Reasons behind the non-starter quality at Broughton Lodge Care Home
Winston Churchill once said that “To improve is to change, to be perfect, is to change often.” (Emery 2014). This resonates perfectly with the principles of service quality management where it is necessary to follow the plan, do, check, and act cycle. The report reflects what happened at Broughton Lodge Care Home where quality was a too little too late case (McDowall 2017). It also explores the remedial actions that should be taken.
There are many reasons why quality at the facility was a non-starter. To start with, employees were not involved in the correct administration of the autistic youths who were patients at the facility. This is clear from the fact that they were not only unhappy with the way management ran the institution, but also went a step further to report to the Care Quality Commission inspectors on the collective abuse of the minors (McDowall 2017).
Secondly, the institution flouted the Health and Social Care Act of 2008. To be steadfast in the pursuit of quality there are bare minimum standards that have to be observed that include following the industry rules and regulations which Broughton management blissfully ignored (Care Quality Commission [CQC] 2018).
The management commitment to adopt a quality culture was also lacking. As with other facets of quality management, the management is one of the most important cogs if not the most important that turns the engine of quality. For a company to be successful in importing quality the management must be ready and willing to be the driving force otherwise the efforts will be futile (Dale 2009).
According to CQC (2018), the employees were inadequately trained to handle the customers, in this case, the autistic patients. As part of employee empowerment, training on the core functions of the business in general and on quality management specifically is the key to unlock the quality potential. That, however, was not the case at Broughton Lodge.
The customer focus strategy was sidelined. The most important figure in any business is the customer. At Broughton Lodge, however, not only were the autistic patients ignored but also abused which is a massive non-conformity towards the quality efforts (Davis 2017).
As already indicated in the introductory statement, quality is not a destination but a journey. Thus when defects are identified, it is very important that they are rectified immediately to attain services free from defects (Protzman, Mayzell & Kerpchar 2011). At Broughton Lodge Care Home, the complaints filed to the management on improper treatment were not acted upon.
Key Performance Indicators for Broughton Lodge Care Home
The Manager who had been tasked with running the operations of the institution was not versed in industry regulations in healthcare and the tenets of quality. Though he was replaced, his deputy was also not registers by CQC or conversant with quality management (McDowall 2017).
There was no benchmarking at the facility to be able to meet and exceed customer expectations as happens with institutions implementing quality management and willing to acquire sustainable competitive advantage (Prajogo & McDermott 2011).
Monitoring the institutional performance was also not observed. The Just in time model of quality management encourages institutions to keep track of their resources to avoid wastage as was witnessed in the disposal of medical utilities at Broughton (Dale 2009).
The facility failed to effectively manage the flow of information at the facility. Information and communication technology cannot be understated in the pursuit of quality. Broughton did not have mechanisms for collecting customer feedback, conducting customer satisfaction surveys or synthesizing data in the facility to help make decisions on quality (CQC 2018).
Broughton Lodge had poor safety management mechanisms. Safety is a sine qua non for any institution to prosper not just in quality management but also other aspects including financial growth (Warrier & McGillen 2018). Broughton did not have solid safety strategies especially on emergency preparedness, fire protection, and risk assessments.
The institution also lacked a quality policy on health improvement, efficient healthcare, accessibility of their medical services, did not track timelines for delivery of healthcare or customer experience for that matter (CQC 2018). The management neither listened to patients nor made fact-based decisions informed by healthcare measurements and outcomes (Health Information and Quality Authority [HIQA] 2013).
The key performance indicators as evidenced by statistical process control, measurements, data analysis, financial performance and such measures like Pareto analysis to identify and correct any service defects were lacking at Broughton. It would be very difficult to monitor performance when there were no quality checks in place (Dale 2009)
There was total lack of a system to identify the patients they could attend to. As indicated, it took several days for the institution to discover they had a patient who they could not manage and needed to be transferred (CQC 2018).
In addition, Broughton Lodge lacked a continuous improvement plan detailed with procedures, standards and qualified teams dedicated to continually improve the systems (Kariya 2015). This indicates that any defects if identified were not rectified or managed on a rolling basis to ensure perfection of the system.
