AO3
Quality assurance is achieved when care settings observe the rights of service users, follow legislation that protects service users and care workers, and follow procedures that are in place within care settings to ensure the health and safety of all who live and work in them. It's important that professional care workers need to know what rights service users have and it's essential for them to know and understand the laws that protect them. It's very important as the rights and responsibilities of service users and care workers are fundamental human rights which laws safeguard. 1
The diagram 1 below incorporates all issues connected with quality care
Following safe working practices
Knowing about relevant legislation
Preventing barriers to access of services
\ t
Not being prejudiced
Encouraging high self esteem
Promoting quality care
Enabling fair and equal access to services
\ \
Applying the care values
Knowing our own attitudes
It's important that any decisions made by service users should be made by the service users and not the care workers. Options instead of solutions should be presented and explained, giving the service user a wider range of information on which they can consider when making their choice. Options also create risks and its part of a care workers job to make these risks clear to the service user so that they can weigh up the advantages and disadvantages of the options. Sometimes it seems like it would be a lot quicker and easier if the care worker were to make the choices for the service user, however it's important that as a professional, this should not be done. The service user needs to have their rights to choose and should be consulted about that decisions that will affect them.
'Your guide to the NHS' is an example of how care workers can provide service users with the information they may need to make an informed decision and also may help them to understand why some actions taken are necessary.
Quality assurance mechanisms at Age Concern and a GP surgery Quality assurance (QA) can have many different guises, it can also be known as Total Quality Management, Continuous Quality Improvement, Clinical Audit or Quality Circles. When talking about quality of care there are many different perspectives in different peoples eyes, what one person may see as very important in maintaining quality care, another person may not think it has suchimportance. However, when talking about QA systems, they should also incorporate these 3 different perspectives on quality:
•Clinical standards
•Performance management
•Client satisfaction
Because of these 3 difference perspectives there are usually more fundaments within the QA system, these could be things such as clinical audit, quality control of laboratory services, standards setting and client satisfaction surveys. All of these can be introduced into the QA system at any times and don't have to be introduced simultaneously. A GP surgery would use some of these measures, one of them being client satisfaction surveys. This allows the GP unit to realise their strong points and also the weaker points of their place of work, allowing them to make room for improvements, and ensuring quality assurance.
QA programmes on a national level are a way to improve standards, however strategies to implement QA at a district and sub-district level are sometimes ill conceived, and that is if they even exist at all. This would lead to a poor service, if a QA system didn't exist at Age Concern or a GP surgery the service that they provide would be very poor and not up to the standards that are needed to provide service users with top quality care.
Recently it has become common for government health policies to include the policy of their health services, by including these it can help to ensure that health services are cost-effective as well as responsive to the needs of the public. The statements promote good quality care and their recognition at a central level is important.
QA policy statements should do these things:
• Commit health services to be responsive to public needs
• Have specific quality objectives for different health services
• Promote collaboration between service providers and clients
• Clearly signal government commitment to achieving better quality
Implementing QA systems can prove to be a peoples issue as well as a technical one. When implementing assurance systems, some people can become over ambitious and this can cause problems later. A single issue could be a good place to start and from here whilst the quality culture develops elements can be additionally added to the programme.
QA initiatives which are part of the annual work plan for the budget should be encouraged in districts. These initiatives should be guided by national policies which have nationally agreed standards and quality of care. Districts with stronger QA strategies should offer support and help to weaker districts when quality assurance is lacking or not taking place.
Interdisciplinary QA teams represent the best mechanism for running the QA process/system, members of the team should have managerial responsibilityso should therefore be able to directly influence service quality. For quality to be maintained for long term all of the roles of the staff should be integrated and all roles and responsibilities should be known.
