UKCBC-HOLBORN COLLEGE

Managing Quality in
Health in Health and
Social Care

Mentor: Solomon Afework

Student: Florinela Naida
Student Number:17000495
 Content
Introduction
1.1 Explain perspectives that stakeholders in health and
social care have regarding quality.
1.2 Analyse the role of external agencies in setting
standards.
1.3 Assess the impact of poor service quality on health and
social care stakeholders.
2.1 Explain the standards that exist in health and social care
for measuring quality
2.2 Evaluate different approaches to implementing quality
systems
2.3 Analyze potential barriers to delivery of quality health
and social care services
3.1 Evaluate the effectiveness of systems, policies and
procedures used in a health and social care setting in
achieving quality in the service(s) offered.
3.2 Analyze other factors that influence the achievement of
quality in the health and social care service.
3.3 Suggest ways in which the health and social care service
could improve its quality.
4.1Evaluate methods for evaluating health and social care
service quality with regard to external and internal
perspectives.
4.2Discuss the impact that involving users of services in the
evaluation process has on service quality.
Conclusion
Reference

PAGE 1
 Introduction
In the next paper we will talk about the perspectives, the role
of the stakeholders in terms of quality in the health field, as
well as the impact of quality on them. In the second part of
the paper, we will explain the existing standards, analyze the
different quality approaches and evaluate the efficiency of
policies and systems. We will also analyze the factors that
influence quality and suggest ways to improve quality in a
health organization. In the last part of the paper, we will
evaluate the methods used to evaluate the quality, from an
external and internal point of view, as well as the impact that
the service users have on the quality of the services.

1.1 Explain perspectives that stakeholders in

health and social care have regarding quality.
According to Mainz (2003), quality of care is the level of
health services offered to the population, developed
consistently with the help of professional knowledge.
Quality in health and social care is the delivery of quality
medical services in an environment conducive to the conduct
of the medical act, with the orientation towards the patient
and his needs.
Stakeholder represent the person or group that has interest
or power, over the organization, over quality of care and may
be internal or external.

PAGE 2
 Source: http://businesscasestudies.co.uk/co-operative-food-group/ethically-
serving-stakeholders/internal-stakeholders.html#axzz3cTp7fTgY

In the case study at Royal United Hospital, stakeholder are

healthcare staff, all professionals, patients and CQC.
Each organization has internal or external stakeholders, and
their views on service quality are totally different.
Internal stakeholders, such as service providers, visualize
quality through human resource issues, the organization's
reputation, as well as through the available budget. The
client is at the forefront of the focus of all the organization's
activities - all of which are oriented towards the systematic
satisfaction of its requirements. All departments, the entire
staff of the organization are important and participate
effectively in quality, each representing a link that can
strengthen or weaken the chain of quality, each being
customer and service provider in this chain.
In the case of external stakeholders, represented by service
users, the value of quality is viewed differently from person
to person. In the case of service users, quality is seen
through care received, good communication, respect. Also,
service users can view quality by facilities, hygiene, data
protection, health care, and standby time. In the case of

PAGE 3
relatives of service users, the quality is measured by
appreciating the patient's level of care and the cost of the
services received.
However, many service users may not agree with what
others say about service quality. Any activity with
repercussions for quality can be continually improved, and
the individual involved workers must be trained, the spirit of
participation and initiative must be awakened, listened,
motivated, continuously trained and trained, their
participation in collective working meetings, solving problems
and finally you need to be properly sensitized. The activities
and their development must be done by constantly pursuing
the profitability and efficiency of the organization, and in the
long run, advantages for the entire staff of the organization
and for society, its prestige and success.
From the case study it is noted that RUH provides services
for a population of 500,000 in Bath. The quality of
stakeholder services is presented in customer reviews
showing positive NHS options. CQC is an external partner of
RUH, which performs quality inspection; this is the interest /
concern of this stakeholder.
In the case study, the providers of care services,
represented by the hospital employees, regarding the quality
of the health and the organizing service have totally different
opinions.
1.2 Analyze the role of external agencies in
setting standards.
The government, government agencies and the ministerial
department are external groups that have an important role
in setting standards for all health organizations. The

