Managing Quality in Health and Social Care

NQF level 5: BTEC Higher National — H1

HND Health and Social Care (Management & Care Practice)

In Course Completion of

UNIT 28: MANAGING QUALITY IN HEALTH AND SOCIAL CARE

Submitted this ___

Submitted to:

Submitted by:

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Contents:

Answer to Question 1 - 1.1 3
Answer to Question 1 – 1.4 7
Answer to Question 2 - 2.411
Answer to Question 2 - 2.512
Answer to Question 3 – 3.112
References 16
Bibliography 17
Appendix 18

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Answer to question 1 – 1.1

The concepts of quality vary depending on every user‟s perspective. It varies depending on the
likes, opinions, and ideas of how each person looks at it. One certain study regarding the user‟s
perspective on pharmaceutical proved the same thing, Traulsen (2002) states:
[t]he lay perspective emphasizes a definite split between lay and expert views on the value and quality of
pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk.

An elderly client may not always approve of what his relatives or care worker‟s likes regarding
the quality of the care home or the care given to him because each of them has his own
preferences when it comes to quality in relation to nursing care.

Whenever an elderly is admitted in a hospital, he is expecting to be treated in a pleasant and
subtle way. He wants to be taken care of and yet the nurses tending to him should also listen to
what he wants. Senior citizens may be old and yet they are also filled with pride. They don‟t
want to be always accompanied or assisted whenever they want to go to the restroom because
they want to prove to everybody that they still can do things by themselves even if they‟re not as
strong as they used to. They want to feel independent. Their perspective of quality care is when
they still have the freedom to do some of the things they want without a lot of restrictions while
feeling “at home” even if they‟re lying in the hospital bed. Elder people mostly get scared or
spooked by “high tech” gadgets and prefer being treated the conventional way with conventional
gadgets like the stethoscope. These are the areas where the elderly rates the quality of care in a
nursing home or hospital, whichever will make them feel “at home” and “independent”.

If you are a relative of an elderly client, your concept of quality in relation to nursing care may
differ from that of a client or the care worker. What keeps you satisfied with regards to quality is
when you see that your sick relative is always being tended and taken care of. We like to see the
nurse always checking how your sick grandmother is doing and always assisting her whenever
she wants to go to the restroom or if she wants to have a walk.

The concept of quality from a care worker‟s standpoint is mostly having a good nurse-patient
relationship. The care worker and patient should establish this certain mutual trust and respect.

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Some patients especially in my country, they treat caregivers as if they‟re servants. Some
patients also are afraid of the nurse or doctor because of the lack of trust. The caregivers want
their patient to trust them and for that to be possible, both parties should establish a certain bond
so that they will understand each others‟ roles for everything to be delivered effectively. For me,
that is how health care professionals see good quality.

Word count: 500

Answer to question 1 - 1.2

There are a lot of models of quality so let me enumerate to you and explain further how to use
these models in nursing care.

First of all, let us start with what W. Edwards Deming‟s model or more known as The Deming
Wheel: PDCA Cycle which means plan, do, check, and then act. Please refer to the Appendix
[page 18] section of the paper for the specific chart sample. This model is very basic and yet if
expounded and understood can be very helpful when applied to nursing care. Let me tell you
how it works; the nurse plans for a certain intervention although the nurse isn‟t sure how
effective it will be. The nurse shows the patient the plan and the patient tries to do it. After a
certain trial period, the nurse will assess how the patient is doing, make a few tweaks and fix
some things to improve, and then that‟s the time they both act or come into a conclusion of what
regimen to finally follow, an improvised and revolutionized intervention resulting to quality care.

Another model as popular as The Deming Wheel is Joseph M. Juran‟s Quality Trilogy. His
Quality Trilogy is composed of quality planning, quality control, and quality improvement. This
cycle can be done in a lot ofareas especially in health care.A belief by Juran (1967cited in
Swinton 2004 ) states that:
[t]he key steps in implementing company-wide strategic goals are:
Identify customers and their needs – both internal and external – and work to meet those needs
Create measures of quality, establish optimal quality goals and organise to meet them.
Create processes capable of meeting quality goals in “real” operating conditions.

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Applying this model in the field of nursing care, quality must start with the care workers
themselves. Quality should start with them and they should think strategically and plan ahead in
order to achieve it. They should identify the needs of everybody such as their clients and their
staff and they work to meet such needs. After all the planning is done, they set certain standards
of what to follow such as realistically benchmarking almost everything in providing good
service. When everything has fallen into place, we measure everything then we should maintain
the things that are giving us good quality while trying to improve steadily from these things.
The last but not the least and my most favorite quality model of all is Philip Crosby‟s “Do it right
first time”, “Zero defects”. I think that this model is brilliant because as you know, most of
every hospital‟s income losses are spent on errors. If we care workers try to do everything as
error-free as possible, then we will be giving quality care to patients without risking time,
money, and effort. This may sound impossible because mistakes are bound to happen but if we
try our hardest then we care workers could get it right the first time.

