The Management of Quality in Health and Social Care

Task 1 - Role of Quality Assurance in Health and Social Care

Quality assurance refers to the process used in setting and analysing a product or service to
meet consumer needs (Donabedian, 2002). Within health and social care, quality assurance
refers to following stipulated standards and practices to provide quality assistance to service
users (Cedefop, 2010). According to Tagggart, Barrins and McCarthy (2017), quality assurance
allows health and social care professionals to identify and address their deficits through suitable
educational and self-regulating needs. In the United Kingdom, health and social care policies
are influenced by public management practices, including coordinating and de-
institutionalising health and social care to deliver high-quality client services (Knapp et al.,
2018). Rychtařiková (2018) agrees that the significantly ageing population in the European
Union depicts that less active individuals will be available in the labour market by 2050
(Cedefop, 2010). Charlesworth and Johnson (2018) further state that with these demographic
fluctuations, there are increasing demands for health and social care providers as increasing
pressure would be placed on hospital beds.

Fig. 1- Components of Quality Assurance [Cedefop, 2010]

Bovaird (2007) believes that quality assurance plays a vital role in eliminating health and social
care threats by providing better services to clients. High-quality services must be provided to
the service user by continuously evaluating healthcare providers and their respective medical
procedures (Cedefop, 2010). These methods should be up-to-date, and employees should be
cautious to prevent errors. Donabedian (2005) again stipulates that quality assurance within

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practice is essential as it reveals weaknesses of hospitals and social care provision and offers
solutions that can be readily implemented or put into action in the future. Reeves et al. (2011)
take note of quality assurance compensations and its guidelines for providing better health and
social care services. In such cases, the process determines what should be removed or
unfollowed to streamline it (Cedefop, 2010). Through these capabilities, health and social care
employees can eliminate potential medical errors that may put the lives of individuals at risk.
The employee's involvement in quality assurance develops an environment of professional
challenge that triggers professional growth. Lohr (1990), Wachter (2004), and the Academies
of Sciences, Engineering, and Medicine (2018) are all in agreement that quality assurance in
health and social care should promote societal accountability and public safety by eliminating
medical errors as much as possible.

Models for Ensuring Quality Improvements

According to Hughes (2008), quality improvement studies and projects aimed at delivering
positive changes in health and social care are delivered using models of care, such as the Plan-
Do-Study-Act (PDSA) model and the Six Sigma model. The PDSA model is crucial for rapid
cycle improvement and has been broadly utilised by the Institute for Healthcare Improvement
(Taylor et al., 2013). A distinct feature of the PDSA model is the recurrent nature of affecting
and evaluating change through small and frequent actions rather than slow and complex actions
(Hughes, 2008). McNicholas (2016) elaborates that the primary purpose of PDSA is to
establish a causal or functional relationship between process changes and results. The change
begins by determining the scope and nature of the problem, the changes to be made, planning
for a particular change, and what to measure to understand the effects as agreed upon (Hughes,
2008). Phillips and Phillips (2016) determine that change implementation takes place, and
information is gathered with the outcomes of the implementation study evaluated and
interpreted by reviewing numerous key measurements demonstrating failure or success. In such
a scenario, the action is taken based on the outcomes of implementing change or initiating the
process again.

Another model of quality improvement is the Six Sigma. DelliFraine et al. (2010) define it as
a business strategy to improve, design, and monitor processes that reduce or eliminate waste to
optimise satisfaction and augment financial stability. In the health and social care sector, the
model enhances the performance of a process or process capabilities (Antony et al 2023). It is
used to measure and compare processes based on baseline capability before improvement and
after piloting the potential solutions of quality improvement. Six Sigma employs two primary
methods: scrutinising process outcomes and counting deficiencies or utilising process
estimates and variations to predict process performance (Khan, 2005). The initial method is
essential when calculating the sigma metrics from defined tolerance limits, while the second
measures the analytic process with precision and quality (Hughes, 2008). Consequently, the
Six Sigma model is beneficial in pre-analytic and post-analytic procedures to measure, control,
and improve processes within the healthcare sector (Emekli et al., 2019).

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Task 2 - The Role of Care Quality Commissioning in Maintaining Quality in Health and
Social Care

According to the National Audit Office (2014), the Care Quality Commission (CQC) is
England's autonomous adult social and health care regulator. The Commission is a non-
departmental public agency accountable to Parliament and under the sponsorship of the
Department of Health (National Audit Office, 2014). CQC has two significant roles: ensuring
individuals are provided safe, compassionate, high-quality, and effective care and, secondly,
encouraging health and social care providers to enhance the quality of services given to their
service users. However, the World Health Organisation (2016) has demonstrated in its
Sustainable Development Goals agenda that almost half of the world's population needs to
access quality healthcare services. Therefore, the Commission is crucial to ensuring registered
social and healthcare providers offer responsive and well-established care to individuals.
National Audit Office (2014) says that the CQC's role includes registering care providers,
protecting medical service users, and monitoring, reviewing, and rating health services. For
registration to occur, the providers should meet specific safety and quality standards.

Additionally, the Commission strives for safe and compassionate care for senior citizens. It has
been shown that about seventy per cent of people over 65 years require long-term care
(Knickman and Snell, 2002). This strategy includes maintaining safe, high-quality care
standards to deliver effective service as the CQC also evaluates compliance with safety and
quality standards. Dubar, Browne and O'Commor (2021) state that compliance evaluations are
essential in the regulatory context, and the CQC accordingly acts against non-compliant social
and healthcare providers. Conversely, evaluating compliance standards aids in maintaining
high-quality service delivery by offering the best possible care regardless of where it is sourced.

