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Managing Quality in Health and social care

Table of Contents
 LO 1 – Understand differing perspectives of quality in relation to health and social care services
1.1 Explain and relate different quality perspectives that board members, employees and service users have regarding quality in relation to Anchor’s health and social care services.
In relation to quality of health and social care services provided by Anchor there are different perspectives of every stakeholders or users. As the ideas, tastes, likes of every person vary so their perceptions towards it also vary. As per the American Medical Association health care service quality as such care can be defined as, “which consistently contributes to the maintenance or improvement of quality and duration of life”. In order to determine the quality the association highlighted particular attributes of care for examination purpose which includes emphasis on health promotion and disease prevention, the more informed participation of patients, punctuality, more attention on specific basis of medicine and efficient and effective use of resources (Barten et al, 2009). When talking about the perspective of patients they define health care quality as per the responsiveness to their particular needs. Their main focus is on effectiveness, interpersonal relations and continuity. As per health care professional viewpoint for quality they focus on the technical nature of health care events like updated skills of physicians. As per the employees’ perspective, it all depends on their commitment and motivation to carry out their duties in an optimal and ideal manner. Those who take this care work as a job rather than interested in training are tend to leave this work when they get better opportunities in terms of money. Those who are committed to the work in Anchor care should be retained through training so as to avail the benefit of their quality and optimal services for a long period of time. These different perspectives clearly show that in order to provide better quality of care services, Anchor should identify the needs of the employees and proper control measures should be taken to retain the quality of their dedicated staff. For patients too, these functional aspects of quality are to be taken care of.
1.2 Analyse the roles of CQC and relevant external agencies in setting quality of service standard in anchor care trust.
Role of External Agencies
The external agencies play a very important role in setting standards of quality care in Anchor care trust. They set the standards with benchmark to be followed by this care home. Several regular inspections and tests are conducted by the external agencies such as sanitization, nursing care, safety measures, equipments availability and almost everything which happens inside the Anchor care trust so as to make it sure that the care trust and their whole system of nursing care are as per the quality standards which they have fixed. In case they find any difference between the set standards and the quality achieved they take strict actions to guide them. Apart from setting quality standards, the external agencies provide training to health care professionals like the nurses, caretakers and the doctors (Cooper and Clarke, 2011). These external agencies are highly updated about the latest trends in health care and they impart the same to the care trust. They mostly work in partnership with other agencies in order to have proper alignment and balance in the implementation and practice of standards of quality care. Anchor care trust can be benefitted a lot by these external agencies as they also help in assisting and retaining their employees and health care professionals by advising them on the responsibilities on occupational health issues. These agencies help in resolving problems by implementing new ways and in this way help the Anchor care trust to take the expectations to higher level.
Role of Care Quality Commission (CQC)
It is an independent health and social care regulator. Care provided by the NHS, authorities, voluntary organizations and companies are regulated by CQC. The make sure to protect interests of people regarding their rights which are restricted under the Mental Health Act. For Anchor care trust, CQC helps in identification and expansion of knowledge regarding good practices of social care performed by work force therein. They make sure to deliver transformed and personalized social care quality services.  
1.3 Assess the impact of poor service quality on anchor staff and service users and relate them with staff retention, training and vocational aspects.
Poor service quality in Anchor care would lay a bad impact on every client, care worker, health care supervisor or any other stakeholder. As a client, when looking for a care home the first thing they consider is the standard and quality of services and the effective care they would get in the care home so as to spend their worth of money. As a care home, Anchor care should guarantee client’s satisfaction in terms of using latest equipment and good aesthetics as well as very efficient and optimal service in providing care. Good quality systems impact the anchor staff in a positive manner by helping them in improving their practice or profession. A poor service quality will result in low confidence of the care workers which eventually leads in low productivity levels. If the satisfaction from the Anchor trust quality services and confidence of the care workers is low then it will have a direct effect on the quality of care clients would receive from them (Chattopadhyay, 2008). As per the case study, some employees work for vocational reasons and tend to change the job in case of better monetary offers. So, first of all identification of staff intentions are very necessary to take any action for them. Those care workers who are interested in pursuing a long term career in this health and social care sector should be trained and motivated well. They should be given right amount of training for practicing the right methodologies in doing their work of quality care. Proper and adequate training and staff welfare measures can help in achieving client satisfaction and as a result there would be more streamlined production of quality social care services.
