AO3
To find out this research I gave a questionnaire to the manager at Age Concern and a questionnaire to a nurse who works in a GP surgery. I have found out that they work with many of the same teams and use the same methods to check quality assurance.
Questionnaires were used to gather information on quality assurance as an interview would be more time consuming and therefore inappropriate for the manager and nurse as they are busy and questionnaires are quicker and easier to complete. Also a face-to-face interview may result in untrue answers as the manager and nurse may be untruthful in their answers in order to show themselves in a better light etc.
I also went on to Age Concerns website to have a look through their Quality Assurance policy called 'Quality Counts' as well as other general information on the organisation, how they work and what they are working for.
Quality care is achieved when care settings observe the rights of the service users, follow legislation that protects both 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. The rights and responsibilities of service users and care workers are fundamental human rights which legislation safeguards.
Quality care therefore encompasses:
•Following safe working practices
•Preventing barriers to access of services
•Applying the care values
•Knowing our own attitudes
•Not being prejudiced
•Encouraging high self esteem
•Knowing about relevant legislation
•And lastly; enabling fair and equal access to services
Age Concern and Quality Assurance
Age Concern aims to provide high quality care and support for older members of society but focusing on their individual needs as well as encouraging independence. They believe that every resident is unique and so individuality will be maintained through choice, opportunity and respect.
Age Concern carry out many quality assurance techniques to ensure that their aims and objectives are being met on a regular basis and that they are carrying out high quality care and support. Care plans are used at their centres which include a high amount of personal information about a particular client including their treatment and their individual needs. As a quality assurance method these care plans are reviewed on a daily basis by a care provider or the manager. The information on what illness they have and how far it has gone is reviewed to make sure that the information is up to date and correct as it could affect the treatment they receive and the medication they are given, as well as the effectiveness that treatment will have on the client.
This is an effective quality assurance procedure as it shows that they are making sure that the clients care and treatment is up to date and meeting their needs. The care providers also make changes to the care plan if necessary so that all the staff can see the alterations made to the care plan and treatment that is provided. It also shows that all of the clients are treated equally as all of their care plans are reviewed so that no one is left out and everyone's treatment is up to date.
It would not be effective if Age Concern did not review the care plans on a regular basis as the care plan would become out of date and the treatment being given may have little if any effect on the patient. This could be seen as neglecting the client's needs which would be against the human rights act.
Another quality assurance procedure would involve an internal inspection. This is where the manager or a senior member of staff from Age Concern would inspect the centre and the staff working there. They could do this by walking around the centre to look at the equipment and facilities that are provided, talking to the staff to see how they feel about the service they provide and what could be done to improve. They may also talk to the clients who receive the care to see how they feel about the services they aregiven. This is a good method of ensuring that everyone is happy with the standard of service they are giving or receiving as it is looking at everyone's point of view. If Age Concern only spoke to the clients and not the staff then the review would be biased and this would not be good care practice.
Age Concern also gives the service users and their carers a questionnaire, requests by a letter or group discussion. By monitoring and evaluating comments and reports enables them to constantly improve their service. They also have a formal complaints procedure and a leaflet about how to make a complaint. The information about their quality assurance systems can be found in the Riverview booklet called 'Statement of purpose'. Age Concern must ensure that both the clients and the care givers are happy, if they receive any bad reports or complaints these must be dealt with in a professional manner as soon as possible to ensure high quality care.
The final way Age Concern monitor quality assurance is that they are inspected by an external company called CSCI (Commission for Social Care Inspection). An inspector comes to Age Concern and assesses a number of criteria. An inspection takes place one day out of every year. They talk to the manager, the staff and the clients in order to receive opinions from all different view points. They ask a range of questions about the care they have received and what it is like to work there etc. They also observe the staff and the way they talk to the clients, how they approach them with sensitive questions such as going to the toilet. They also observe how lunch and afternoon tea is served. The findings are written into a report which is sent to Age Concern, it is then put on the Internet for pubic viewing. The report covers many different things such as positive aspects of their service as well as areas that could be improved upon.
This is an effective type of quality assessment as it is bringing an external body that has a different viewpoint as they are someone from outside the company who can clearly see the positive and negative aspects of the company. It is also effective as it completed every year so it shows if the service is improving from year to year and if the recommendations for improvement are being acted upon.
It would not be an effective method of monitoring quality care if it was not conducted annually as because it is carried out on a regular basis it does not allow time for the standards of the service to slip and nothing be done about it. Due to the inspection taking place every year it allows negative aspects of the service to be picked up on and improved before they affect clients.
GP Surgery Practitioners and Quality Assurance
The GP Surgery practitioners will have similar procedures for carrying out quality assurance and monitoring. The first quality assurance monitoring procedure is that the patient's needs are reviewed by an outside member. This is done as an appointment and a copy of the review is sent to the patient. This ensures that the nurse's work is still effective and that she is carrying out the work that she says she is. It would not be effective if these reviews were not carried out because the client may not be getting the correct care and this would go unnoticed if the review did not take place.
GP Surgery practitioners also have regular weekly meetings to make sure that all of their practices and procedures are up to date and whether they need to be changed. These meetings are also about clinical governance which is all about patient safety and including a patient's carer in the treatment.
Staff at the GP Surgery are given a code of practice booklet that tells them what they are and are not allowed to do. In the meetings and reviews the manager will ensure that the nurses are following these codes. This is effective as it ensures that the nurses are doing their job effectively by following the correct guidelines thus the service is providing good quality care. It would not be effective if these meetings and reviews were not carried out because if the nurse was doing something incorrectly it would go unnoticed and therefore it would be unable to be corrected.