The Role of Benchmarks in Maintaining Quality in Health and Social Care

Benchmarking is a structured technique used in the United Kingdom to compare hospital

results for cost-containment purposes (Willmington et al.,2022). Willmington further posits
benchmarking as an invaluable tool that helps identify the strengths and weaknesses at all
organisational levels. Ettorchi-Tardy, Levif and Michel (2012) concur with Guven-Uslu (2005)
on the point that health and social care benchmarking responds to service user expectations
through sustained efforts to measure results which are then compared with those from other
organisations to understand how they were attained and use the lessons to improve.
Willmington highlights that benchmarking has been used significantly since the 1990s to
measure and compare clinical results across health and social care organisations. Sewell (1997)
continues that it allows individuals and groups to learn from each other and use best practices.

Today, benchmarking is a critical approach in quality improvements to instil changes to

provide better service user outcomes (Ettorchi-Tardy, Levif and Michel, 2012). It also helps
develop system performance and improve professional development. Thus, benchmarking uses
various steps, such as identifying the best healthcare performers through analysis and
investigating factors that support quality improvement. Ettorchi-Tardy, Levif, and Michel
(2012) argue that benchmarking allows health and social care providers to compare their output
with others and their care providers. It is a crucial process for successful performance and
quality improvement. The practice benefits clinical registries that use rankings but focus on
attaining real-world outcomes. Benchmarking aims to improve efficiency, quality, and service
users' experience in these registries. Through accurate comparisons, fair benchmarking offers

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critical elements for appropriate quality improvement. Ettorchi-Tardy, Levif, and Michel
(2012) show that benchmarking is helpful in healthcare organisations, such as hospitals, to
monitor performance and compare with other firms in which benchmarking can be utilised to
determine patient characteristics, processes, volume, results, and other expressive categories.

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Task 3 - Evaluating the Methods by Which Health and Social Care Can Gather Feedback
to Improve Quality

According to Wong, Mavondo, and Fisher (2020), service user feedback is essential in health
and social care because it provides opinions and views of the service users, placing them firmly
in the driving seat of the person-centred care approach. Care providers can collect feedback in
different ways, including surveys, focus groups, interviews, audits, and comments and
complaints. However, a survey program conjoined with analysis effectively collects tangible
patient feedback (Boyce et al., 2014). Evaluation also helps understand how individuals in the
health and social care industry can improve service delivery. An omnichannel approach to
gathering service users' experiences via surveys allows individuals to collect effective and
accurate information (Wong, Mavondo, and Fisher, 2020). For instance, digital surveys allow
healthcare practitioners to drive visitors to the provider's webpage to answer anonymously or
to be identifiable. This, however, does not consider the older, not-so-tech-savvy aged.

Focus groups refer to small gatherings of people who discuss and examine their perspectives
in detail (Picker Institute, 2020). These groups provide an opportunity to gather various
opinions and experiences. They also help identify discussion topics, and trained facilitators are
used to facilitate discussion. One-on-one interviews are another method for gathering feedback
on social and health care to improve quality (Picker Institute, 2020). Conversing with
individual service users or service users offers detailed insights into specific problems or issues.
Like in focus groups, the issues are identified first, and interviewers are trained to guide
interviewees into answering predetermined questions.

Identify the Stakeholders in the Improvement of Quality Delivery in Health and Social
Care

Stakeholders refer to individuals and groups interested in specific projects and their influence
to determine their outcomes (Huotari and Havrdova, 2016). The health and social care industry
can support or resist transformations presented as part of quality improvement. Sen et al (2007)
believe it is essential to identify stakeholders who can bring changes early to ensure robust
relationships are nurtured, aiding in understanding resistors. Issues may aid in preventing
conflicting situations and delays as the project progresses. Health and social care stakeholders
include service users, healthcare practitioners, local government authorities, social groups,
pharmacies, quitlines, and social health groups (Huotari and Havrdova, 2016). Stakeholder
analysis is the dynamic process that promotes streamlined quality improvement in social and
health care, familiar stakeholders including managers, clinicians, service users, clinical
assistants, executives, and payers (Huotari and Havrdova, 2016).

Evaluate Strategies that Can Be Used to Improve Service Users' Safety

According to Ferla et al. (2022), safeguarding a service use is a significant component of

person-centred care that correlates service user experience and health outcomes. Nonetheless,
healthcare practitioners view person-centred care and service user safety as separate issues.
Ferla et al. (2022) say that clinicians observe the safeguarding of a service user as a component
of clinical care. Applying monitoring technology such as Birdie or Access Planner is beneficial
in fulfilling the various service user needs as all documentation about their care is readily

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available for the carer. Carers can leave visit notes, which can then be viewed by the care
provider in real-time. In other instances, to prevent medication errors, service providers care
for their service users during shifts by administering medications; therefore, the utilisation of
monitoring technology can assist physicians and nurses in verifying whether they are on the
right track and using the correct procedures (Ferla et al., 2022). As an example, bed alarms
notify employees when their service user falls, which can, along with medication
administration, be logged on the digital platform.

Another strategy is verifying and reviewing all assessment processes and procedures. A regular
confirmation process is needed to prevent errors in assessment procedures (Keshta and Odeh,
2021). For instance, there have been horror stories where a patient received a left knee
replacement, whereas the right knee was scheduled for surgery. One of the popular verification
processes is the universal protocol that prevents surgical mistakes by allowing participants to
call a time-out and verify the surgical details (Keshta and Odeh, 2021). Keshta and Odeh 2021
agree with Ventola (2014) on the benefits of the mobile app and verify different aspects of
healthcare, such as timing and medical dosage.

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