Royal United Hospital Bath NHS Trust: Stakeholder Perspectives And The Role Of External Agencies In Quality Standards

Task 1: Stakeholder’s Perspective in Health and Social care Regarding Quality

The Royal United Hospital Bath NHS Trust was not being able to meet the general standards that were set regarding the quality of health and social care. In this regard, there occurred compliance actions due to several inspections by the CQC to respect as well as involve the service users, care as well as welfare, providing protection and to assess as well as monitor the quality regarding the provision of service. Due to this, the trust was served a Warning Notice after getting inspected in June 2013 since it failed to meet the standards in respect of Regulation 20 (1) (a) and (2) (a) (b) (Records) of the Health and Social Care Act 2008.

Stakeholders are considered being an individual, group or establishment that is having an interest or concern within a company. They will be affecting the actions, goals as well as policies of an establishment.

In this context, some of the stakeholders are CQC, Senior staffs as well as Service users.

In respect of the quality of service at Royal United Hospitals Bath, the perception of the stakeholders are mentioned as under,

• CQC (Care Quality Commission) – The CQC showcased that when there was a high demand regarding the services from the hospital, there was not sufficient capacity for meeting those demands. For ensuring the quality regarding the events, the CQC socialised with the local communities as well as other individuals for knowing what is good and bad in the area of health care for ensuring that they are offering an outstanding service.
• Senior Staffs – The determination of the perspective regarding the quality by the hospital nurses as well as senior staffs are depending upon few characteristics. The senior staffs consider that by receiving an appropriate on-the-job training as well as functioning in a friendly environment having a better condition is the key for providing a better service quality for the patients. From the case study, it can be seen that because of the changing scenarios within the hospital by involving the Emergency Care Intensive Care Support Teams, the senior staffs are having the belief that the change assisted in the improvement of the service quality that was offered to the patients, who were supported in an indirect manner. In addition, the staffs were having the ability for working in a less stressful manner and were having the ability for focusing more on the needs of the patients as well as treating them with the best care-support (Cameron 2014).
• Service Users – Although the service users of the health and social care are not having particular parameters or indicators similar to CQC, the service users at the Royal United Hospital are having a lot of concern regarding the service quality they are receiving. When an emergency situation occurs, they are required checking in as well as registering at the earliest and receiving treatment in respect of that emergency with utmost care. The case study is suggesting that feedback regarding the survey of the patients was mostly positive. It is stating that due to the involvement of the Emergency Intensive Care Support Teams to change the services regarding the hospital as well as to improve the administration, it provided the guarantee regarding the facilities that the patients were receiving in a dignified manner. Moreover, the care regarding the patients was taken in accord to the basic processes. Also, positive reviews were provided by the patients, in respect of ways through which the support-staffs tried to handle them. The service users stared they were treated with respect and admiration (Livingstone 2014).

Understanding of External Agencies 

These are the establishments that assist in ensuring the availability of quality at the place of work.

From this case study, three different external agencies can be identified that are having the responsibility to set the standards. First, is the Care Quality Commission (CQC) that is preparing the report regarding the Royal United Hospital. In addition, the National Institute for Care Excellence (NICE) as well as Emergency Care Intensive Support Team (ECIST) are also being recognized.

The major role of the Care Quality Commission is doing whatever it takes for providing better quality regarding health care by checking whether the standards of the government will cover the entire units of health care. As per the CQC, they are also having the responsibility to set the standards since it assists in ensuring safety as well as quality regarding the individuals that are expecting health care support.

The disadvantage of the CQC concerning the Royal United Hospital is stating that there has been an issue relating to the aspect of safety. Certain social care services exist that are not sufficient concerning safety. There are also significant differences relating to the quality of care that individuals are receiving.

There have also been doubts that cropped up regarding the good rankings that were given by the CQC to the different hospitals. For instance, in Basildon Hospital there had occurred the death of dozens of patients due to insufficient care however, CQC had ranked the hospital as ‘good’, a month earlier.