LO 2 – Understand strategies for achieving quality in health and social care services
2.1 Choose and explain at least 5 standards (minimum standards; best practice; benchmarks; performance indicators and legislation) that exist for measuring and achieving quality in relation with Anchor’s health and social care services.
For measuring and achieving quality in relation with Anchor’s health and social care services, there are several standards established. Some of them are ISO 9000/14000, Federal Standard 1037C, Good Manufacturing Practice (GMP), PS 9000, TL 9000, AS 9000, BS 5400 and many more. These standards are very important as they help the users of health care sectors to meet these standards and it is ensured that the services being provided are efficient and timely so as the client will get quality care with satisfaction. They are also giving bases for health and safety and are helping in transferring technologies to developing countries.
Good Manufacturing Practice (GMP)
GMP regulations require a safety approach and enables companies to eliminate chances of contamination and mix-ups which eventually helps the customers to purchase products which are not dangerous and not effective. Along with safety measures these regulations ensure cleanliness, equipment verification, and complaint handling matters too. Such requirements are open ended and very general for the manufacturer resulting in flexibility for them to implement the necessary controls.     
ISO Standards
ISO make sure that consumers and buyers rights are safeguard. Their role is to guarantee customer satisfaction along with a thirst to continuously improve their performance so as to achieve the desired objectives. They make it sure that every penny incurred by the customer is worth for the quality of services they get in return (Davis and Souza, 2009).
BS 5400
It is a British Standard which is formed for designing and construction related standards of steel, concrete and composite bridges. Whenever hospitals, care home like Anchor care and other health establishments are constructed, this standard ensures construction of building according to the standards.
PS 9000
This standard is all about global telecommunications quality. It also ensures industry wide performance excellence. This standard ensures safety of consumers in relation to pharmaceutical materials. It guarantees genuine material for the customers and helps in avoiding risks in purchasing pharmaceutics.
TL 9000
As in our growing world, telecommunications are used widely, so, this standard is all about telecommunications quality. It also ensures industry wide performance excellence.
2.2 Evaluate the different approaches which are available, to implementing quality systems and compare them where it is appropriate. Explain your rationale behind each approach that you would evaluate.
In order to improve quality, every care home has to implement quality system in health and social care development. The quality system is that process which helps in enhancing quality in the entire system of care home. It is all covered in documents and the stakeholders have to learn it by heart so as to ensure positive results. If different approaches are needed to be implemented to form quality system in care home, health care employer is being focused. There should be right set of workforce fitting the job requirements. They must understand their role and responsibilities well to perform their functions properly.  To have the support of whole staff for the overall development of organization following must be considered.
There should be a structured approach to share the relevant information between the peers. It should be clear that what set of information is to be shared with professionals, with regulatory bodies, with care workers, with managers and other agencies.  Also, feedback from the clients and providers is very essential to assure the quality of services and if needed, a proper and strategic approach is to be designed for further improvements (Earle and Heymann, 2009).
Coordination and Planning
A clear and understandable approach should be there to monitor that quality systems are effectively implemented and which clearly demonstrates the benefits to service users and providers. In order to enable this, care home has to ensure planning of lines of reporting which should be effective, workable and robust.
Roles and responsibilities
The quality of services provided depends upon the culture, working practices, and performance of service providers. The care home has the responsibility to support the individuals to perform their task by coordinating with the overall process.
Monitoring and evaluation
In this approach progress is being checked against the set standards and if needed the action plans of service users and careers can be monitored and improved for better results.
All these approaches are needed to ensure that the quality systems are really implemented and well monitored afterwards.