In order for QA to be successful, both ends of the health system should promote it. To work well and support QA, resource people are required at national, regional and also district level. To get things started technical assistance coming externally can help, especially if there is limited expertise. The role of national level is to advocate the importance of quality improvements strategies and facilitate them locally by:
•Providing resources
•Co-ordinating training
•Co-ordinating standards of care
A national QA committee would be appropriate to hold this responsibility, and the committee could also support district development by requiring quality of care to be included in the training curriculum of all health service workers, so that a culture of quality is fostered in the health service community, both public and private. This national committee should be going round to different services including Age Concern and GP surgeries to asses the services. They should also be making sure that in the training for the staff at Age Concern how to provide the service user with quality of care is included. A national QA committee would be a vital part of QA in a GP surgery, as they would provide the training for all staff at the GP surgery on how quality of care can be provided for the service user. The national QA committee would also be important in making sure that there are resources available in the GP surgery and at Age Concern. Resources could include leaflets, posters, and also websites which offer a wider span on information. Underneath the national QA committee, the standards of care in a GP surgery and Age Concern would need to be synchronized and this could be done through staff training days and outside members coming into the settings to check and review the standards of care.
Regionally, there should be a quality strategy group which should be monitoring quality and providing supportive supervision to districts. There should be a regional training programme which reflects upon the national strategy with quality indicators and standards based on regional priorities. All GP surgeries and Age Concern branches should be aware of regional targets and should be working towards these being met. By having regional targets to follow, Age Concern and GP surgeries have something to work towards and should hopefully inspire them into working hard and together to met the targets set. If any staff (individual or group) at either Age Concern or in a GP surgery felt as if they were struggling, they could go to the supportive supervision unit and discuss and talk through their problems. An example of a problem they may go to a regional supportive group may be if they weren't getting on with a superior new member of staff. If problems such as these were sorted out, better QA would be available for the service user, therefore Age Concern and a GP surgery's service would be of a higher standard.
At a district level, there should be a quality steering team which supports facility-level quality improvements. This team should facilitate effective communications between primary and secondary level facilities. Support groups and seminars could be held by regional groups to provide nurses, managers, doctors and such like at Age Concern and in a GP's surgery, to provide them with that extra bit to make sure that quality assurance is being carried through with. Staffs working in GP surgeries often have group meetings in order to discuss current outbreaks, any trends that they have noticed which are affecting health and discuss general topics. These groups and meetings can give staff working in GP surgery's a well rounded insight as to current problems, and therefore can work to ensure QA. Meetings like these can also give staff the chance at Age Concern and those working in GP surgery, to discuss ways that they tackle problems and such like. This can give other staff pointers and tips and they are therefore helping each other, combining different strengths to gain the information that they can use in order to provide the service user with the best possible service.
Finally, at a facility level an interdisciplinary QA team should be responsible for continuously monitoring, assessing and improving quality. Targets should be set for its services, and these targets should be in line with regional standards, the teams should be able to re-allocate resources according to priorities and planned interventions.2 Age Concern and a GP surgery would have national targets for them to follow in order to met the guidelines set; following through with these targets should mean that staff should be organised in a way so that they are met in a way where quality assurance is maintained. All staff working at Age Concern and at a GP's surgery should know the targets in order to make sure that the service that they are providing are in sync with the targets set by interdisciplinary QA teams. It would be the responsibility for the staff in higher positions to make sure that all staff working at a GP surgery and Age Concern should know the current targets that they are working towards.
I found all of the above information from the internet, which gave me a huge range on information and research that I could look into.