There is also a complaints procedure that the GP Surgery has if a client is not satisfied with the treatment they have received. The complaint form comes in the form of a booklet which gives the care user information about how to make a complaint and contains a complaint form and envelope to send it to social services who deals with the complaint. This is effective as itis quick, easy and simple to fill in which the client can do in their own time. If there was no complaint procedure or it had to be filled out by a member of staff this would not be effective practice as the client may feel embarrassed about telling the person their complaint especially if it personal.
Therefore it is easy to see that both of the services use many of the same quality assurance techniques. This may be because they both work with Age Concern so therefore work with the same people and have the same aim; to provide the highest quality of care possible.
The quality assurance can be maintained by:
• Allowing the service user to express preferences
How Age Concern achieves this:
Examples of allowing services users to express preferences could include Age Concern allowing their service users to decide which services they may want / allowing them to choose what time they go to bed or when they will have a bath.
How the GP surgery practitioners achieves this:
Staff such as the nurses could provide information on all available treatments and let the service user decide on the treatment they would prefer.
• Allowing the services users to make choices
How Age Concern achieves this:
Age Concern would provide options whenever possible for the service users to choose from as they understand that the service user making their own decisions or at least being involved in any decisions concerning them is a service users right. All service users should be given options and the right to chose for themselves, not just given a solution they are made to accept. Such options should be explained so the service user has a wide range of information to consider, from which they can make their decision.
How the GP surgery practitioners achieves this:
In the nurse's case, service users may wish to make choices about the treatment they have or whether they have traditional or alternative forms of treatment. The nurse would provide all information needed on each form of treatment and the service user would make their decision from the knowledge they receive. Whenever there are options, there are also risks. Care workers have a responsibility to present both sides of a situation so the service user can weigh up the pros and cons. By the service user participating in the decision making it allows them feel in control of their lives, valued and independent. This empowers the service user and boasts their self esteem.
- Enabling service users to develop their full potential
A service user may be a four year old attending a play group, an adult visiting a GP surgery or an older adult in a residential home. Whatever their ability or age the service user should always be encouraged to meet their full potential by:
- having individualised action/learning plans
- providing activities that are both challenging and stimulating
- assisting the service user to reflect on and analyse the experience
How Age Concern achieves this:
Service users at Age Concern may be encouraged to do things for themselves to the best of their ability as long as this does not put the service user or anyone else's safety at risk. For example, just because a service user may be unable to use their legs it doesn't mean they are completely dependent on other people; they can still do things for themselves. So wherever possible the care workers at Age Concern would encourage service users to do what they can. This is important as they need to feel a sense of independence, as it is crucial for the service users self esteem.
How the GP surgery practitioners achieves this:
The staff at the GP surgery should allow every patient to make they're own decisions etc. regardless of their age or ability. Each patient should be encouraged to reach their full potential at all times.
- Allowing service users to make complex decisions
Making difficult decisions requires:
- providing information about what is available
- discussing options and looking at each from different perspectives
- finding the best solution for the situation
Care workers must take the time to have discussions with the service user and to make sure they have understood the information given.
It is important for services to constantly improve information given and taken from service users through consultations. Sometimes it may seem hard for a service user to make a decision and on other occasions it may seem both quicker and easier for the care worker to make the decisions for the service user, particularly if the service user has difficulty in communicating. However difficult the situation, the professional care worker should not make the decisions for the services user. All must be done to ensure that the service user has their right to choose and to be consulted about the decisions that will affect them.
How Age Concern achieves this:
The staff at Age Concern must ensure that its clients are always involved in making decisions about themselves, even complex decisions. The service users have a right to be included on matters that concern them and they must be fully educated on all options available to them and supported where necessary in order to come up with a decision.
How the GP Surgery practitioners achieves this:
The staff at the GP Surgery must allow patients to decide for themselves whenever possible. They must be made fully aware of the situation, the options available to them, and the fact that they are fully entitled to their own opinion and beliefs when it comes to decisions including themselves.
Making sure the service users understand regardless of age and ability
Effective communication is essential. The care worker will need to use language the service user can understand, and speak at a pace that is appropriate. Providing service users with information, for example giving them 'your guide to the NHS' or providing them with a copy of the settings 'Mission Statement' may help them to understand why some actions are necessary.
How Age Concern achieves this:
Age Concern could make service users completely understand everything that has happened, is happening and is going to happen with them. Service users must feel fully informed and agree with their care plan.
How the GP Surgery practitioners achieves this:
In the case of the nurse, when dealing with young children he/she would adopt a more softer approach as the nurse would take into account the fact that the child may not understand the situation and could be feeling scared and vulnerable, the nurse would explain everything in a more simpler way and talk to both the child and parent so that the parent is kept completely informed and the nurse would perhaps ask the parent to just re-iterate what the nurse has said as the parent is likely to know the best way to communicate to that child. Especially if the child has a learning difficulty or is deaf etc. as the nurse may not have all the appropriate skills to communicate to these children.
In order to improve long-term care the 'National Service Framework' (NSF's) have been set in place. Their purpose is to improve specific areas of care by setting measurable goals which are to be achieved in specific time scales. The National Service Framework aims to:
- set national standards and to identify main interventions for a specific service or group, e.g. children or older people
- put in place strategies to support implementation
- establish ways to make sure progress is within an agreed time scale
- raise quality and decrease variations in services in 'a new and first class service' that is being provided.
The NSF's started in April 1998. They bring together health professionals, service users, carers, health service managers, partner agencies and others.