2.3 Analyse the internal and external potential barriers to delivery of quality in the above scenario.
In the delivery of quality care services there are some factors which act as barriers. These factors discourage people from accepting changes and taking positive actions. Some of the barriers are apathy, Cynicism, resistance to change, lack of resources. First is apathy, which is a main barrier in the field of health care. As per Marshal (1999) his research on barriers of quality services showed that in a small minority of doctors there is effective working relationship contrary to majority who has a high degree of apathy. This study shows us the existence of barriers and disinterest of the staff to change their old routines. They do not believe in the effectiveness of the rules and frameworks promoting quality systems. Second is Cynicism which is different from skepticism and resistance to change. As a hindrance or barrier it discourages the staff to change for some better quality care service (Healy, 2011). In this case, the deviant persons who never agree and are antagonize have a different viewpoint toward an idea of change in comparison to other who accepts the need for change or reconstruct things. They see such changes as a benefit for the managers only and not for them. Their thinking is developed due to the mistrust about their co workers or managers. Third is Resistance to change in which the workers are of the opinion that they are fine with the current working. But as is always said that there is some room for improvement always, they need to accept the required changes in their current system of working for improving the quality of work. But due to lack of knowledge, interest they resist to new changes and do not push themselves to come out of their comfort zone. Finally, lack of resources is a big hindrance in the improvement procedure as there is always an excuse that there is not enough money, they are too busy to change or there is no willingness to spend.
LO 3 – Be able to evaluate systems, policies and procedures in health and social care services
3.1 Your Board members requires you to suggest another selection process you would use in this case and evaluate the effectiveness of systems, policies and procedures used in achieving quality in the service(s) offered in this scenario.
The effectiveness of systems, policies and procedures used in achieving quality in the Anchor care home services offered is substantial due to the fact that after following the guidelines, good results can be attained in terms of quality services. The systems, policies and procedures that are being implemented are well tested by experience or by any method like trial and error. Such systems and policies are derived from the positive results of every care home where they have been implemented earlier. It becomes very essential for the care home to implement good systems, inline policies and procedures and it is to be ensured that they reach each and every member so as to enhance their knowledge and their practice skills. They should be instilled with the practices so that they can get ideas of providing effective and quality services to the clients. The systems, policies and procedures which are to be implemented in the care home should focus upon innovation, a good quality management of time and energy, ways of minimizing errors and such ways to get feedbacks from clients and other stakeholders so as to achieve the desired objectives of providing quality and highly improved services to the care users (Hughes and Ferrett, 2012). These systems and procedures should be innovative as the managers would find new methods to improve and enhance their quality of services and also focus to minimize mistakes so as to avoid monetary losses. One of the ways can be doing survey with each stakeholder to listen to their requirements and to note down their suggestions regarding the areas which need improvement. For this purpose and for efficient running of systems and policies time and task management is very necessary which will eventually result in achieving quality in providing care services.
3.2 Analyse various methods that influence the achievement of quality and incorporate the factors in relation with anchor service quality improvement.   
There are several methods to influence the achievement of quality in anchor care home. Such methods are the role of external agencies, the quality systems to be set up, and the desire of all the management and workers to provide better quality services. External agencies play a very vital role in the achievement of quality standards by assisting the care professionals in a lot of things. They do the benchmarking for the care workers and the care home to be followed on a regular basis. By arranging seminars and workshops they help the care professionals by equipping them with more vast knowledge about how to provide better quality services. They test the care home from time to time to make it sure that whether the care home is following the right set of policies and methods in imparting quality care. This testing seems necessary as it obliged the managers to do their best (Kriebel et al, 2011). Quality systems also play a significant role in the achievement of quality in anchor care home. The quality systems set guidelines to be followed by everyone and these guidelines are tested ones and act as laws to govern the health care issues of care homes. These quality systems along with policies provide right procedural methods to get success in areas of improvement in achieving quality care. The workforce or say managers are also the influencing factors for achieving the quality services. They should impart sincere efforts by heart in providing good care services to the clients so as to satisfy the needs of the clients. They should be motivated and encouraged to get into their passion and as a result provide good care services.
3.3 Suggest ways in which the anchor care service could improve its quality improvement. Discuss what potential conflict or difficult situations might arise in this scenario and how would you deal with them.
The anchor care service may take actions to improve their quality of care services by implementing all the quality systems, policies and procedures effectively, by choosing the right set of methodologies. It should always be ready to adapt any new changes or improvement in the smallest sector even in order to achieve the desired quality of services. Anchor care can do surveys and take feedback from various stakeholders to gain a viewpoint that on which areas there is more requirement of improvement. Most of these findings came from previous experiences of positive and negative outcomes (Lowell, 2008). They are tested and verified from the previous experiences and trial and errors methods. As a health care provider, Anchor must follow these guidelines consistently.  If anchor will do the work sincerely with quality then they will surely get good and positive responses from their clients. Data collection from previous studies is also helpful to improve quality services being provided to the clients. Listening to others will eventually result in knowing their viewpoint about Anchor Care and they may also face negative and rude responses. As asking for comments or feedback is like looking into a mirror. In such difficult situations, Anchor workforce should take the criticism positively and should focus to do some constructive rebuilding as a way to achieve improvement of type of services being provided to the clients.