Finance
The Key Performance Indicators in any institution are very important in identifying the quality areas that need to be addressed by the whole institution in general and also identify specific areas that employees need to focus on (Anderson 2017).
The KPIs for Broughton Lodge will be categorized under finance, catering management, healthcare management, human resource and staffing, customer satisfaction, safety management and lastly conformity to regulations and standards.
On financial KPIs, the first measurable is the cost of medical services. This can be compared to other institutions implementing quality to identify if the Broughton is efficient in service delivery. Secondly, the percentage of income to expenses could also give an idea of financial performance. Another KPI would be the Return on investment as a ratio of profits to the investments put forth. This would give an indication whether the quality efforts are profitable or otherwise. Daily cash flow comparisons can also be used (Kariya 2015).
The finance team could target 80% lower costs by targeting 20% of inefficiencies as provided by Pareto principle. They could also target 25% revenue growth from satisfied customer referrals (Association for Project Management [APM] 2018).
On catering management, Broughton Lodge could focus on the number of people served in their catering facility during the month and also compare that number year on year YOY basis. An increase in the number of persons served could be a measure of quality improvement (Bordoloi & Islam 2012).
The catering team may also measure the average waiting time per person seeking catering services. This includes the family members seeking catering services and the autistic patients who are the direct customers. This would help in identifying inefficiencies and action them in advance (Arlen 2008).
On healthcare management, one indicator is the number of autistic patients treated at the end of a specific month and comparing that to other months or year on year basis. This should be also compared to the set goals for that period (Kariya 2015).
Secondly, Broughton could conduct a patience survey which gauges patients’ response to specific treatment areas and the patient could then depending on their satisfaction, rate the institution (HIQA 2015)
It may be prudent to also measure the feedback on patients regarding the number of people referred as a result their met or exceeded quality expectations by Broughton. The number can be compared for a specific period to note quality improvement or lack thereof (APM 2017).
Catering Management
Indicators can be developed to measure the percentage of staff retention at the facility compared to the employee turnover for a specific period for instance yearly. This can indicate internal customer service quality perception (Hill 2016).
The number of training sessions related to quality management at Broughton Lodge Care Home would also help in bringing consistency and elevate the quality standing from “Improvement required” to “good” as awarded by CQC.
The workload per employee compared month to month is also an indicator that can be used to determine whether the staff is fully utilized or not (Hill 2016). Employee appraisals are done and a feedback survey on employees on their perception of quality would also be conducted to help the institution to gauge performance (Agrizzi 2010).
Broughton could use the feedback mechanism to measure the quality of their services. For instance, they could measure quality aspects like customer satisfaction on service delivery, the average waiting time, perception of their amenities and much more (HIQA 2013).
On customer survey, the customers could also be asked to rate the experience of their stay on many aspects such as how they were handled, customer care aspects, the pricing of the service, if the issues they were seeking assistance were addressed and such which can help Broughton to improve their services (Kariya 2015).
On safety management Broughton could compare the number of incidents reported on a month to month basis, emergencies recorded, any near misses, customer falls, the wrong diagnosis and, compare these on a periodic basis to improve the working conditions as well as the overall safety of the workplace (Anderson 2017).
The same can apply to regulations where the institution can compare the reports taken to authorities like CQC annually, the number of audits conducted quarterly or the number of improvement notices given by regulators to help improve service quality (CQC 2018).
Benchmarking is the process of identifying the best practices in business, whether related or not and adopting those practices to achieve comparable or superior competitive advantage. In quality management, it is prudent to identify specific measurable practices that can be benchmarked to be able to monitor and track progress achieved in adopting those practices. For this reason, benchmarking and key performance indicators go hand in hand. It is only then that an organization can vividly tell if the benchmarking efforts on quality are effective or not (Chen 2013).
There are various ways in which Broughton Lodge Home Care can benchmark to ensure consistency in its quality management practices. These areas are discussed in the remaining part of the report.
Healthcare Management
This involves a company adopting the best practices from within its processes. Brighton, for instance, may find that its customer care department is implementing its service quality very well. It may at the same time be lagging in quality in other departments such as procurement, or human resources or finance (El-Saed & Weber 2013).
