Three stakeholders
The term stakeholder refers to a person who has an interest in an organisation or a firm. Stakeholders are affected by the major decisions a firm or an organisation makes in the course of executing business operations (Paeglis 2012). In a hospital setting, the stakeholders include the healthcare providers, the clients, and the regulatory boards just to mention a few. In the case reviewed in this paper, the stakeholders include
- The CQC
- The patients
- The healthcare providers
The CQC is the health regulatory body in England mandated to oversee the running of the health facilities in the country. The regulatory body ensures that healthcare providers act according to the set standards. The body makes unprecedented visits in all the healthcare facilities in England to ensure that the rights of customers are observed. On the other hand, the patients are important stakeholders since they are directly affected by the decisions of the healthcare providers. Lastly, the healthcare providers are important stakeholders in this case since they are directly affected by the standards set by the regulatory bodies.
The stakeholders’ perspectives regarding quality care
The stakeholders’ perspectives vary greatly depending on the nature of stakeholders in question. The CQC expects the healthcare providers to offer quality services to customers and to exercise justice when handling patients. The regulatory bodies are well versed with what comprises quality services to customers. Patients know less about the standards of health, and they may accept the services offered without questions. Research indicates that most patients perceive doctors as qualified individuals with the ability to offer quality services to their clients (Tadros et al. 2015). However, patients can differentiate between healthcare providers who offer quality services from those who compromise the quality as can be deduced from the report reviewed in this paper. During the CQC visit, most patients offered positive responses for healthcare providers who treated them with respect.
Examples
The patients perceive quality care as the ability of a healthcare provider to handle the needs of each patient competently. They tend to overlook the standards set apparently due to lack of knowledge about such standards. CQC found that patients receiving care at the Day Surgery Unit were not handled properly. Patients in one of the wards were dressed in suits and ties, and upon interrogation, they revealed that they enjoyed being supported to dress according to one’s desires.
External agencies involved in setting the standards
There are various agencies responsible for formulating the health care standards applicable to all the healthcare facilities in England. These external agencies include:
- The government
- The legislature
- The Care Quality Commission (CQC)
The government’s healthcare quality standards are outlined in the country’s constitution. The Constitution defines the standards that each care provider should follow while dispensing his/her mandates (Oliver 2012). The legislature also plays a major role in setting the standards applicable to all healthcare facilities in England. The CQC is responsible for assessing the adherence to the set standards for the healthcare providers.
The role of each over the other
The Constitution is the supreme law of the land hence the standards outlined in the document supersedes those of other agencies. In case the legislature enacts laws that do not align with the Constitution, the latter prevails. CQC makes recommendations to various facilities after assessing the quality of services offered. The agency also publishes the results of the reviews and advises users of the healthcare facilities they should choose for health services (Hammond, Jaffe, & Kush 2009). These reviews compel providers to comply with the set standards to obtain positive reviews.
Impacts of poor quality services
Financial impacts
Poor quality healthcare results in an increase in the healthcare cost. Poor care may lead to health complications among patients, hence increased costs following readmissions. The increased cost not only affects the patients but also the healthcare providers since it increases the number of patients leading to variances in the budget.
Poor health outcomes
Poor quality services affect the health outcome of patients leading to poor health due to the inefficient treatment afforded to them in the first phase. Inappropriate care may also result in falls especially among the older patients causing other health issues. Falls not only increases the cost of health but also affects the patients’ outcome (Paeglis 2012).
Causes
Inadequacy of facilities
The provision of quality care services in RUH is limited by the unavailability of the necessary equipment. During the visit, the CQC officers observed that in one ward there lacked enough cleaning equipment hence causing patients inadequate sleep due to the extended time consumed during washing.
Little knowledge about standards by nurses
Nurses do not have adequate knowledge regarding the set standards of healthcare. They do not understand the benefits of providing quality services to patients.
Impact analysis
Impact monitoring is essential in RUH since it will form the platform through which nurses will be educated on the benefits of complying with the set standards to satisfy the needs of clients. It will highlight the consequences of poor quality treatment regarding poor patient outcome and increased workload.