LO 4 – Understand methodologies for evaluating health and social care service quality.
4.1 Evaluate methods for evaluating anchor service quality with regard to external and internal perspectives.  
There are numerous methods for evaluating anchor service quality. First is Marketing as marketing depends upon the needs of the customers then second comes service marketing which helps in understanding the nature of services and the quality of services provided; and third is the service quality models which are used commonly within the service marketing discipline. For evaluating anchor care service quality healthcare providers take interests in the different perceptions while anchor itself seeks for cost minimizing issues and decreased employee turnover issues. These perspectives are the internal factors with regard to evaluation. These factors take place within the organization structure and also include the basic service model which comprises of operations system, service delivery system and marketing system (Lund, 2011). This model describes the relation between the different parts of the care trust and explains the visible and the invisible parts of it like its clients and the physical environment. The external perspectives comprises of the service quality offered and customer satisfaction. Client satisfaction is the overall evaluation of anchor quality services. It can be said as the previous client’s reflection toward the services experienced by him/her. The more their expectations exceed, the more their loyalty becomes. Customer satisfaction should be the major priority in Anchor’s business. The relationship between service quality and customer satisfaction should be considered for evaluating the different perspectives precisely. The researchers has suggested that with superior service quality would yield a more satisfied customer base which would eventually help the Anchor Care Trust in the achievement of quality services and desired objectives. Both the internal and external perspectives will help Anchor to understand the service relationships within the internal health care environment as well as the external factors of customer satisfaction.
4.2 Discuss the impact that involving a user of services and staff in the evaluation process has on service quality.
As per the study of evaluation process, it would have a real impact both on the user and staff of care home. We can discuss the case by taking example of an elderly client. An elderly person expects to be treated and served in a pleasant way. He wants the staff to take care of him well and to listen to his requirements. Old age people have pride and they do not want to take help every time so as to show that they still can do things on their own.  Their perspective toward quality care is that they should have freedom to do things as per their wish without much restriction. They consider convention ways of treatment over high tech gadgets. So, these issues are considered by them when they rate the service quality being offered to them. From the view point of a care worker, good quality service means a good nurse patient relationship. In order to achieve this purpose, the care worker wants their patient to trust them fully which can only be possible if they have a mutual understanding and respect for each other (Healy, 2011). In order to establish a good bonding, the care worker has to understand the mental state of mind along with the physical help needed by the patient and the client should develop a feeling of trust and respect for the care professional. This way only a good and impact can be made on the overall evaluation process of service quality measurement. These methods of improvement will not only benefit the customers and the staff but will be also beneficial for the whole Anchor care trust leading to a win-win situation from both sides.        
Barten, F., Fustukian, S. and De Haan, S. (2009) ‘The Occupational Health Needs of Workers: A New International Approach.’ Social Justice, 23 Burke,
Cooper, R and Clarke, S. (2011) Occupational Health and Safety, 2nd ed. England: Gower Publishing, Ltd.
Chattopadhyay, O. (2008) ‘Safety and Health of Urban Informal Sector Workers’, Indian Journal of Community Medicine, 30
Davis, L. and Souza, K. (2009) Integrating occupational health with mainstream public health in Massachusetts: an approach to intervention. Public Health Rep. 124(1):5-14.
Earle, A. and Heymann, J. (2009) ‘A comparative analysis of paid leave for the health needs of workers and their families around the world.’ Journal of Comparative Policy Analysis, 8
Healy, J. (2011) Improving health care safety and quality: reluctant regulators, 3rd ed. England: Ashgate Publishing
Hughes, P. and Ferrett, E. (2012) International Health and Safety at Work, 2nd ed. London: Routledge
Kriebel, D., Jacobs, M. M. and Tickner, J. (2011) Lessons Learned Solutions for Workplace Safety and Health, University of Massachusetts
Lowell L. (2008) Health impact of occupational risks in the informal sector in Zimbabwe, International Journal of Occupational and Environmental Health, 4(4): 264-74
Lund, F. (2011) ‘Towards and inclusive Occupational Safety and security
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