To maintain consistency in quality management Broughton could implement an aspect from customer care department such as serving customers within 3 minutes within the finance payroll processing or furnishing the medical supplies by procurement after exhaustion (Sower, Duffy & Kohers 2008).
The benefits include consistency in quality management practice, efficiency, reduced lead-time, cost-effective as hardly any expenses are incurred, both internal and external customer satisfaction and lowered cost of production (Warner 2013).
In this benchmarking, a company looks outside its processes and identifies best practices from another company which it is in direct competition with. It will then adopt a service offered by the company or take on a process that is beneficial (Protzman, Mayzell & Kerpchar 2011).
Broughton, for instance, may adopt superior quality customer care process from Cera, or Radfield Home Care or My Home care all health service providers in the UK offering comparable services to Broughton.
This will not only help Broughton Lodge to have a superior quality customer care process but also gain competitive advantage while at the same time understanding the industry better since it has quantitative data on the industry and market dynamics (Sower, Duffy & Kohers 2008).
Broughton Lodge will also be able to compare performance indicators and metrics with other comparable businesses and from the comparison, be able to identify quality gaps and how to bridge those gaps by coming up with a continuous improvement program.
Though almost similar to competitive benchmarking, in this method, Broughton only seeks superior and performing service quality strategies and adopts them. Examples of strategic quality benchmarking include six sigma strategy spearheaded by Motorola Company which focuses on preventing defects through a set of six processes (Dale 2009).
Another example is lean manufacturing strategy by Toyota Company that focuses on efficiency and rapid response to quality manufacturing. Broughton could adopt portions of these strategies to fast track customer response and ensure efficient processes (Protzman, Mayzell & Kerpchar 2011).
In this benchmarking, a company seeks superior processes within a similar functional area whether in related or unrelated industry. An example is a functional area such as customer care which is functionally related to many industries (Warner 2013).
Human Resource and Staffing
Broughton may adopt superior infrared technology already being implemented by Kroger, a grocery company in the USA that has achieved over 350 percent reduction in customer wait times. This will enable consistency in customer care and improve the quality of service provision (Nash 2016).
The benefits of adopting this benchmark include significant service quality improvement rate and allows key performance indicator comparisons. It can, however, be expensive to adopt and difficult to scale to the healthcare industry (Warner 2013).
This benchmarking, allows a company to adopt quality processes in both related and unrelated functional areas in different industries. An example is a just-in-time process used by Walmart to supply products to their customers. This process allows Walmart to save holding costs incurred during material storage. Walmart only sources a product from their dealers immediately an order is made by a customer. This helps to improve their competitive advantage as they pass the lower product cost to their customers (Prajogo & McDermott 2011).
Similarly, Broughton may acquire the above process to expedite quality service delivery in procurement since they only supply medical products when a customer is diagnosed. The process will also save on storage costs and stem losses from expired medical products (Dale 2009).
Conclusion
From the foregoing, it can be concluded that Broughton may have had a momentary quality lapse by alienating the employees from the quality efforts, failing to train their employees, flouting regulatory procedures, breaching the law, lacking customer focus and failure of management to commit to quality. The paper explores various ways that key performance indicators can bring Broughton back in the game by ensuring quality goals are tied to measurable outcomes. Finally, the report shows how benchmarking can help Broughton to achieve consistency in quality management and even soar higher than expected in their quality endeavours.
References
Agrizzi, D. (2010). Key Performance Indicators (KPIs) for healthcare accreditation system. Southampton: Soton, pp.2-13.
Anderson, J. (2017). 9 Important Key Performance Indicators for Hospitals. [online] Munplanet. Available at: https://www.munplanet.com/articles/healthcare-solutions/9-important-key-performance-indicators-for-hospitals [Accessed 17 Apr. 2018].
Arlen, C. (2008). The 5 Service Dimensions All Customers Care About. [online] Service Performance. Available at: https://www.serviceperformance.com/the-5-service-dimensions-all-customers-care-about/ [Accessed 17 Apr. 2018].
