The Quality Standards for Health and Social Care set out the standards that people can expect from Health and Personal Social Services (HPSS). In developing these standards, this report aim's to discuss the quality of services and to improve the health and social wellbeing of the people of UK. (Department of Health, Social Services and Public Safety, March 2006). At the heart of these standards are key service user and carer values including dignity, respect, independence, rights, choice and safety.
The recent NHS Next Stage Review (England, 2008) outlined a number of initiatives designed to improve the measurement and monitoring of quality within the NHS. In the other UK countries, despite a reduced focus on market mechanisms to incentivise quality, data which helps others understand the patient experience and the quality of care delivered by the multidisciplinary team still remains an important theme. (RCN position statement, Publication no: 003 535, 2010).
The measurement and communication of health and social care quality therefore requires assessment of key and consensual variables that reflect the breadth and complexity of health care. Engaging with multiple stakeholders to identify core elements of health and social care quality is essential to this process (See Figure 1) (Soane DM and Silber JH 2003).
Figure-1 Health Care Environment Setting System Regulation.
What is Quality?
The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favourable balance of risks and benefits (Avedis Donabedian, M.D., 1980).
As matter of fact, one cannot assure of guarantee quality only increase the probability that care 'good, or 'better' because quality can't be guaranteed, many my-self included have criticized the term assurance. (A.Donabedian & R. Bashshur, 2003). Quality is an umbrella for continuous staff and organization development using new methods, an equal emphasis on specification and measurement as an attitudes and relationships. It also building on good practices as well as introducing new procedure raising satisfaction at the same time reducing costs and increasing productivity. (J.Ovretveit, 1992). Definition of quality is different from many others according to Maxwell (1984), accessibility, relevance to need, equity, social acceptability, efficiency and effectiveness. But here is something missed which is central to the quality which is customer's responsiveness and what customers want. Fully meeting customer requirements' or 'the totality of futures and characteristics stated of implied needs' (BSI, 1990). The most comprehensive and perhaps the simplest definition of quality is that used by advocates of total quality management doing the right thing right, right away.(Quality Assurance Project, Lori DiPrete Brown, 2010).
''Quality is proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition''.
-M.I. Roemer and C. Montoya Aguilar, WHO, 1988
According to Roemer, M.I., (1998) the most comprehensive and conceivably the simplest definition of quality is that used by advocates of total quality management: .Doing the right thing right, right away.
Quality frame Work:
As health and social care quality is, by necessity, a multi-factorial and broad ranging concept, the definition, measurement and communication of quality in health and social care should involve multiple stakeholders. (RCN position statement, 2010). In health care, quality assurance has been meant to apply predominantly, or even exclusively to health and social care practitioner (A.Donabedian, 2003). However discrepant views between the different stakeholders, ranging from service users (the public, patients and carers) to service providers (nurses, allied health professionals and clinicians) and commissioners of health and social care, exist with regards to the definition and prioritisation of quality issues (Leatherman and Sutherland, 2008, Campbell et al., 2002). Many authorities and organisations in the UK and elsewhere have chosen to adopt an off the shelf performance improvement model or tool in order to help them manage strategically and deliver against the national modernisation agenda. (Review of Performance Improvement Models and Tools, 2006). These are the Investor in People, ISO9001:2000 quality system and Practical Quality Assurance System for Small Organisations (PQASSO) etc. On the other hand there are many other approaches and tools available on the market - and the choice which to use can be a difficult one.
Investor in People:
Over 34,000 UK organisations are recognised as Investors in People employing around 27% of the UK workforce.
'Investors in People provide a straightforward, proven framework for delivering business improvement through people. 73% of Captains of Industry working with recognised Investors in People organisations believe that working with the framework leads to increased productivity.Â 79% of employers recognised with the Investors in People Standard say it helps all types of organisations adapt to change and growth'(Ipsos Mori Tracking study 2008).
