Factors Affecting Healthcare Quality At The Princess Royal Hospital

Quality Management and Framework in Healthcare

The Princess Royal Hospital has had challenges that prompted the CQC to conduct an inspection on its operations. It is located at Apley Castle, Telford, England, and started it operations in the year 1989. The teaching hospital forms the Telford site of Telford and Shrewsbury Hospital NHS Trust which serves patients from Wrekin, Telford, Powys, and Shropshire. It has about 327 hospital beds. The hospital’s overall rating is inadequate, which means that it is below the set standards in terms of service delivery and patient satisfaction. The services safety was rated inadequate, services effectiveness was rated inadequate, services caring requires improvement, services responsiveness was inadequate, and services leadership was inadequate. The assignment objective will be met through extensive research from books, online sources, the university library resources, the classwork materials, and a lot of consultations where necessary. The three components approach for assessing the quality of care reinforces measurement for development and they are structure, process and outcomes. Dimension for development has an additional constituent called the balancing measures.

He believed that measures for structure have an outcome on measures of process which in turn affect measures of outcome. Combined, they form the basis of what is required for an operative group of measures. The relationship is more complex, particularly within the hospitals with so much variability in patients (Donabedian, 2005).  The gap analysis by Parasuraman will also be used and is between prospects and insights of the consumers, recommended ten dimensions for measuring the gaps in their service quality model; security, reliability, competence, responsiveness, access, communication, courtesy, credibility, tangibles, and understanding. (Parasuraman et al., 1985). It will help in explaining the processes within the hospital setting. The hospital does not have the right staff because, from the findings, some are not competent enough to handle treatment and care cases within the facility. To ensure that service delivery is up to the bar, training programs need to be introduced and screened before recruitment. Actions on negligence should be fierce to deal with the reckless individual. (213)

Define quality management, then using suitable quality management framework for Health and Social Care services, identify and evaluate factors affecting the quality of healthcare for patients at The Princess Royal Hospital.

Quality Management comprises planning, assurance, control, and continuous improvement. It is usually done to enhance consistency in a product or service (Deming, 2013). The principles associated with quality management are relationship management, continuous improvement, evidence-based decision making, leadership, customer focus, process approach, and engagement of people (Deming, 2013). Quality management framework exhibits the operating environment in which the health care sector operates, a set of strategies, goals, processes, policies, procedures, that the hospitals will use to assure the patients, manage and control their quality (Lloyd, 2017). The quality management framework that will be used to identify the factors affecting the quality of service offered by the Princess Royal Hospital is the GAP analysis. GAP analysis was used to assess the level of skills (competence) and the needs of the hospital facility so as to help in the decision-making process (process) (Frankline, 2006). It is a process that involves the comparison of current hospital performance against standardized performance. The factors identified that affect the quality of healthcare are inadequate staff training (competence), inadequate safeguarding systems in place (structure), poor care plans (credibility), inadequate assessment and management of risks (responsiveness), and poor leadership (credibility).

Quality Management Framework for The Princess Royal Hospital

Staff competency determines the level of service in any hospital or institution. This measures their ability to deliver the level of service that meets the set standards and ensures no errors or events that will compromise their work (reliability). The staff who were working in the hospital were inadequately trained because of the following reasons. They did not know how to protect young children and people from abuse nor how to follow local and national guidance in relation to safeguards (outcomes). They did not conduct adequate risk assessment and management on patients with special mental health conditions, negligence cases were not investigated and actioned upon, and they lacked the capacity to carry out the assigned duties to the required standards endangering the lives of children and young people (Craig et al, 2014).

The hospital lacked adequate safeguarding systems. This enhanced the risks of making mistakes by its staff. There were no clear policies and procedures that could guide and control the behaviour of the health care workers in performing their roles (structures). The system did not provide implementable ways to handle patients with special needs and did not take into consideration the individual needs of the patients (credibility). From the investigation, it was not inclusive and could not identify health service staff who would neglect their roles and investigate them for action as prescribed in their conduct (outcomes). The staff did not recognize and report any safeguarding concerns as required. There was no assessment of adequate and safeguarding concerns relating to children and young people. Staff also lacked training on how to identify and report any safeguarding concerns.