Another mechanism that can be taken into account when looking at Quality Assurance would be the Quality Assurance cycle. Below are the 10 stages of the QA cycle:
1. Plan for Quality Assurance
o preparing for QA in the institution o forming a quality of care team o deciding the focus of your QA plan
2. Set standards and guidelines
o statement of the quality that is expected
3. Monitor quality of services
o selecting indicators (indicator = measure of a quality factor) o Selecting information source (clinic records etc.) o design of data collection system o implementing monitoring
4. Identify and prioritise what can be improved
o identifying areas for quality improvement using the monitoring information or identifying areas of local collective concern
5. Define the problem
o agree on and state the problem (as a team)
6. Identify who will work on the problem
o assign appropriate people to work on the problem (delegate responsibilities for QA to non-members of QA team)
7. Analyse and study the problem
o understand what is causing the problem
8. Suggest solutions
o suggest ways of correcting the problem
9. Decide on and implement solution
o action plan, implement the chosen solution
10. See how things have changed and decide what to do next
o Monitor and evaluate to see if it worked
After these 10 stages have been followed, the person should then go back to the beginning of the 10 and must continuously carry it through, this helps to improve the quality of health services.3
At Age Concern a system likewise to this would be followed in order to check for quality assurance. For the first step the manager and senior members of staff would get together and create a quality of care team; who would be a vital part of the organisation as these people are who would make sure that Age Concern were working and offering services with high standards of quality assurance. In step one the two settings, Age Concern and a GP surgery would also decided on the focus of their QA plan making all targets that they set out to achieve clear for the rest of the staff working in the settings. Both settings would then follow through with each of the steps which offer great guidance in making sure that quality of care is carried through with and assured. The final step that they would follow through with would be to monitor and evaluate to see if their quality assurance plan is working well in favour of the service users. These evaluations can take place through a number of different ways, including questionnaires reviews and interviews. People could come into Age Concern or the GP surgery through different organisations to check and give an un-biast view on the provision of service. Again I used the internet to research this information as it offered a wide range that I could use and also included lots of detail into it.
There are many different aspects of quality assurance, and they can all take different forms. Some aspects include:4
• Improving information and consultation with service users The NHS plan in 2000 and the Health and Social Care Act in 2001 caused many changes, for the better, involving patients and the public health services. The NHS, local councils and social service departments all involve users in the development of services and information about these services are offered in a variety of different ways
• Involving service users in the NHS and social care In the Health and Social Care Act, section 11 places a duty on NHS trusts to involve and consult with patients and the public in service planning, operation and proposals for change. Local councils also now have a duty to consult the public, this could be through questionnaires.
• PALS (patients advice and liaison services) All NHS services have these, which offer advice to patients. Problems are tried to be resolved on the spot, being a complaint about the cleaning or the quality of food. People can be put in touch with external support groups in PALS, and people can also be directed to ICAS (independent complaints and advocacy service) or they could be referred to the trusts own complaints service.
• Patients forums (Patient and public involvement forums Since 2003 all NHS trusts have a PPI form, it's a statutory body of voluntary patients and others living in the community appointed by the Commission for Patient and Public involvement in Health (CPPIH). The quality of services from the patients perspective is monitored, and evidence is contributed to other monitoring bodies, for example
the Overview and Scrutiny Committees. PPI forums hold several meetings a year in public and these are advertised by the local press
• Patient choice This is an example of how patients are being
involved in making decisions about their own care. This was set up due to public complaint on waiting times for operations and also high levels or patients not attending outpatient clinics or cancelling admission to hospital
• Patients charters This was replaced in 2001 by the new NHS charter, Your Guide to the NHS. It's designed to give patients a clear guide to their rights and responsibilities to the standards and services they can expect under the NHS plan. Information on where to get the right treatment is offered and also explains how complaints can be made. A GP surgery would use this guide to show service users all the different options that are available for them which assures that quality assurance is taking place.
Maintenance of Quality Assurance
Quality assurance can be maintained in many different ways, below are some
of the ways in which this can happen
• Allowing the service user to express preferences: An example of this would be allowing them to choose what time they would like to do things such as getting out of bed and what time they would like to have a bath. Deciding what services and what GP they will have also allows them to express preferences. At Age Concern the manager and care workers will always make sure they find out what the patients enjoy and don't enjoy, and whether they would like to do something or not. As the patients often stay for a prolonged period of time, the care workers at age concern should learn their preferences therefore ensuring that quality assurance is maintained. In a GP's surgery patients should express preferences by asking questions, such as who they would like to see and what time would they like to be seen or make an appointment for. Riverview should allow service users to express their own preferences; this could simply be on what TV they would like to watch or what they would prefer to do for the day. Freda would get this treatment at Age Concern and it's important in making the service user feeling cared for and also assures that the service is providing a quality assurance.