Identify three standards
The National Institute of Health and Clinical and Healthcare Excellence (NICE) identifies two areas of quality concerns, which include the physical and psychological needs of clients (Tadros et al. 2015). Another standard established by NICE centres on pressure ulcers. The Commission requires that healthcare providers mitigate rather than treat the condition. The Mental Capacity Act requires that healthcare providers to execute the liniment control procedure if patient control is necessary.
Explain the healthcare standards
Healthcare standards are an important component of healthcare provision since they define the procedures for administration of health care services. Healthcare standards are formulated to minimise unethical conduct among medical staff (Oliver 2012). The secondary functions include
- To standardise healthcare provision among different hospitals
- To guide decision-making
- To ensure patient safety
- To instil confidence in customers
How standards can improve care
The existence of healthcare standards guides the process of decision making since they oblige the healthcare providers to make decisions that maximise the health outcomes of the patients. Moreover, standards eliminate chances of healthcare personnel to make errors during the decision-making process leading to increased patient safety (Gopee 2015). The set standards are subject to reviews by the concerned bodies. Such reviews amend the regulations depending on the problems or difficulties observed in execution.
Two quality systems
The two quality systems identified are:
- Total quality management (TQM)
- Benchmarking
Total quality management
TQM refers to the managerial organisation system that aims at streamlining the activities of an organisation to provide high-quality goods or services at the minimum possible cost. In healthcare, TQM involves teamwork, collective responsibility and the formulation of a flexible strategic plan to achieve high-quality services at minimal cost. TQM identifies the following stakeholders:
- Patients
- Patients’ families
- Nurses
- Other medical personnel
- The employer
- The government
Under this system, the top managers are highly encouraged to enhance communication with all the stakeholders involved when making major decisions.
Benchmarking
Benchmarking in Healthcare refers to the process of establishing a standard of excellence and making a comparison of the effectiveness of the standard with that of the competitors (Reid 2012). Benchmarking is currently gaining popularity as hospitals seek to minimise the cost of health while improving the quality of services.
Approaches
Benchmarking follows the following steps for successful implementation and appraisals
Plan
Planning is the first stage in the implementation process of the proposed changes in a healthcare facility. It involves determining how to execute the proposed changes and the resources required to effect the changes.
Do
After the plan has been formulated and the necessary resources mobilised, the execution process commences right away.
Study
This stage involves making constant appraisal assessment on the performance of the implemented changes.
Act
In this stage, any deviations from the set standards are corrected based on the findings obtained from the study phase.
Consequences for not following the process
The described processes are important to implementing benchmarking in an organisation. Failure to follow the procedures may result in inefficiencies in the implementation processes. For example, planning seeks to establish the amount of resources required to implement a proposed change.
TQM
Customer focus
The approach involves prioritising on the customers’ needs to guarantee their satisfaction. Constant appraisals are done to measure customer satisfaction.
Strategic planning and leadership
This aspect involves establishing the short-term and long-term goals and formulating strategies aimed at achieving them.
Empowerment and teamwork
Employees are the main determinants of the success of the strategic goals established by the firm. In light of the mentioned fact, they should be empowered to make certain decisions independently.
Benefits and consequences
Adopting the approach described above is beneficial since it enhances teamwork and helps a firm achieve its short-term and long-term goals. Failure to follow this approach may lead to failure of the TQM.
The best approach for RUH
Benchmarking suits RUH since it calls for the involvement of all staff members in major decision-making processes. The system allows for comparison of the set standards with that adopted by the competitors to assess the progress of achievement of the set goals (Fowler, Agha, & Sevdalis 2014). In RUH, some shortfalls were noted in customer attendance whereby in some wards, patients’ privacy was not respected. Adopting benchmarking will bring together all staff members to work as a team to enhance the quality of services. The comparisons made with other leaders in the set standard will motivate the workers to work towards defeating the rivals.
Potential barriers
Internal
Lack of knowledge
The staff members are not well equipped with the quality standards stipulated by the regulatory bodies. This aspect limits their ability to perform their duties appropriately. The hospital does not train nurses on the effective use of the food and hydration charts leading to inappropriate or lack of proper monitoring.
Organisation structure
The current organisation structure does not allow for teamwork and collective responsibility leading to delays and gaps in quality achievement.
External
Legislation
The quality standards are prone to changes due to the amendments initiated by the legislature. Changes in the law create confusion due to the introduction of new procedures.