Definition of Stakeholders

The function of National Institute for Care Excellence is associated with the aspect of developing as well as expanding the outcomes in respect of individuals by the use of NHS and in addition, the services regarding health and social care. NICE is participating in the creation of proposal-based methods as well as information in respect of the specialists for health care.

There is a responsibility for Social Care Institute for Excellence (SCIE) to enlighten the lives of people, who are using health care services through the sharing of facts regarding what will be working. The SCIE is considered being a self-governing charitable organization that is performing closely with the adults, children as well as individuals throughout the UK.

The disadvantages for SCIE had been associated with the fact that they are costing time as well as resources and might be challenging to commission externally, particularly at short notice. Moreover, when the survey methods are relied upon, enquiries might be suffering from poor rates of response.

The CQC are intensely observing the health care community for ensuring that they will be continuing to meet the standards with the hope that every individual will be receiving a high quality, safe, compassionate as well as efficient health care support. When the needs will not get followed, they will be present for providing the improvements (Munn-Giddings 2013).

NICE is improving the quality principles and performance measurements as well as offering different informational services in respect of health and social care professionals. Due to their involvement in the health care, the health care establishments will be getting standardised and will be assisting the doctors for providing with the best possible cures for the individuals depending upon the current facts.

SCIE assists in recognizing as well as sharing the information regarding what is new and providing assistance to the individuals that are interested in putting such knowledge into practice. In addition, due to the activities regarding this service, it assists in the expansion of the abilities as well as knowledge regarding individuals that are involved in the health care service (Cherry 2016).

Understanding for Service Quality 

Concerning the aspect of health care, a service regarding poor quality cannot be accepted. The stakeholders can get influenced by the poor service quality in respect of the sensitive, physical as well as public scenarios.

Some of the stakeholders regarding health and social care are inspecting bodies, owners of care services and the service users.

Name of Stakeholders

From the case study, it can be realized that the Royal United Hospital is tackling a major challenging aspect, which is associated with the inability of the hospital towards providing sufficient capacity for meeting the demands regarding the patients. The patients are required staying in lines to get admitted as well as getting treatment. There also occurred the avoidance of elective medical measures that resulted in individuals staying in long queues for getting through with their operational aspects. The patients were losing their temper and they were also not at all happy regarding the hospital staff’s involvement. This is displaying the fact that there did not occur appropriate implementation of the proper standards that the Royal United Hospital has set.

Because of the absence of training facilities as well as inappropriate working conditions, the nurses were mostly inactive and as a result, they had a very low involvement. There did not occur better distribution of the materials and therefore, the employees were not able to learn from their mistakes. Moreover, when the times were demanding, the employees were unable to do the checking with the requirements of the patients. This resulted in creating a huge influence on the service quality at the Royal United Hospital. There was the requirement for having a changing scenario for maintaining the better quality regarding the services (Brett 2014). As a result, the monitoring of the impact at Royal United Hospital is essential since it assists the Royal United Hospital for functioning all through the dated limits for effectively delivering care as well as assistance that is encountering the requirements relating to the patients as well as the service users.

Standard is explained as a morale of principles that will get used by measuring certain aspects. There can occur the basic introduction of a standard as a level of brilliance. From the case study, it can be stated that the Care Quality Commission did the setting up of various standards for developing as well as preserving the quality of health care as well as social services.

The purpose of standards is assisting the consumers of the facilities as well as keepers for recognizing what service quality they are capable of (Glasby 2017).  

Standards for measuring service quality in HSC is done with the help of questionnaires, surveys as well as interviews.

The major standards that the Care Quality Commission has set are based on the fact that, it must be a care that is person-centred (Betancourt 2016). The tailoring of the treatments should be done in accord to the meets as well as preferences regarding the patients. Most importantly, the patients should receive a dignified as well as respectful treatment. All the patients are required receiving dignified as well as respectful treatments. All the patients should receive equal treatments irrespective of their age, religion, sex or the level of income and privacy should be provided when there will occur a need. The healthcare establishments are required ensuring that they will be providing their services in a manner that will be achieving the established benchmarks. In addition, the employees within the health care establishments must receive appropriate qualification, and should have the capability as well as experience for meeting these benchmarks (Moorhead 2013).