Association for Project Management (2018). Introduction to Quality Management. [online] Association for Project Management. Available at: https://www.apm.org.uk/body-of-knowledge/delivery/quality-management/ [Accessed 16 Apr. 2018].
Bordoloi, P. and Islam, N. (2012). Knowledge Management Practices and Healthcare Delivery: A Contingency Framework. The Electronic Journal of Knowledge Management, 10(2), pp.110-120.
Care Quality Commission (2018). Broughton Lodge Requires improvement. [online] Care Quality Commission. Available at: https://www.cqc.org.uk/location/1-2131341102 [Accessed 17 Apr. 2018].
Chen, H. (2013). Benchmarking and quality improvement. International Journal of Quality & Reliability Management, 19(6), pp.757-773.
Dale, H. (2009). Quality Control. Upper Saddle River, N.J.: Pearson/Prentice Hall, pp.20-34.
Davis, P. (2017). 7 Simple Strategies for Improving Your Customer Service Quality. [online] Business Community. Available at: https://www.business2community.com/customer-experience/7-simple-strategies-improving-customer-service-quality-01789314 [Accessed 18 Apr. 2018].
El-Saed, A., Balkhy, H., and Weber, D. (2013). Benchmarking local healthcare-associated infections: Available benchmarks and interpretation challenges. Journal of Infection and Public Health, 6(5), pp.323-330.
Emery, N. (2014). To Improve Is to Change; To Be Perfect Is to Change Often. [online] HuffPost. Available at: https://www.huffingtonpost.com/nick-emery/stream-epitomises-the-fam_b_5544963.html [Accessed 25 Mar. 2018].
Health Information and Quality Authority (2013). Guidance on Developing Key Performance Indicators and Minimum Data Sets to Monitor Healthcare Quality. Dublin: Health Information and Quality Authority, pp.13-24.
Hill, E. (2016). 5 Quality Key Performance Indicators you should be tracking. [online] Qualsys. Available at: https://quality.eqms.co.uk/blog/quality-kpis-to-track [Accessed 17 Apr. 2018].
Kariya, P. (2015). Improving Efficiency of Hospitals and Healthcare Centres. [online] Mumbai: PACE Jr. Science College, pp.13-29. Available at: https://arxiv.org/pdf/1511.03204. [Accessed 17 Apr. 2018].
McDowall, R. (2017). Police called over ‘allegations of abuse’ at Macclesfield care home. [online] Macclesfield Express. Available at: https://www.macclesfield-express.co.uk/news/local-news/police-called-over-allegations-abuse-13649585 [Accessed 17 Apr. 2018].
Nash, K. (2016). At Kroger, Technology Is Changing the Grocery-Store Shopping Experience. [online] Wall Street Journal. Available at: https://www.wsj.com/articles/at-kroger-technology-is-changing-the-grocery-store-shopping-experience-1487646362 [Accessed 17 Apr. 2018].
Prajogo, D. and McDermott, P. (2011). Examining competitive priorities and competitive advantage in service organizations using Importance?Performance Analysis matrix. Managing Service Quality: An International Journal, 21(5), pp.465-472.
Protzman, C., Mayzell, G. and Kerpchar, J. (2011). Leveraging Lean in Healthcare: Transforming Your Enterprise into a High-Quality Patient Care Delivery System. New York: Productivity Press, pp.17-31.
Sower, V., Duffy, J. and Kohers, G. (2008). Benchmarking for hospitals. Milwaukee, Wis.: ASQ Quality Press, pp.24-36.
Warner, J. (2013). Quality Benchmarking- Ready to Manage. [online] Ready to Manage. Available at: https://blog.readytomanage.com/quality-benchmarking/ [Accessed 17 Apr. 2018].
Warrier, S. and McGillen, B. (2018). Quality Care and Patient Safety for the Practicing Physician: The Evolution of Quality Improvement. Medicine and Health Rhode Island, [online] 94(7), pp.211-212. Available at: https://www.rimed.org/medhealthri/2011-07/2011-07-211 [Accessed 17 Apr. 2018].
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