Word count: 490


The principles of nursing care in relationship to quality is mutual because when you talk about
the profession “Nursing” and what it is about, it goes back to providing patients with quality
care. Every nurse‟s goal is to satisfy their client so that they can feel good that they‟re doing
great in their line of work which is to give care. If it is the nurse‟s goal is to give satisfaction to a
client then we are talking about quality here. Even in research studies, the inclusion of clients as
subjects will always remain in accordance to the rights and welfare of the patients. This view
has been supported in the entry coming from Connelly (2009). Quality after all is about how the
outlook of others on what we are trying to sell or serve to our clients or patients.

In this line of work in health care in which we are dealing mainly with people, it is so fulfilling
to see even a single expression of satisfaction from our client‟s face. If our way of doing our
work which is giving care to our clients makes our clients happy then we are happy. That is why
we try to provide the best nursing care possible instinctively without being reminded or told

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because we want to provide our clients the best quality care as possible. That is why the
relationship of the principles of nursing care is always going to be connected with quality
because this is a profession where we always try to serve with quality.

I have been studying nursing for the past 5 years or so since I was in the Philippines and now that
I‟m studying health care here in the UK, there‟s still no difference when talking about the
principles of nursing care. What I have learned a lot when I hear the lines “to nurse” is to give
care which means prioritizing others before oneself. Judging just by that principle, there‟s no
other quality more noble than that and that is sacrificing our own welfare in order to serve our
clients.

Word count: 347


In setting the standards of nursing care, the role of external agencies play a very vital part. These
external agencies set the standards in which every clinic, care home, or hospital follow. They set
the benchmark of the standards these hospitals will try to achieve. They conduct regular
inspections and tests like sanitization, safety, equipments, nursing care, and almost everything
that‟s happening inside the hospitals and they make sure to it that these health establishmentsand
their systems of nursing care are passing their quality standards or else they have to take certain
actions in guiding them. Outcomes identification and planning in the nursing standards of care
has been said to be greatly influenced by external agencies according to „Winter Haven Hospital‟
(n.d).

Aside from setting the standards of nursing care, these external agencies also provide some
adequate and useful training to health care professionals such as nurses, doctors, radiologists, and
scientists. They keep everything innovative by always making sure that the system of care in
every hospital or care home are up to date to the latest trends in health care. These external
agencies also provide some integrated approach to protecting public health by supporting and
giving advice to other external sectors and health organizations. Most of these external agencies

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are working in partnership with one another to make sure that everything is aligned and balanced
when it comes to the standards of nursing care. These agencies also assist health managers and
employees with regards to the responsibilities on occupational health issues and these agencies
also help in the research of finding new ways to resolve some problems of today‟s diseases
whether communicable or not and this is helping the standards of nursing care by taking things
and expectations to higher levels.
Care Quality Commission – This is the independent regulator of health and social care in
England. They regulate care provided by the NHS, authorities, companies, and voluntary
organizations. They also protect interests of people with rights restricted under the Mental Health
Act.
Social Care Institute for Excellence (SCIE) – They identify and spread knowledge about good
practice to the social care workforce and support the delivery of transformed, personalized social
care services.
The National Institute for Health and Clinical Excellence (NICE) – They provide guidance, set
quality standards and manages a national database to improve health care for the people.

Word count: 390


There are lots of standards for measuring quality and these could also be used in measuring
quality of care. To name a few; there‟s the ISO 9000/14000, Federal standard 1037C, Good
Manufacturing Practice (GMP), BS 5400, PS 9000, AS 9000, TL 9000, and many more. These
standards for measuring quality are very important because they make sure that the users of
health care sectors meet those standards and maintain them in order to give quality and efficient
service to their clients.

ISO standards make sure that the supply and manufacture of all products and services are
efficient, safer, and cleaner so that the consumers will get quality of products with satisfaction
and everything will be worth it. They also are setting examples by giving governments some
bases for health, safety, and environmental legislation and transfer technologies to developing

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countries. The role of ISO also safeguards consumers and buyers of products and services. They
make sure to it that the customers are guaranteed satisfaction plus some never ending
improvement of its performance in pursuit of all of these objectives so the health and social care
consumers are guaranteed that everything they invest on is worth every penny and are satisfied
by its standards of quality.