PAGE 4
government is the key agency in which DH is located, and
government agencies are under the ministerial department
(DH). These agencies set standards that are followed in
every health and social care organization. To meet these
standards, these agencies organize regular inspections on
issues such as equipment, safety, care provided, etc.
In addition, organizations provide training to staff, precisely
to develop service quality and maintain standards.
Two important external bodies for the implementation of
standards in healthcare organizations: the National Institute
of Clinical Excellence (NICE) and the Quality of Care
Committee (CQC).

Source: https://www.imperial.nhs.uk/about-us/news/cqc-october-2017

The Care Quality Commission (CQC): is a UK public body

that sets health standards, safeguards care and sets
standards so that service users can get all the basic facilities
also regulates and supervises home care and social care
services, ensuring the rights of vulnerable people. According
to Blake and all (2015), CQC must act if organizations fail to
meet established standards of care.

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 Source: https://www.e-lfh.org.uk/programmes/nice/
The National Institute of Clinical Excellence (NICE) provides
advice on service quality in the National Health Services
(NHS) in the UK. NICE, provides regular advice on meeting
quality standards, health services and social services. It also
generates guidelines and evolves care standards for social
care and home care services. According to Rawlins (2015),
NICE sends medical institutions a wide range of information
to help them deliver quality services.
The NHS public, private, voluntary and community sectors
and local authorities receive advice and recommendations
from NICE on ways to increase people's health and reduce
costs through best practices.
In our case study, CQC performs regular inspections to
verify safety, service quality and how to address people's
needs. Because the organization did not meet the standards,
it received warnings from CQC about the deficiencies found.
1.3 Assess the impact of poor service quality on
health and social care stakeholders.
Quality of service is an important factor that has a major
impact on Health and Social Care organizations. Poor quality
will have an impact on all stakeholders, patient needs will
remain unsatisfied due to poor service quality, intimacy and
dignity will not be maintained, lack of facilities and
disruptions may arise due to various activities in the hospital.

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The low quality of the services offered may reduce the
organization's productivity, as the profitability of the Royal
United Hospital Bath NHS Trust may also decline. On the
other hand, the poor quality of the organization can also
reduce customer satisfaction that may lead to the
organization's closure. CQC and other health regulators may
take certain legal actions that can also destroy the
organization's brand building (Blake, et al., 2015).
In the case study, Royal United Hospital, had insufficient
capacity to deal with emergency cases when the request
was lifted. Patients had to wait in the service emergency
corridors, and during this period the stay stayed in the day-
to-day unit. These were the poor-quality impact on the
organization. Low salaries were not evaluated, waiting time
for surgery was long, increase in patient complaints, the
NHS had low patient safety indicators compared to other
confidence and standards were unmet. These indicate poor
service quality and its effect on stakeholders at Royal United
Hospital.
2.1 Explain the standards that exist in health
and social care for measuring quality.
Each healthcare organization has standards to help deliver
quality services to service users and a secure workplace for
professionals working within the organization.
There are many standards proposed by CQC, NICE, code of
practice, etc., which must be followed in each organization,
standards being set to maintain activity and service quality
(Sahel, et al., 2015).
According to Sharon (2008), quality standards are very
important in the health and social care sector. All