Figure: The Investors in People Standard
There are three principles of Investor in People to which an organisations key indicators and to work towards have donate to and It is the reflects of business planning cycle (plan, do, review) for following and implement in their own planning cycle structure it obvious for organisations .The structure is based on three main principles:
Plan -development to improve the performance of the organisation.
Do -to improve the performance of the organisation they take necessary step/action.
Review - assess the impact of its investment in people on the performance of the organisation.
Organisations perform better when their employees have clear goals and are supported by human resource (HR) practices Investors in People recognised organisations have greater human capital flexibility. This denotes to alter their behaviour, to cope with changing workplace circumstances or practices in practice are employees in Investors in People organisations are more capable. Including doing poles apart jobs and acclimatizing to new ways of working with the Investors in People Standard has a positive contact on novelty of a greater willingness to gain new skills. People acknowledgment is more expected to have high levels of service and product innovation effectual communication has a straight and positive result on profitability of Organisations that have Investors. By the learning to have a positive effect on communication inside an organisation and therefore a collision on profitability, assessed by profit margin and profit per employee is shown for Investors in People standing. (Institute for Employment Studies, 2008).
The whole process is driven by your needs as a customer. Investors in People specialist will establish with organisational priorities and goals are at the start and then identify the most relevant parts of the framework for your organisation and its particular needs. Through the assessment process Investors in People specialist will provide feedback and advice on the areas of achievement and where there is room for development and Continual support which is personal, practical and flexible in the form of visits, online tools such as the business improvement tool IIP Interactive. Relationship with the Investors in People specialist is enhanced and their input is even more consultative (IIP, 2010).
ISO9001:2000 quality system:
ISO 9001:2000 is the global standard and come up for quality management systems. The standard mainly focuses on the management of processes and documentation work in order to meet customer's needs and expectations. The standard originated in the UK in 1976 as BS 5750. It later evolved to ISO9001 and was revised in 2000 to ISO9001:2000. The nature and reduced documentation requirements of the latest edition of the standard have significantly increased its applicability to the public sector. (ISO: 9000, 2010)
The technical committee (TC) 176 developed a series of international standards for quality systems, which were first published in 1987. The standards (ISO 9000.9001, and 9004) were intended to be advisory and were developed for use in two-party contractual situation and internal auditing. However with their adoption by the European community (EC) and a worldwide emphasis on quality and economic competitiveness, the standards have become universally accepted (Besterfield, D. H. 2007).
ISO 9001:2000 - Quality management systems (QMS)- requirements in the standard used for registration by demonstrating conformity of the QMS to customers, regulatory, and the organization's own requirements (Besterfield, D. H. 2007). The mark is a public demonstration that the organisation's quality system has been assessed and is internationally recognised. Once an organisation has gained ISO9001:2000 status it will be visited at regular intervals each year to ensure the standard is maintained.
Practical Quality Assurance System for Small Organisations (PQASSO):
Practical Quality Assurance System for Small Organisations (PQASSO) is an 'off-the-shelf' quality assurance system. It was first developed in 1997, which offers a practical step-by-step and designed specifically for use within voluntary and community sector organisations to improve the way organization runs and to help them to improve the quality of their services (PQASSO 3rd edition 2008). 'It provides a stage approach to working out what an organisation is doing well and what could be improved and approach to implementing 3 qualities through levels of achievement'(Proveandimprove 2010).