BS 5400 is a British Standard for designs and construction of steel, concrete and composite
bridges. This quality standard is useful whenever hospitals, care homes, or other health
establishments are being constructed because this ensures that these designated buildings for
giving health care services are safe and should pass this standard and guaranteeing safer
strongholds for health care consumers.

PS 9000 is an application of the standard for Pharmaceutical Packaging Materials. The PS 9000
makes sure that all pharmaceutical materials are safe for the consumers. It ensures that risks are
avoided in purchasing pharmaceutics and drugs and users are guaranteed only genuine materials
used.
TL 9000 ensures global telecommunications quality and industry-wide performance excellence
because in our growing health and social care world, telecommunications are widely used.

Word count: 331


First of all, a need for improving quality and increased concern about costs and appropriateness
of health and social care in every nursing home has led to some implementation of quality
systems in health care establishment. Quality systems are the organizational structures and
processes for implementing quality in a nursing home. It is controlled mostly by documentation
and stakeholders should follow these by heart so that everyone in the nursing home will achieve
positive results.

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To implement different approaches to having quality systems in a nursing home, everything
starts from the health care employer. You should have the right group of people or staff fit for
their designated jobs. You must make sure that the people you are getting are suitable to enter the
social care workforce and must understand their roles and responsibilities. Your staff should be
diverse and flexible because we are dealing with different kinds of patients here. The more
quality employees you recruit, the more quality your care home will be.

Now if you‟re part of the staff, you should understand your role and responsibilities. You should
know the basic and the most complicated processes of your job and you should have some
certain know-how in dealing with different clients. As a health care provider, you should follow
the quality systems and your codes of your own profession by heart.

Quality systems are composed of philosophies, principles and strategies, practices, and proof of
every outcome. For these quality systems to be implemented in every nursing or care home,
everybody should follow them. Just by following these guidelines religiously goes a long way in
successfully producing quality service to every client there is. Giving some training and
guidelines could also influence some results to the patient level. Everyone should also provide
feedback on the outcomes to assess which areas to improve inside the nursing home to make sure
that these quality systems are really implemented.

Word count: 318


The value of established quality systems in a nursing home is vital because this is where we
measure the consistency of quality inside the establishment. As we already know, quality
systems are processes, guidelines, and policies which everyone should follow. If an already
established nursing home has been following quality systems over the years, then the only thing
that this health establishment needs to do is be more consistent and to further find ways to
improve from what they have already been practicing and should always continue to seek
perfection in providing good quality service for all their stakeholders.

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The tricky part is when you‟re a nursing home that is still trying to develop and establish some
effective quality systems to follow. You must identify some needs and which areas you need to
focus on improving or fixing, strategically plan, implement some changes and fix some minor
bugs within the nursing home. Next, we should keep records so that we can evaluate the
outcomes if we had positive results or not. The administrators and supervisors must plan or make
some certain guidelines in dealing with the staff. If your nursing home can establish some
effective quality systems and practice these systems, processes, and policies consistently then
there should be never ending improved health care delivery within the nursing home. If we
address the needs of every patient including their families and commit ourselves to improving
the nursing home environment and establish good quality systems then our environment within
the nursing home will have effective qualities. If we can establish good quality systems within
the nursing home then that‟s the time the quality of the nursing home will quantify resulting to
some more improved products and services offered and then more stakeholders will be willing to
invest in it. With these established quality systems followed by every user in the nursing home,
the admission of patients will increase significantly.

Word count: 318


The impacts of quality systems on every client, care worker, health care supervisor,
administrator, or any other stakeholder are beneficial. No matter which area you are assigned in,
as long as these quality systems are present, then your environment inside the nursing home will
be optimal.

If you are a client, the first thing you look first when looking for a care home to be admitted is
that they are providing really good service and you get the quality‟s worth of your money and the
most effective care you deserve. A care home with effective quality systems can guarantee you
as a client some satisfaction not only in the latest equipment and good aesthetics within the care
home but also some very efficient service in providing care.

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The impact of quality systems on care workers are far more important because if you are a health
care provider looking to improve on your practice or profession, you need to be guided by
effective quality systems. The numerous processes and policies you should follow are substantial
in guiding you on what to do to ensure that you are giving good service to clients. Your
confidence in your own practice of profession will rise resulting to your productivity levels going
up because you are practicing the right methodologies in doing your profession.