Perspective of Stakeholders

National Institute for Health Care and Excellence (NICE) did the setting of strong as well as basic standards for measuring the quality regarding the industry for health care. They are having the expectations from the health care facilities for taking decisions regarding the care depending upon the current findings as well as facts and then the practice. In addition, the information concerning the quality standard should always be available in respect of the patients at any point of time from the doctors. The providers of health care are required having the ability for inspecting the advancement regarding their administration as well as assessing the development regarding the standards of care they are delivering (Drummond 2015).

The setting of the standards by the Nursing as well as Midwifery Council is majorly centred around the nurses as well as midwives that are having an involvement within the health care sector. They are required functioning within the proper line of code that the Nursery and Midwifery Council has set. They are required to primarily do their registration at the Nursery and Midwifery Council and then their major expectation is associated with the aspect of prioritizing the individuals, and providing effective performance, preserving safety as well as encouraging expertise and trust (Valentin 2013). The Nursery and Midwifery Council is believing on the fact that they are preserving the talents as well as knowledge of their nurses as well as midwives in an updated manner for sustaining the professional standards.

To appraise as well as determine the processes to apply quality methods within the health care sector is very essential since the success as well as the organizational future is depending upon it. Moreover, it is essential to maintain the high standards.

For the measurement of quality, the two most effective approaches could be Quality control as well as Total Quality Management (Chassin 2015).

The introduction of quality control standard can occur as a method or group of activities whose planning occurs for ensuring that a service that has been accomplished will be obeying to a distinct group of quality principles or does the encountering of the needs regarding the patients or the service users. At the Royal United Hospital, this will be supporting the aspect of regulating the effectiveness regarding the job duty and will be guaranteeing the offering of high standard of care. Total Quality Management is defined as the aspect of explaining the point of view, approach as well as organizational business that is fighting the aspect of delivering the customers with the products and services that will be satisfying their requirements. To set up the policies and procedures are considered being one of the most effective ways for implementing the aforesaid standards of quality (Aveyard 2014). A policy is considered being an action code whose application or proposition is done by an establishment for making its services better. This will be increasing the service quality as well as the organizational morale since there is a set manner by which the company is required conducting its activities. It will also be including significant rules in respect of the employees that includes arriving on time, employee uniform, as well as to communicate with them regarding what is right and what is wrong (Valentijn 2013). The availability of policies as well as techniques state that the employees are sufficiently educated for handling detailed tasks and makes sure that they will not be breaching the regulations.

Roles of External Agencies in Setting Standards

The setting of target regarding Quality Control for RUH is best, as because it is essential when it is associated with the setting as well as sustaining of the organizational quality standards. Through the setting of a particular set of standards, the establishment or the employees will be knowing in what ways to balance what they are doing and in what ways to perform their tasks for achieving the same. By the method of actualizing these set targets, they are able to ascertain the flaws they have committed, and then make their correction and perform in an effective manner (Wager 2017). Without any set targets, there will not be any goals that could get achieved. In respect of the Royal United Hospital, to stop the process of failing and beginning to achieve success again, it might require following each of these approaches. This will not be considered being excessive regarding the hospital since it is undergoing a challenging phase (Brady 2013). These approaches will prove to be highly beneficial when the patients are making complaints or the staffs are getting more and more lazier.

A barrier can be explained as the obstacle for preventing something from taking place. At Royal United Hospital (RUH), there will be existing internal barriers as well as external barriers.