PAGE 7
organizations must maintain quality standards, service users
must receive quality information and care to meet their
needs. Periodic measurement of performance and
organization standards is essential to reduce errors, improve
quality, and promote high efficiency.
A quality standard is a “detail of the requirements
specifications, the various guidelines and characteristics to
be able to meet its quality by the product in order to meet the
purpose of the product, process or the service” (Quality
Standards Definition, online source).
Organizations that maintain quality standards provide both
service providers and people in care, respect, security,
dignity and independence.
There are also some aspects that can measure quality as
objectives were requirements receive response on time and
errors or findings can be seen in reviews (for example, a
home care quality care services will be measured as
delivering quality service by the amount of reviews that will
show their performance process, their quality can be also
seen in their strategies meant to meet their project
deadlines), subjective were is needed to consider
stakeholders expectation (for example, involving service
users in the process and gather their feedback can help), but
from experience feedback is not always helping as the
manager were volunteer was asking feedback from residents
and their family regarding a matter but they only wanted to
have them as a record, quality improvement were not meet.
Referring to our case study, hospital use quality
measurement as a process where data is used to evaluate
their health plan performance and improve patients records,
and they are monitored by CQC to “make sure they meet

PAGE 8
fundamental standards of quality and safety”(UKCBC, case
study, 2019). Monitoring can also help to “evaluate the
infrastructure of the hospital in case of recording the
capabilities of staff as well as their service towards patient’s
treatment” (Davis, et.al., 2015), it also implements duties
related to human and equality rights.
2.2 Evaluate different approaches to
implementing quality systems
To achieve quality standards in the organization, the steps of
change are created, and the steps are followed precisely, to
obtain quality services for the users of services.
According to Sahel et. of (2015), having quality systems in
the organization, offers a better understanding of quality and
quality elements.
TQM- Total Quality Management, it can be adopted to
implement quality standards, to monitor performance and to
permanently improve the care offered. TQM is used with
Continuous Quality Improvement (CQI), CQI is vital when
comes to develop organizational practices and according to
Hughes (2014) “is based on the principle that tremendous
opportunities exist for improvement in care process and
facilitations”.
The quality systems are monitored through the management
of the unit, with the direct involvement of the persons
working in the organization. The goals of all being common,
that is, providing quality services, helps the organization to
grow and offer quality services.
The approaches used to maintain quality standards have
advantages and disadvantages. The advantage is that: the
quality systems offer a systematic process of organization,

PAGE 9
with the help of which they develop and revise the practices,
offering a quality service. The disadvantages arise when the
approaches are not applied, changing the organization's
objectives and priorities, and this can lead to failure to
monitor progress.
In the case study, at the Royal United hospital, TQM can be
used. It can be used as an approach to implement quality
systems, and using TQM, the hospital can reduce costs and
focus on regulatory issues.
2.3 Analyze potential barriers to delivery of
quality health and social care services.
All health organizations face internal and external barriers
that stand in the way of providing quality services.
Internal barriers-In order to provide quality services, it has
been found that there are several potential barriers that
restrict the organization, such as lack of financial resources,
which is the main problem for any organization. Also, the
lack of equipment, human resources, etc. represents the
major concerns for any health organization.
Also, resistance to change is an obstacle to providing quality
services, because staff members would resist changes
implemented within the organization.
The lack of a leader capable of managing, planning and
coordinating health services is also a barrier.
External barriers lack of health insurance, financial systems
were the organization can find difficulty when comes to
founding the new changes, lack of family and social support,
legislation were organization can face different legal issue
and can affect organization image, social policy were safety
must be promoted. According to Ozok (2012) “lack of health

PAGE 10
insurance can also result in inefficiency in the conformation
of programs to all the natives”, lack of health care culture.
The Royal United Hospital Bath NHS Trust are facing both
external and internal barriers, lack of knowledge as well as
lack of facilities, poor management causes the organization
to face problems.as employee’s demotivation and this can
lead to new changes failure.
3.1 Evaluate the effectiveness of systems,
policies and procedures used in a health and
social care setting in achieving quality in the
service(s) offered.
The systems, policies and procedures are in a close
relationship, in order to provide quality care to service users.
The quality hierarchy must be followed exactly when the
organization wishes to provide quality care, the organization
must follow up if the plan is fulfilled. The prevention of
possible problems is very important, the organization must
ensure continuous improvement of the performance and the
achievement of the proposed objectives.
From the group discussion, with my colleagues Laura, Maria,
Elena and Renata, we have come to the conclusion that
every organization must take into account the elements
found for the detection of problems, and the prevention of
errors and the continuous improvement is important for
obtaining quality results.
Organizations must have well-established plans, respecting
the laws, procedures and policies of the organization. Also,
very important is to check the results of the actions, to
diagnose in order to find out in advance any problems that