If you belong to any group of stakeholders then the impact of quality systems should also be
beneficial for you. If you are an investor who is thinking of buying a share or investing in some
equipments or service in health care then you will also reap the rewards. Let me tell you how
these quality systems could also impact you. I shall state this again that these quality systems
define processes which will result in a more streamlined production of quality products and
services. Quality systems eliminate wastage of products or services just because you just found
out that they are defective right after they have been produced. These quality systems will not
only benefit the customers or partners but will also benefit the whole organization. This is a win-
win situation where nobody has to lose.

Word count: 356


There are some barriers to the delivery of quality nursing care services. Let me tell you why
these common barriers get in the way to the provision of quality nursing care services.

Apathy –According to Marshal (1999) from his research results regarding the barriers in
improving quality practice, „...health authority described an effective working relationship with
only a small minority of doctors but a high degree of apathy among the majority.‟ This study
thus confirms such existence of a barrier in the field of health care.The staff may feel that it is
unnecessary to change or improve something because he or she feels contented about the service.
He/she may think that it is useless to exert some effort in order to change things and when asked

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to change, his or her reaction would be “why would I do it if there‟s no problem with our old
routines?” This type of approach to ideas of improvising to deliver quality nursing service is a
big hindrance because how can we innovate? I am sure that with what they‟re currently doing is
fine but there may be some room for improvement but because of the lack of interest or concern,
then how can we improve our services to provide a more qualitative manner of giving care?

Cynicism –This type of approach when it comes to change for some better quality nursing
service is also widely normal as a hindrance or barrier. Even if everybody involved wants the
positive need for change or reconstruct things, the deviant persons who just wish to antagonize
may have a different outlook of the idea. This are usually caused by mistrust about his/her co-
workers or managers. They see this as just excuses or unnecessary changes that are too
extravagant and may only benefit the managers and not them.

Lack of resources – To rebuild, innovate, and improve things isn‟t always easy especially when
you have this kind of barrier which is lack of resources. This needs time, money, personnel, or
training of producing quality care services. There‟s always the excuse of “we are too busy to
change things” or “we don‟t have enough money” or “why would we spend more to do that?” If
the management or the staff is hesitant because of the lack of resources then we cannot do
anything to boost our quality and this always takes effect in the near future when you‟re putting
your quality at risk.

Word count: 404


The effectiveness of systems, policies and procedures used in a nursing home in achieving
quality in the nursing care service offered is substantial because with following these guidelines,
we are ensured good results in achieving quality in the nursing home. These said systems,
policies, and procedures are being implemented because they have been there for quite some
time and they are tested by experience whether trial and error or because they have always

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resulted to positive results in producing valid quality nursing care services in every nursing
home.

It is really important to establish good systems, policies, and procedures in a nursing home and
implement all of these to every member of the staff so that they will know which things to
practice. These practices should be instilled upon them so that they will get some ideas of how to
really provide good service to the patients that are admitted in the nursing home so that the
clients will be ensured of getting quality service in care from this nursing home.

These systems, policies, and procedures should focus around innovation within the nursing
home, erasing or minimizing errors, getting feedbacks from clients and every other stakeholder,
and a good quality management of time and work load. These systems, policies, and procedures
should always be ever-changing or innovative in which the managers should always find new
ways to improve their quality of service. They should also try to minimize mistakes and near
misses so that the quality of service will be more efficient and there will be less monetary losses.
Doing a survey from everybody in the nursing home should also help because it is important to
hear what every stakeholder wants especially in those areas which need improvement the most.
If you listen to the people then most likely, you will know which areas you need to focus the
most in. Time and task management is also very important because with this, we could maximize
everything and this will most likely result to achieving quality in providing nursing care services.

Word count: 340


There are a lot of other factors that influence the achievement of quality in nursing care. There
are the external agencies, the quality systems to be followed, and the willingness of all the
management and staff to provide better services in every hospital and nursing home.

External agencies are important because they assist the health care sectors in a lot of things. They
also set standards and do the benchmarking for every health care professional and health care

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organization to follow. They also find ways to improve things and then train health care
professionals in workshops or seminars and equipping them with more knowledge in providing
better quality care. These external agencies also inspect those health care establishments like
nursing homes and hospitals and really test them to make sure that they are really following the
right systems and procedures in providing care. With this, those health care professionals in all
health care establishments are more motivated and obliged to do their best providing quality care
services to every client.

Quality systems are equally important in influencing the achievement of quality in nursing care
because these quality systems are guidelines for everybody to follow. These quality systems are
guidelines which are already tested and proven and they‟re like laws which govern every health
care establishment in providing the right procedural methods in giving care which will result in
success in the areas which you are trying to improve in achieving quality in nursing care.