The internal barriers are majorly associated with the organizational structures. From the given case study, it can be seen that the National Emergency Care Intensive Support Team or ECIST made changes to the environment of the hospital and as a result, making a direct influence on the employees. Although, this might be considered effective regarding the hospital services, the staffs however, may be perceiving it as something that might be degrading them. Their might occur within the staffs the fear of getting replaced as well as their absence of information for handling the new changing scenarios (Dickinson 2016). When this will occur, it is very much essential to communicate and the staffs are required being well-informed as well as trained regarding these activities. Nevertheless, the influence of this barrier will be negative since, the training of the employees with courses and equipments that are new, will be affecting the organizational budget. Moreover, dearth of resources can be considered being a significant barrier when the delivery of effective health care services occurs. This is referring to the availability of appropriate equipments, funds, manpower as well as time. For competing effectively with the competitors, the establishment is required being well-equipped with these resources. This influence can be considered being positive since, by getting well equipped, the contribution regarding the organizational activities will be huge (Bowling 2014).

Understanding of External Agencies

In addition, the posing of organizational legislation can be considered to be an adverse organizational influence in respect of external barriers since, it will be amending the activities that the employees will be performing in accord to the way of conducting activities that will be resulting in better quality, which everyone will be perceiving. When RUH will be getting affected by the legislations, the employees are required getting trained as well as developed since, they are lacking the information regarding the ways by which the tasks need to get completed. This, however, will be influencing the patients in a harmful manner since, the staffs that are taking care of them have little or no idea of how they should be conducting their duties correctly (Manary 2013).

The efficiency regarding the performing systems, policies as well as procedures are considered to be crucial in the situation of health and social care since, it is having a direct co-relation for actualizing the best quality. From this case study, it can be stated that there exists policies, procedures as well as methods for improving RUH’s quality.

The tools for monitoring quality were used by the employees as a process regarding the welfare of the patients. There took place the monitoring of the information regarding the patients that includes their current development, any strange activities, as well as reaction to a drug and was noted down at the RUH every week. This process will be having a positive as well as negative influence. The positive impact is that the monitoring of the patient’s all the time can be considered to be effective regarding the health of the patients. The negative impact is that the process to monitor all the patients will consume a lot a time and will create a problematic situation when there will not be enough number of staffs (Greaves 2013).

One of the effective systems are considered as Total Quality Management (TQM) that is stating about the aspect of clarifying the philosophical outlook as well as tactical outlook regarding the hospital, which is struggling to do the delivery of customers with a quality service for accomplishing their requirements (Grol 2013). They brought a change to the hospital environment so that, the service users can be served better by the staffs.

The disadvantages of TQM is that it’s implementation is considered to be very expensive. The process of implementation requires additional training costs, team-development costs, infrastructural development costs and so on. Moreover, TQM is focusing on the standardization of the tasks for ensuring consistency, which is discouraging creativity as well as innovation.

Name of External Agencies

In addition, the effective procedure whose implementation is done within the RUH is considered as ‘Incident Reporting Method’. Within the RUH, a report regarding an accident or an event is considered being a process that get completed for recording the information regarding an atypical incident that occurs within the hospital like harming a patient. The staffs at RUH were given the permission for reporting such incidents and this has improved the patient’s safety and as a result, did the reduction of the risk that the users are facing (Aveyard 2013).

The disadvantage regarding the Incident Reporting Method is that, unless there is usual monitoring as well as updated paperwork is maintained, this process is more appropriate regarding the ongoing performance communication in comparison towards using in a once-a-year performance review meeting. In this context, it needs to be kept in mind that there are certain tasks that are not lending themselves to direct observation of events and the staffs might be feeling “over-monitored” as well as mistrusted when there will be increased occurrences of managerial observation.

The effective policy of Hydration Bundle was used in RUH, which showcased the amount of liquid that a patient is drinking. This assists in marking the inflow and outflow of the fluids that a patient is having. From the case study, it was found out that the contagions regarding the tube and urinary zone, blood blobs as well as pressure sores were very high within the patents stating that the intake of their medicinal fluid must have also gone off-balance (Street 2013).

Further factors that will influence the accomplishment of quality within the health and social care service 

From the case study, it can be seen that CQC pays a closer look regarding the regulatory requirement activities of RUH. It has given a notice of warning to the RUH for not adhering to the principles. Therefore, the aspect of controlling these entities is considered being effective towards developing the hospital. After the mistakes were pointed out, RUH bounced back and made major development due to the instruction that CQC has provided.