Inter-agency interactions
There are numerous legislations governing the handling of clients in England. The multiple sources of standards complicate the working of the nurses since they are not sure of which standards to apply when dealing with customers (Duggirala, Rajendran, & Anantharaman 2008). The standards are not harmonised due to the lack of inter-agency interactions leading to confusion among nurses.
Impact of the barriers
The identified barriers lead to poor treatment outcomes among patients due to ineffective care. It also leads to high cost of health emanating from readmissions and health complications.
Potential barriers to quality healthcare
The hospital’s staff members are responsible for the poor quality healthcare services in the facility, but other factors compound the problem. These factors include:
- Inadequate resources
- Inadequate training
- Legislations
Inadequate resources
The inadequacy of funds by the hospital can be largely attributed to the poor quality of services in the facility. For example, the facility lacks enough resources to build enough toilets for both genders. The hospital management revealed documents that supported the construction of sanitary facilities, which were yet to be completed due to the inadequacy of funds. Washing machines were also inadequate, thus causing disturbances in the wards as the exercise took longer than it would be expected.
Inadequate training
The nurses interviewed during the survey raised the alarm that they had little knowledge about major policies introduced by the management. For example, the nurses were not trained appropriately on the best way to use the hydration charts resulting in incomplete records. Inappropriate recording of patients’ hydration data amounts to a violation of the trust policy.
Legislations
The legislations defining the standards of health care have greatly shaped the provision of quality healthcare services in RUH. Following the assessment made by CQC, the facility improved its services in a bid to comply with the recommendations made. Some of the notable changes following the CQC visit are observable in the DSU where the process of making assessments greatly improved.
Two problems in RUM
Patient privacy and dignity
Patients are entitled to privacy, dignity, and independence during their stay in the hospital. The CQC reported that patients’ dignity and privacy had been compromised at some of the wards. A case in point is the elderly ward where the CQC panel observed two female patients in the toilet with the doors open. The hospital also lacks enough facilities with patients of both genders sharing bathrooms and toilets. Nurses in this ward did not bother to help the patients despite being in the room.
Non-compliance with the systems
RUH has in place systems that allow timely assessment of patients care needs and the delivery of such needs. However, CQC observed delays in patients’ assessment and care delivery especially in the intensive care unit and in the Day Surgery Unit. The CQC also observed that 90% of the fluid charts were not properly utilised to monitor the patients’ daily fluid intake.
Solutions
To remedy the identified shortfalls, the facility needs to introduce a non-discriminatory training program that will equip staff members from various departments with the appropriate knowledge regarding the handling of patients (Reid 2012). The CQC learned that the nurses in the ward were not aware of the importance of patients’ privacy and dignity. The staff members should receive training on the importance of complying with the healthcare standards.
Therefore, to ensure compliance with the hospital norms, the charge nurses should conduct regular audits of the hydration and meal charts and seek for an explanation as to the missing data. The appropriate disciplinary actions should be reinforced to the non-complying staff members. The hospital should cultivate a culture that enhances teamwork and collective responsibility to fill the gaps in quality.
Two strategies, policies, or procedures in RUM
RUH scored high in the involvement of clients in its quality care provision endeavours. In one ward, patients were allowed to wear the clothes of their choice. The patients felt comfortable in the garments of their choice as detected from the interviews between them and the CQC staff members. The patients’ needs are twofold, which include the psychological and the physical needs. By allowing patients to wear their favourite clothes, the hospital addressed their psychological and physical needs.
The other scenario worth mentioning is the instance where the CQC visited the elderly wards. The nurses had enough knowledge about the essentials of taking care of patients in a healthcare setting. The interviews with the nurses revealed that all the staff members were well versed in the methods of handling the older groups.
Three methods of evaluating quality
Internal
Questionnaires
Patients are the direct clients of a hospital, and their satisfaction should be prioritised. Enhancing communication with the clients would be a sure way of ensuring that all staff members in a healthcare facility comply with the set standards. Questionnaires may be used to evaluate customers’ satisfaction regarding the services offered.
Advantages
Questionnaires allow patients to give information about their areas of dissatisfaction with the services given. The questionnaires may also act as a venue through which mistreatments by the staff members could be aired since questionnaires afford anonymity.