Of course, not only systems and policies are factors to influencing success in reaching quality
nursing care, it also depends on the workforce itself which is the managers, the care workers, and
all the staff. These people should have that certain desire in giving good service to the clients by
heart and not just by profession. They should be sincere in striving to provide good quality care
to patients and they should be driven by passion in doing this. If you‟re a health care provider
and you want to give better service to your patient, nothing is impossible if you put your mind
and heart into it.

Word count: 351


My recommendations for actions to make improvements in the quality of nursing care service is
by following all these quality systems, policies, procedures, the right methodologies, and to
always commit finding ways to improve even the smallest detail in giving care so that you can
achieve improvements in the quality of nursing care. Doing surveys and asking feedback from

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others will also help you open your mind on which areas you must improve in order to give
improved quality nursing care services.

These systems, policies, and procedures are very important to effecting improvements in quality
nursing care services. As what I have learned, most of these things are rooted from previous
experiences of negative and positive outcomes. They are tested by trial and errors and they were
made because of previous findings of how to produce good quality service. If you as a health
care provider will follow these guidelines consistently then there should be no way that you‟re
not going to get improvements in providing quality nursing care.

As a health care provider, everything starts from you. If you are committed to doing your job and
providing quality service to the patients then the effects will be continuous improvement in
giving quality nursing care services. Let us put it this way, if you do your work sincerely with
quality then you will get good quality results.

Doing surveys by asking people comments about how you are doing your job in providing care
services and collecting data from previous studies is also helpful in getting improvements in
providing quality nursing care services. Listening to others and asking comments about how you
are currently doing your job is like looking at a mirror. By listening to the clients and asking
them, you will know which areas you must improve on and if you are open to these criticisms
then you‟re bound to do some constructive rebuilding in trying to improve your way of giving
your services to the patients.

Word count: 328

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References

Traulsen, JM., Almarsdóttir, AB. & Björnsdóttir, I., 2002. Pharmacy World and Science. The
lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services--
results of focus group discussions [Online]. 24 (5), p.196-200. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/12426964 [Accessed 24 July 2010]

Swinton, L., 2004. Management For The Rest Of Us. Management Gurus – The Quick and
Easy Guide [Online]. Available at: http://www.mftrou.com/joseph-juran.html [Accessed 24
July 2010]

Connelly, L.M., 2009. Medsurg Nursing: Official journey of the Academy of Medical-Surgical
Nurses. Staff nurses' responsibilities when caring for patients in a research study [Online]. 18
(6), p.385-6, 388. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20088195 [Accessed 24
July 2010]

„Winter Haven Hospital‟, n.d. Model of Professional Nursing Care Delivery [Online]. p.10.
Available at: http://www.winterhavenhospital.org/docs/nursing/model_of_care.pdf [Accessed
24 July 2010]

Marshall, M., 1999. British Medical Journal. Improving quality in general practice: qualitative
case study of barriers faced by health authorities [Online]. 319 (7203), p.164-167. Available at:
http://www.bmj.com/cgi/content/full/319/7203/164[Accessed 24 July 2010]

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Bibliography

Scott, J., 2001. Removing Barriers to Improved Healthcare Quality - health care management
theory - Brief Article[Online].Available
at:http://findarticles.com/p/articles/mi_m3257/is_5_55/ai_75215151/ [Accessed 24 July 2010]

O‟Dowd, A., 2010. British Medical Journal. NHS staff numbers begin to fall as fears rise over
effect of efficiency savings[Online]. Available at:
http://www.bmj.com/cgi/content/extract/341/jul23_2/c4005?maxtoshow=&hits=10&RESULTF
ORMAT=&fulltext=health+care+quality&searchid=1&FIRSTINDEX=0&sortspec=date&resour
cetype=HWCIT [Accessed July 24, 2010]

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Appendix
PDCA CYCLE

PLAN DO

What factors influenced the Technical maintenance and
downfall of service consumer‟s upgrades, skill building
rate for this month? Things to do: activities, interpersonal
Reassessment of services, relation enhancements,
workforce and other general meeting.
stakeholders involved. Distribute questionnaires to
Perform quality assurance clients, build service
monitoring. customer support team.

The service consumer‟s rate increased the following
month.
Level of satisfaction became higher compared to the
CHECK previous months.
Increase in new health care subscribers.
Customer support team documented expressed
convenience coming from clients.

Revision and creation of new policies and standards.
Creation of quality assurance team responsible for
standard maintenance, squeezing room for
ACT improvements, conducting scheduled trainings, seminars
and reassessments.
Creating a standardized point of hazardous level in
terms of service consumer monitoring and establishing
planned procedures.

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Managing Quality in Health and Social Care

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