The satisfaction regarding the user of service expectations can be considered to be one of the factors that will be the quality aspect regarding RUH. When the hospital will be continuing to offer outstanding health care services in respect of its patients, there won’t be any uncertainty that the patients will not be returning to their respective homes feeling dissatisfied with the service.

Analysis and Importance Regarding the Role of External Agencies

Funding is also considered to be essential for the growth of any organization as well as its future success. When funds will get received in respect of RUH, they will be using it for setting the organizational standards, functioning according to the governmental rules and regulations as well as training the employees in accord with the modern technical aspects, which will be increasing the RUH’s overtime quality.

From the case study, it can be seen that after the occurrence of change by the National Emergency Care Intensive Support Team of RUH, training was offered to the hospital staffs and they were not having any reluctance for working harder. Moreover, due to that, the patients were getting treated with dignity as well as respect that resulted in providing an overall boost regarding the quality at RUH (Buchbinder 2016).

The management of the RUH is required training the staff members in a proper manner so that they are able to cater to the particular requirements of the patients. It is stating that the complaining of the patients were high because of the low employee involvement. Therefore, through the employment of more employees and with a proper training, the staffs will be assisting all the patients and ensure that they won’t be undergoing a bad experience while receiving treatment at the RUH (Anhang 2015).

Moreover, as because RUH was not being able to meet the standards set by the CQC due to certain specific reasons, RUH was using the funds they had received for building more facilities as well as contributing to the development of the employees that are working at the RUH. As a result, they will be working with the set standards that will assist in improving the service quality.

There is the requirement for understanding the different methodologies to evaluate the improvement of health and social care in RUH.

The methods for evaluating the quality of health and social care are questionnaires, surveys as well as interviews.

Questionnaires are considered being a technique to do the assessment of quality regarding health and social care. It is considered being a goal oriented approach and is also considered being a cheap, fast as well as suitable process to gather information.

The disadvantages of the questionnaire method are that they are regarded to be insufficient for understanding certain kinds of information such as emotional changes, behavioural changes and so on. Moreover, there is the absence of validity.

Importance Regarding the Role of Each Agency in Setting Standards

Conducting a survey will assist in improving the understanding regarding the needs, viewpoints as well as behavioural aspects regarding the target population. This process will get used for discovering the attitudes as well as reactions for measuring the satisfaction of the patients as well as adding integrity regarding the research (Stanhope 2014).

The disadvantages of the survey method is that respondents might not be feeling motivated towards providing answers that are considered to be accurate as well as honest. Moreover, options relating to the survey question answers might be leading towards unclear data due to the fact that, certain options relating to answers might be having different interpretation by the respondents.

Interviews are considered being a complex scenario but it is the most efficient means for collecting information. This will assist in finding out information regarding various individuals as well as asking for their viewpoints regarding an issue from their viewpoint. However, it is considered being very costly and consumes a lot of time (Middleton 2013).

The disadvantages of the interview process is that the interviewer might be biased which will have a negative influence on the interview process and the interviewer’s inefficiency might be leading towards distorted outcomes.

Therefore, the most effective process in respect of RUH is to issue questionnaires regarding the service users as well as the employees, since it is considered being cheaper and will not be taking sufficient time for getting completed. This will assist the organization in finding out the flaws and the areas that need to get improved.

To include the service users relating to health will be making a significant influence regarding service quality. It might be having a positive or negative influence. When the organizational performance will get evaluated, it is essential towards knowing the type of experience that the patients will be receiving from their viewpoint. It is always considered being effective regarding the involvement of the service users in the process of evaluation, as it assists them in feeling important as well as getting accepted. The feedbacks that are received from the service users are the major elements for improving as well as developing the processes within the hospital in a manner towards providing outstanding services regarding its users (Bao 2013).

RUH is required improving as well as developing the staff quality for improved performance as well as catering to the needs of the patients.