PAGE 11
may appear to act in time, to take measures to resolve the
shortcomings.
According to Ovreteveit (1994), absolutely all the activities
carried out by the management to improve and monitor the
quality of care. represents the quality system. The evaluation
and monitoring of quality systems is important, as well as the
audit is a method used to see if the services offered are of
quality and where they need further improvement.
The policies and procedures used by each health and social
care organization to provide and ensure quality care as well
as safety at the workplace, regulatory or legal issues. they
are used for the welfare and benefit of service users.
Regarding the case study, the organization can achieve its
objectives, implementing policies related to severe diseases,
working in partnership and offering benefits to service users.
If they do not comply with the established policies and
procedures, they have problems regarding the care given
and will be sanctioned following the periodic checks carried
out by the CQC
3.2 Analyze other factors that influence the
achievement of quality in the health and social
care service.
We have discussed with my colleagues that there are
several factors that can negatively influence the provision of
quality care. These factors are represented by lack of
economic resources, lack of qualified personnel, etc.
The lack of resources and financial aid makes the
organization unable to bring its objectives to fruition. Lack of
resources can be a barrier to staff recruitment. Because of
this, the organization cannot have qualified personnel.

PAGE 12
Failing to provide decent salaries, depending on the
qualification of each employee, they leave the organization.
Always the organization must recruit personally, and the lack
of experience and knowledge is a serious problem, the
problem faced by many health organizations.
Time management is also a problem that can be managed
through the recruitment of enough staff, which can provide
quality care. And staff who cannot manage their time and
who are late for work is a problem in the way of quality care,
because service users do not receive their medicines on
time or are not taken care of in time.
In any health organization, the achievement of quality things,
requires funds and different aspects necessary to maintain
quality standards, so it is not an easy task according to Kim
and Ahn (2002).
The lack of registration - correct and timely, is another
problem that has a negative influence on obtaining quality
care. Failure to observe the observations correctly and in a
timely manner can affect the health and well-being of service
users.
From a clinical point of view, there are professionals
responsible for the training of care services, and these
services help the NHS in spending advice, improving the
organization and quality of care.
Patient support services help and enable patients to choose
in their interest all they need and the best services.
National and local responsibility - represents a clear quality
of care and helps to improve the services offered, helping
organizations to provide quality services.
All these factors influence the provision of quality care at
Royal United Hospital where, by applying efficient and

PAGE 13
successful quality systems, working in the right direction, to
achieve performance objectives.

3.3 Suggest ways in which the health and social

care service could improve its quality.
Following the group discussion, there are different measures
that can be used to improve the quality of health and social
care, such as:
The activity monitoring and the periodic evaluation of the
personnel are used and necessary modalities for improving
the quality and care offered to the service users.
The training, supervision and monitoring of the personnel,
offers the employees the opportunity to acquire more
knowledge regarding the services and the medical
assistance offered. At the same time, they will have a better
understanding regarding the continuous improvement of the
quality of the offered services.
The leader of the organization and his attitude is also a
priority for quality. It must monitor and take the necessary
measures, work in partnership to help the organization
achieve high quality standards Ozok (2012).
Motivation of the staff - creates a better and more efficient
working environment, the staff to be paid according to
qualification and achievement. Also, facilitating the
organization with the right and quality equipment,
professional equipment, will increase the staff's satisfaction
and increase your level of care.
Information - the correct and timely information, helps the
professionals regarding the services offered, favoring the