Disadvantages
Extraction of information through questionnaires may lead to the collection of the wrong information since some patients may be biased. Besides, patients may have little understanding of what comprises quality services.
Interviews
Interviewing individual patients could also be a good strategy to employ to gain insight of the customers’ perceptions regarding the services. The chief nurses should conduct regular interviews with the clients to detect any form of mistreatments in the various departments.
Advantages
Interviews allow the evaluator to get first-hand information regarding clients’ satisfaction levels. Through face-to-face interviews, the charge nurses can detect the emotions exhibited by the patient.
Disadvantages
Conducting interviews with the clients may be expensive in terms of time and cost. Additionally patients may be biased when giving sensitive information leading to unreliable data (Greenfield & Braithwaite 2009). Besides, patients may shy from reporting irresponsible staff members is the privacy of the information given is not guaranteed.
Comment cards
Patients’ relatives ought to be provided with comment cards designed to extract useful information regarding the care afforded to their patients. The comment cards should include simple questions designed to obtain only the relevant information on the quality of services offered.
Advantages
Visitors act as observers and can give unbiased information regarding the quality of care given to their patients. Moreover, their view represents the view of the community thus their inputs could be of great significance.
Disadvantages
The process of collecting information from patients’ relatives using comment cards is expensive since respondents may require to be trained on how to fill the forms.
External
Surveys
The regulatory bodies may play a great role in ensuring that the standards set by the government are adhered to in the respective hospitals. This goal could be achieved through surveys in the respective hospital. By conducting a survey of the situation during the official working, the agencies can detect areas of deviance and make the relevant recommendations.
Advantages
Surveys help the review boards to assess the actual scene on the ground. The information obtained through surveys is first hand since it involves observations.
Disadvantages
Surveys are expensive, time-consuming, and they may cause interruptions in the hospital’s operations.
Interviews
Interviewing the staff on the steps made towards the realisation of the implementation of the set quality standards is another good way of evaluating the quality of health in the various hospitals. The staff should be tasked to explain how they handle different situations in the hospital and their understanding of the health standards.
Advantages
Interviews with patients supplement the information obtained through observations. Interviews with the staff explain the situation on the ground.
Disadvantages
The staff may be reluctant to give truthful information for fear of loss of jobs especially is the objective of the evaluation process is not well explained.
In light of the advantages and disadvantages of the methods described above, I would recommend the use of the management to employ the following two methods:
Questionnaire
In RUM, the junior staff members are accused of failure to observe the standards when working independently in their respective working stations. Therefore, to eliminate this aspect, patients should be allowed to give their view regarding the services provided. The anonymity granted by this method allows clients to report cases of unprofessional behaviours by the responsible staff without fear of being victimised.
Comment cards
Comment cards are useful tools for obtaining data from both the patients and the relatives. The relatives are better placed to give reliable information given that they are in stable condition and obtained first-hand information through observations. The observers may help identify the weaknesses in the department since they are not directly involved in the process.
Advantages and disadvantages of Users’ involvement
Advantages
The involvement of the users is important since it allows the assessors to evaluate the perceptions of patients regarding the quality of services offered in the facility in question. It helps the assessors to assess the quality of services offered in the facility (DeNisco & Barker 2012). Patients are directly affected by the decisions made by the healthcare providers hence their inputs cannot be overlooked.
An interview with patients during the evaluation process is essential since they help confirm the situation on the ground as detected through observations. Their involvement in RUH was significant since they gave additional information regarding the compliance of the providers to the standards set.
Disadvantages
Ignorance by patients
Patients have little knowledge regarding the standards set to regulate quality healthcare provision in hospitals. Moreover, their perceptions about quality healthcare vary from one patient to the other. In RUH, patients gave positive responses even when the situation on the ground was different.
Expensive
Reviewing each patient at a time is costly in terms of time and finances. The assessment in RUH involved appraising the nature of services offered to each patient, which is lengthy and expensive.
Recommendations
- RUH should implement a non-discriminatory training program in the facility to educate nurses on the importance of giving quality care to patients.
- The hospital should partner with the relevant regulatory bodies to offer the training to the employees.
- The hospital’s management needs to introduce a quality assessment strategy that will enable the chief nurses to make constant appraisals of the junior nurses’ operations.
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