Practical Quality Assurance System for Small Organisations (PQASSO) is a quality assurance system that was produced by the Charities Evaluation Service (CES) specifically for small and medium sized voluntary and community sector organisations (PMMI 2006). It aims to help organisations to set priorities for the future to improve their performance. Charities Evaluation Services (CES) has also designed a CD-ROM to complement the work pack and make the self-assessment process more manageable. PQASSO covers twelve standard quality areas, which organisations should address in order to operate efficiently and achieve good results. The twelve areas are:
Planning for quality
4. User-centred service
5. Staff and volunteers
6. Training and development
7. Managing money
8. Managing resources
9. Managing activities
10. Networking and partnerships
11. Monitoring and evaluation
Practical Quality Assurance System for Small Organisations (PQASSO) is currently a self assessment tool although the CES are looking at building peer review into the approach. The system is very flexible and is designed to be worked through over a period of time - anything from 12 months to several years. Its focuses strongly outcomes, and helps you to measure the differences to any organization and users that come about by planning and implementing improvements. Organization also can choose to work towards the externally assessed PQASSO quality mark. Especially any small or medium-sized organisation without any paid members of staff or organisations with one or two members of staff can use Quality First. The PQASSO quality mark validates an organization's progress made through self assessment, and it will be cost 'between' £1,055 to £1,200 depending on the size of your organization [Islington Voluntary Action Council (IVAC), 2010]. It is a good starting point for organisations that are unfamiliar with quality tools. According to Paton (2003), suggests that organizations which allow plenty of time to engage properly in the PQASSO process are more likely to gain significant organisational benefits.
However research conducted by Aston Business School (2004) advises funders of 'the critical importance of allowing and encouraging VCOs to make informed choices about quality systems.
Health and Social care Quality standard in UK:
In the UK government's White Paper A First class service: Quality in the NHS clinical governance is defined as 'a framework through which NHS organizations are accountable for continuously improving the quality of their services safeguarding high standards of care by creating an environment in which excellence in clinical care flourish' (DoH, 1998). There are numerous concepts and theories associated with ever-increasing base of knowledge on the subject of quality assurance, so much so that it was difficult to choose which to develop. There are many definitions of the term 'quality assurance' written by people who have researched the subject thoroughly (Diana N.T. Sale 2000).
'Quality assurance is the measurement of the actual level of the service provided plus the efforts to modify when necessary the provision of these service in the light of the results of the measurement' (Williamson, 1979). In Britain, the 1990 government NHS reform put quality on the agenda for the first time (DoH 1989). A standard is a level of quality against which performance can be measured. It can be described as 'essential'- the absolute minimum to ensure safe and effective practice, or 'developmental', - designed to encourage and support a move to better practice.
The Quality Standards for Health and Social Care, which is contained in this document, is classed as essential. Given the rapidly changing environment in which the HPSS operates, it is important that standards do not become outdated or serve to stifle innovation. To prevent this, standards need to be regularly reviewed and updated. It will be the Department's responsibility, drawing on the best evidence available, including advice, reports and/or information from the Regulation and Quality Improvement Authority (RQIA), to keep the quality standards under consideration, with a formal review being completed by the end of 2008.
In recent years under the rubric of 'total quality management' it has become popular to include in the idea of quality assurance almost every function or activity a health care organization (A.Donabedian, 2003). It is reasonable to say that the quality of the environment of health care, including the managerial activities in it, have an influence of the quality of care- either directly, by influencing the performance of practitioner or indirectly, by influencing the convenience, comfort, or safety patients(Berwick, D.M., 1989).
Some believe that quality in health care is too abstract and nebulous a concept to precisely defined or objectively measured and one cannot assure or guarantee quality. One only increases probability that will be 'good' or 'better' (A.Donabedian, 2003). Quality cannot be guaranteed, many, included myself, it criticized the term assurance. It suggested alternatives have been improvement or, better still continuous improvement, terms meant to remind us that no given level of quality can be fully satisfactory; one should always try to do even better, progressing to ever higher level of goodness (Berwick, D. 1989).
Quality if care is the responsibility of everyone involved in health care and it has never been more important than it is today. Setting and monitoring standards of care and quality assurance are separate issues, although they are sometimes discussed as though they are same (Diana N.T. Sale 2000 p.34-38). Standard must be evidence based and dynamic always moving, always changing to ensure or improve the quality of patient care rather than just a paper exercise.