Inadequate assessment and management of risks also contributed to the influence of quality management for the hospital. The hospital staff did not finalize or update risk assessments for the children and young people who were admitted with mental health problems or disabilities in learning. The staff did not assess and manage risks as well as follow the best practices in anticipating and managing behaviours (responsiveness). There was also no monitoring of post-administration of rapid tranquilisation. Medicines were also not administered safely exposing young people and children to the risk of harm (outcomes). There were also inadequate policies and procedures that could not help the hospital administration track and assess the effectiveness of service delivery in relation to the hospital prescriptions and requirements.

Lastly, poor leadership structures and governance contributed to the inability of the hospital to execute its roles accurately (structure). Leaders were unskilled and could not run the service as expected. They weren’t able to coordinate hospital activities for effective and satisfactory service delivery and had no direct contact with all the hospital staff (credibility). They were also operating in an environment where they were not even aware of the challenges the facility was facing (understanding). It is a requirement and obligation that the leaders were supposed to ensure that policies and procedures reflected the guidelines that staff was supposed to follow which never happened (process). They also lacked strategic plans to deal with unusual happenings and lacked the ability to manage and develop performance. Leadership will always remain the focus since it is through effective leadership that an organization is able to achieve its main goals and work towards a core objective (outcomes). CQC inspection was unannounced and that is why the problems were identified. Benchmarking can be used to help the hospital perform to the required standard.  Benchmarking is the activity of comparing institutions’ performance metrics and processes to industry’s best performing institutions using the dimensions of time, quality, and cost as units of measures for purposes of improvement (Camp, 2006). The first thing to do is identify problem areas in the hospital. Techniques to be used can include conducting informal conversations with patients, suppliers, or employees, use of surveys, questionnaires, process mapping, financial ratio analysis, quality control variance reports, and reviewing other indicators of performance. There is need to know how the benchmarked organization function and processes. The second stage is to identify other hospitals that have similar processes. The third stage is to identify hospitals that are performers in quality, cost, and time. If need be, consult for professional advice. Then survey hospitals for measures and practices that can be adopted. Provide room for alternatives in case they don’t work as expected. Visit the hospital and learn what they are doing different. Employ the use of surveys to protect confidentiality. Lastly, implement the new and improved hospital practices and develop plans for implementation which include opportunity identification, supporting and selling the ideas to the hospital trust for the purpose of embracing value from the benchmarking process.

Factors Affecting Healthcare Quality

Define capacity, capability, and competence in a service operation context, then analyse and conclude whether The Princess Royal Hospital has capacity with capable and competent staff to improve the quality-of-service delivery.

Capacity is the ability, power, and possibility of doing something (Olokuton et al, 2012). It is the maximum output a company can withstand to provide its services. It is the ability to learn, hold, and absorb new knowledge and skills. It can also be defined as a measure of volume. Capability is the countenance or the enunciation of the materials, expertise, and capacity an institution requires in order to undertake core functions (Besterfield et al, 2003). It can also be defined as the application and use of improved practises and approaches that determine whether expected results will be achieved. Competence is the ability to do something successfully and efficiently because of the expertise in experience, knowledge, and qualities attributed to personnel (Kiran, 2016). The Princess Royal Hospital has does not have adequate capacity, capability, and competency in its staff, and this is solely based on the CQC inspection.

The hospital does not have the ability, the power, and the possibility of providing services to patients at the hospital with its current staff. It is clear that the staff are inadequate and undertrained to conduct their assignments in relation to serving humanity (competence). The hospital has been under investigation and it lacked the required capacity to excel and deliver up to the required standards. The hospital lacks capacity because it has a poor leadership structure, a poor system of safeguards, inadequate risks assessment and management, and staff who are unskilled. It is through capacity that capability is developed. CQC inspection on the hospital operations and gave it an overall score on inadequate capacity (CQC report).

Capability is another word for advanced capacity. When capacity grows and becomes effective, an organization is considered capable. It is measured in terms of the developments of labour, resources, technology, and infrastructure necessary to perform functions efficiently and effectively. Capability in hospital service delivery means that the staff of the hospital should be skilled enough to perform their duties diligently and as expected without recourse. The Princess Royal Hospital has staff and leadership that do not have the necessary skills to enhance the capability of the institution in its service delivery (responsiveness). Capacity and capability are related to competency. The competent staff has the capacity and capability to perform unlike the unskilled. The staff of this hospital are not competent enough and can therefore not deliver the level of service required.