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increase of the quality for the benefit of the users of services
and at the same time for the benefit of the organization.
In our case study, the efficiency and capacity of the
workforce was reduced, the clients waiting long to receive
care, the hospital is crowded and needs extra beds and the
lack of equipment and personnel creates problems, the
management being unable to maintain quality.
The Hospital need to have the necessary amount of staff
(CQC rules) and more founds that can help management to
recruit the staff and give them training Sahel et.al (2015).
4.1Evaluate methods for evaluating health and
social care service quality with regard to
external and internal perspectives.
From the discussion with my colleagues, to verify the quality
of the services offered, there are different external and
internal methods as follows:
The audit of quality and review is based on periodic
inspections, with the help of which the irregularities can be
observed early and at the same time urgent measures can
be taken to remedy them. For example, at work, at Northwick
Park Hospital, every month the staff participates in the audit.
There are 5 teams, which every month checks the activity.
The team of which I am a member, this month we checked
"infection control" next month we will check the entries in the
observation sheet, etc. After the inspections, the possible
problems are identified and at the same time measures are
taken, so that they will not be repeated.
Quality surveys are used to find out the opinions of the
service users, regarding the personnel who serve a certain

PAGE 15
section, their relationships, behavior, attitude with the service
users.
Quality inspections performed by the manager are important
to see how staff provide care and to see where
improvements are needed. Also, CQC, performs periodic
checks to see if the standards of care are met. Unfortunately,
the CQC inspectors announce the inspection early, and this
makes the organization's managers prepare for the
inspection, and they manage to hide the poor quality of the
services. I personally believe that these announced
inspections are to the detriment of service users.
The quality tour is organized without having a set schedule,
this quality tour is very efficient. It is beneficial for the staff,
they can receive opinions about the quality of the services
offered, opinions for the improvement of the services for the
users of services and of course for the prosperity of the
organization.
Talking to my colleagues, it can be said that there are many
methods that have not been mentioned above, such as the
staff survey. The opinions of the staff regarding the quality of
the care offered are very important for measuring the quality
in an organization. Unfortunately, given the function they
hold in the organization, the attributions are limited, and
most of the time, the managers do not consider the opinion
of the staff.
Refer to the case study, the hospital may review the activity
annually to help improve and raise quality standards.
TQM also requests information on financial performance. It
is helpful for the hospital's activity, helping to sustainably
increase the quality and by providing competitive
advantages McKee (2012).

PAGE 16
4.2Discuss the impact that involving users of
services in the evaluation process has on
service quality
Discussing with my colleagues about the impact of service
users on quality, we have concluded that their involvement is
beneficial in the quality process if both employees and users
fully understand what collaboration means. According to
Healy (2011), workers want their service users to trust them,
and this is only possible through mutual understanding and
respect.
Mutual trust and respect have a positive impact on quality in
the organization because it will promote user independence
and reduce costs. Managers, for quality care, must support
collaboration between staff and service users.
User reviews and Stuff analysis help improve quality,
because this way the organization finds out where
improvements need to be made.
According to Health Care Quality (2002), staff and service
users can point to system issues, which are obstacles to
providing quality services.
Involving users in performing the quality process in the
hospital from the case study can be valuable, helping to
create an efficient system.
Any health organization, having a continuous review from
patients, could detect your problems in time as well as solve
them in a timely manner and thus the reputation of the
organization can grow.

PAGE 17
Also, not considering the opinion of the service users, it
leads to the decrease of the quality of the organization and
to the loss of the service users.
In the case study, the CQC states that continuous regulation
and inspection help maintain quality.
Also promoting equality and independence as well as putting
service users first increases their satisfaction and helps the
hospital achieve its goals.
The quality depends on the involvement and efforts of the
professionals, whom they provide in the workplace. It is
necessary for the organization to involve the users of the
services for a better improvement of the quality services. as
they can provide better explanations of their problems and
needs.

Conclusion
From the above report, we concluded that it is very important
to know the correct quality management, so that everyone
involved, both organizations and users of services can
benefit from it. This paper shows how organizations can
improve their quality, how procedures, systems and policies
are involved as well as their efficiency in managing quality.
Discussing with my colleagues helped me identify methods
and ways to improve quality, used in different organizations
that have the same purpose, to provide care to people.

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