Conclusion 

To conclude, it can be stated that quality is a major element regarding health and social care services and developing the superiority of service will be having the involvement of both the consent as well as contribution regarding the service users. In this case study, the internal as well as external stakeholders were being discussed about at the RUH. Also, critical assessment was made regarding the standards that were set by the CQC, NICE for preserving the quality of the healthcare services. In addition, methods to improve the service quality were also discussed.

Impact of Poor service Quality on the the Stakeholders of Health and Social Care

Reference 

Anhang Price, R., Elliott, M.N., Zaslavsky, A.M., Hays, R.D., Lehrman, W.G., Rybowski, L., Edgman-Levitan, S. and Cleary, P.D., 2014. Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review, 71(5), pp.522-554.

Aveyard, H. and Sharp, P., 2013. A Beginner’s Guide to Evidence-based Practice in Health and Social Care. McGraw-Hill Education (UK).

Aveyard, H., 2014. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).

Bao, Y., Casalino, L.P. and Pincus, H.A., 2013. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. The journal of behavioral health services & research, 40(1), pp.121-132.

Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

Bowling, A., 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Brady, T.J., Murphy, L., O’Colmain, B.J., Beauchesne, D., Daniels, B., Greenberg, M., House, M. and Chervin, D., 2013. Peer reviewed: A meta-analysis of health status, health behaviors, and health care utilization outcomes of the chronic disease self-management program. Preventing chronic disease, 10.

Brett, J., Staniszewska, S., Mockford, C., Herron?Marx, S., Hughes, J., Tysall, C. and Suleman, R., 2014. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expectations, 17(5), pp.637-650.

Buchbinder, S.B. and Shanks, N.H., 2016. Introduction to health care management. Jones & Bartlett Publishers.

Cameron, A., Lart, R., Bostock, L. and Coomber, C., 2014. Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health & social care in the community, 22(3), pp.225-233.

Chassin, M.R. and Loeb, J.M., 2013. High?reliability health care: getting there from here. Milbank Quarterly, 91(3), pp.459-490.

Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Dickinson, H. and O’Flynn, J., 2016. Evaluating outcomes in health and social care. Policy Press.

Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L. and Torrance, G.W., 2015. Methods for the economic evaluation of health care programmes. Oxford university press.

Glasby, J., 2017. Understanding health and social care. Policy Press.

Greaves, F., Ramirez-Cano, D., Millett, C., Darzi, A. and Donaldson, L., 2013. Harnessing the cloud of patient experience: using social media to detect poor quality healthcare. BMJ quality & safety, pp.bmjqs-2012.

Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, R.Z., Katona, C. and Cooper, C., 2014. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.

Manary, M.P., Boulding, W., Staelin, R. and Glickman, S.W., 2013. The patient experience and health outcomes. New England Journal of Medicine, 368(3), pp.201-203.

Middleton, B., Bloomrosen, M., Dente, M.A., Hashmat, B., Koppel, R., Overhage, J.M., Payne, T.H., Rosenbloom, S.T., Weaver, C. and Zhang, J., 2013. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the American Medical Informatics Association, 20(e1), pp.e2-e8.

Moorhead, S.A., Hazlett, D.E., Harrison, L., Carroll, J.K., Irwin, A. and Hoving, C., 2013. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. Journal of medical Internet research, 15(4), p.e85.

Munn-Giddings, C. and Winter, R., 2013. A handbook for action research in health and social care. Routledge.

Stanhope, M. and Lancaster, J., 2015. Public health nursing: Population-centered health care in the community. Elsevier Health Sciences.

Street, R.L., Gold, W.R. and Manning, T.R., 2013. Health promotion and interactive technology: Theoretical applications and future directions. Routledge.

Valentijn, P.P., Schepman, S.M., Opheij, W. and Bruijnzeels, M.A., 2013. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13(1), pp.655-679.

Valentine, M.A., Nembhard, I.M. and Edmondson, A.C., 2015. Measuring teamwork in health care settings: a review of survey instruments. Medical care, 53(4), pp.e16-e30.

Wager, K.A., Lee, F.W. and Glaser, J.P., 2017. Health care information systems: a practical approach for health care management. John Wiley & Sons.