Competence is key in the achievement of core objectives within a hospital setting. Unskilled medical staff endangers the life of patients because they might inject them with the wrong substances or give them a wrong prescription that can be harmful to their health. Unfamiliarity of unskilled staff can also lead to the loss of lives. The hospital trust was under investigation for misconduct and unfamiliarity in reporting safeguard concerns to the responsible parties for corrective action. Some of the staff did not even know their roles and seemed unskilled in the profession. The leadership of the hospital was not executing their roles diligently as expected and this rendered them ineffective and unskilled (outcomes).

Staff Training and Competence

Conducting risk assessments and evaluating the performance of staff can make them more serious in carrying out their duties. The hospital should come up with ways of conducting services in a controlled manner, that is, by providing its staff with policies and procedures that will enable them to perform what is required as well follow what is expected in the delivery of quality service to its patients. Let the health of the children and the young people be valued and taken care of.  The capacity, capability, and competency of the hospital need to be developed and advanced to meet the industry standards and create a trust for the hospital clients. Staff needs to be aligned to the needs and expertise in specific areas and not just given responsibilities. The hospital, therefore, needs to protect its reputation and must invest more in staff screening and development to enhance service delivery. Those found to have deviated from the specifications and directives or guidelines provided locally and nationally should be punished accordingly (credibility).

Make at least 3 recommendations and providing solutions for effective ways to improve quality of the service at The Princess Royal Hospital highlighted in the CQC report. Using a relevant technique for implementing recommendations.

These recommendations will help the hospital achieve its main objectives in cost-cutting, reasonable use of financial resources, effective and satisfactory service provision, prevention of human harm, and effective and efficient leadership. It is not easy to just come up with recommendations that will work by the first trial but they need to be implemented and with time help the facility achieve its main objectives. Financially, the hospital will save money by employing competent staff who will ensure that there are no litigation claims lodged against it in terms of negligence and unreliability. The leadership or rather the management is responsible for implementing these recommendations and is supposed to employ the use of available resources to ensure that the recommendations work effectively to achieve the objectives. They are simply meant to provide corrective action to the previous mistakes identified from the investigations and assessments. All the staff also need to participate in the implementation process for unified corrective action. The recommendations implementation is a continuous process and at no one time should the process be at a halt. The hospital will then gain trust from the surrounding community and this will help it gain back its competitive advantage over other hospitals. It should also be a participatory event where every staff is supposed to participate and the evaluation and monitoring of these recommendations once they have been implemented should be done in a continuous manner to avoid shortfalls. People say prevention is the cure and by putting policies and procedures in place, any institution with adequate resources that have employed prudent ways of management will make it to the finishing line no matter what.

References

Besterfield, D. H., Besterfield-Michna, C., Besterfield, G. H., Besterfield-Sacre, M., Hemant R., 2003. Total Quality Management. Pearson Education Inc.

Camp, R. C., 2006. Benchmarking. The Search for Industry Best Practices that Lead to Superior Performance. 1^st Edition. Productivity Press.

CQC, 2021. Shrewsbury and Telford Hospital NHS Trust. The Princess Royal Hospital.

Craig M. B. and Mary A. G., 2014. Process measures: a leadership tool for management”, The TQM Journal, Vol. 26 Issue: 1, pp. 50-62.

Deming, W. E., 2013. The Essential Deming: Leadership Principles from the Father of Quality. McGraw Hill. edition. Jones & Bartlett Learning.

Donabedian, A 2005. Evaluating the Quality of Medical Care, The Milbank Quarterly, 83(4):691-729

Frankline, M., 2006. Performance Gap Analysis: Tips, Tools, and Intelligence for Trainers. American Society for Training and Development.

Kiran, D. R., 2016. Total Quality Management: Key Concepts and Case Studies. Elsevier Science.

Lloyd, R. 2017. Quality Health Care: A Guide to Developing and Using Indicators, 2nd

Rose, K. H., 2005. Project Quality Management: Why, What and How. Fort Lauderdale, Florida: J. Ross Publishing

Steffensen, M. and Assmusen, S., 2022. Risk and Insurance: A Graduate Text. Volume 96 of Probability Theory and Stochastic Modelling. Springer Nature.

Sule, J. G., Ogbadu, E. E., and Olukuton, G. A., 2012. Capacity Planning and Its Implications on the Infrastructural Development Needs of Some Selected Higher Institutions in the Eastern Senatorial District of Kogi State. Global Journal of Management and Business Research. Volume 12(23).

Wilkinson, D. M., 2006. Fundamental Processes in Ecology: An Earth Systems Approach. Oxford University Press.

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