nature.
4.2 Impact of service seekers in the evaluation process of service quality
In present scenario, service quality has become highly customized and customer centric
including their responses and behavioural patterns when designing a process. Therefore, it is
important that while evaluating such service quality the aforementioned factors are considered so
that maximum satisfaction can be provided by the organisation to their clients. In case of Royal
United, CQC provides a detailed account in their inspection report while keeping in mind the
needs of the patients. In order to achieve standard service quality, one must improve performance
by promoting regular investigation of its policies, procedures and standards.
CQC strives to ensure that the healthcare organisations adopt and adhere to the set quality
standards and provide respect, safety, care and proper treatment to their patients at every minute
level. This will help in preserving quality and code of conduct in the trust. The given case study
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depicts a circumstance where the employees and the trust management were not able to identify
the importance of reviewing plans, awareness of knowledge gaps as well as identification of
areas where policies were not being implemented strictly and properly. They were not able to
identify the needs of their patients as their policies were not up to mark and client-centric, this
not only resulted in downfall in quality service on Royal hospital's part but also led to fall in the
service rendered to the patients. If these criterion are not met with in due time the trust could lose
their registration certificate issued by CQC and shut down altogether, therefore, it is important
for RUH to revise and implement suggested changes as soon as possible.
CONCLUSION
From the above report it can be concluded that managing quality in a health and social
care organisation is crux of the matter as their existence depends on the superiority of services
provided by them. As different stakeholders have varied interests and perspectives in an entity, it
is important to recognize them and formulate quality benchmarks that satisfy all of their needs
and preferences. Thus, RUH should respect and employ these views while ensuring that quality
standards are met with and evaluated regularly for incorporating improvements and changes as
and when they happen by following proper rules and regulations.
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REFERENCES
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