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Module code: MOD006923 Module title: Quality improvement in health and social care Coursework - Reflective Account Student Name: Student ID: Word count: 2735 Date of Submission: Table of Contents Introduction3 Application of Improvement Tools or Approach3 Improvement Plan on Stakeholder Perspectives7 Reflection using Gibb’s Reflective Cycle10 Personal Development Plan13 Conclusion15 Reference list16 Introduction Quality refers to the overall features and attributes of a product or service which can satisfy the needs of the consumers or even exceed their expectations. Richard House Care Home is chosen to discuss the tools and approaches that can be used to improve the quality of the healthcare services in this home where 33 aged people having more than 65 years of age stay. The inspection report highlights the areas that need to be improved such as safety, the role of management, the effectiveness of the service providers, etc. of this care house. Different quality improvement tools such as benchmarking, PDSA, and situational analysis will be discussed and the best-suited one for this care house will be identified. Application of Improvement Tools or Approach The inspection report shows that Richard House Care Home lacks the safety of its residents and they can be victims of abuse and other harm. The previous report also mentioned that this aspect needs to be improved and during the previous inspection and violation of regulation 12 of the health and social care act 2008 also has been noticed in this care home. In the latest inspection, regulation 12 was maintained and no breaching of the act has been noticed but still, there were many aspects regarding safety that need to be improved. The service was not effective in this care home and many times it failed to provide a better quality of life to its residents in terms of care, mental support, treatments, etc. Though breaching of regulation 18 was no longer noticed, the overall effectiveness of the service needs to be improved. No such improvements have been seen regarding the governance, leadership activities, and role of the management of this care home, and violation of regulation 17 of the health and social care act 2008 is still observed. Many tools can be used to improve the quality of the health services and health care processes to meet the expectations of the service taker and satisfy them by improving the quality of the services. It in a way helps to improve the quality of life of the service seekers. Benchmarking, PDSA, situational analysis, etc. are different tools that can be used to improve the quality of the healthcare processes in terms of superior services, person-centred care, superior management, governance, etc. Figure 1: PDSA Cycle: A quality improvement tool (Source: ihi.org) PDSA is a proven tool for improving quality and one of the most widely accepted approaches which can be used to improve the quality of healthcare services (Knudsen et al., 2019, p.1-10). PDSA cycle refers to the plan-do-study-act cycle where a 'trial and learning' approach is taken to repeat these four sequences logically to ensure steady improvement in the long run. In the 'plan' phase, the ideas to improve the quality have been taken and work is allocated to the human resources. The ideas are then implemented in the 'do' phase and any deviations observed in this phase are considered defects. In the 'study' phase the defects are critically evaluated and workers are questioned about what went right and what went wrong in the testing cycle (McNicholas et al., 2019, p.356-365). The necessary measures are decided and incorporated into the process in the ‘act’ phase after analysing the results obtained in the study phase. Figure 2: Benchmarking as an improvement tool (Source: theinvestorsbook.com) Benchmarking is another tool that can be used to improve the quality of the services in health care processes. Benchmarking refers to the process of continuous attempts to the overall improvement of services or products than the previous ones within the organization or the competitors present outside the organization. The benchmarking tool is often used in health care services but along with a few advantages, it has some disadvantages as well. It increases the tendency to depend on others as benchmarking itself is a comparing tool and this leads to a lack of understanding of the core issues in the organization and increases the copying tendency without evaluating the actual needs (AYDUĞ, HİMMETOĞLU and AGAOGLU 2020, p.16-33). But the healthcare sector is very different from other sectors and the scopes and needs are different from other businesses. The main focus should be on the improvement of health services, care, and catering needs of the patients. Benchmarking can shift the focus from person-centred care to unhealthy competition among different organizations which is secondary for the care homes like Richard House. Figure 3: Situational analysis as a quality improvement tool (Source: AYDUĞ, HİMMETOĞLU and AGAOGLU 2020, p.16-33) Situational analysis is another improvement tool that can be used in healthcare processes, and it has 5 main components (5 Cs) that help to improve the quality and outcome of an organization: company, customer, competitor, collaborator, and climate. In this analysis, internal and external strengths and weaknesses of the organizations are identified and potential threats and future opportunities are also addressed (Clarke, 2021, p.223-266). But the inspection report already clearly mentions the weakness and pitfalls of Richard House Care Home and evaluating these three tools and approaches, the PDSA cycle seems to be the most effective one for improving the quality of the services in this care home. The continual approach to the PDSA cycle helps to improve constantly and it also allows control over the analysis and incorporation of improvement strategies. The issues and areas of improvement identified for Richard House Care Home are diverse in nature and the PDSA cycle model would be effective to implement strategies in repeated cycles which will improve the safety and care of the aged people residing there and in turn, would also improve the quality of their lives (Wongsala et al., 2022, p.1-10). Improvement Plan on Stakeholder Perspectives Goal Programme/Approach Actions Time Stakeholders Benchmark Performance Indicators Outcome Indicator To create safe management and administration of medicines Improving the management and administration of medicines adhering to the regulation 12 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Educating the worker on the proper management of each type of medicine and proper ways to administer them Conducting seminars for the health worker on related issues Four months Academy for Healthcare Science (AHCS) National School of Healthcare Science (NSHCS) Monthly data of up-to-date medicines, storage conditions of the medicines, proper allotment of medicines Percentages of medicines found in the safe conditions, percentages of the patients giving a review of the safe administration of the medicines Ensuring the proper recruitment of health staff according to the regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Proper evaluation of the candidates’ background Employing the mandatory Disclosure and Barring Service (DBS) check for safe recruitment Filing and safe keeping records of each staff’s qualification and experience Percentages of qualified workers with the proper DBS result To create effective services for people’s care, treatment and support Promoting the training, induction and supervision of the staff following the regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Selecting only the workers with the proper training knowledge and experiences Employing competent supervision and induction programmes for the recruited staff Studying and following the care plans made by senior staff Five months National School of Healthcare Science (NSHCS) Academic Health Science Networks (AHSNs) Academy for Healthcare Science (AHCS) Testing the training knowledge, care plans and abilities of the staff members by the concerned stakeholders Percentages of qualified and skilled staff working, placement of supervision and induction training, percentages of satisfied people with their care plans To ensure that the services are well-led Appraisal of the service-related leadership, management, supported learning and innovation, fair culture etc. related to the regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Employing a well-rounded leader with the health care background Deploying programmes for the improvement of roles of managers as well as the staff, quality of the governance, performance, risks and regulatory requirements Two months Academic Health Science Networks (AHSNs) North West Healthcare Science Network (NWHSN) Assessing the consistency of the leadership, quality of the care and fair culture, risks ad audit systems Percentages of the effective governance and risk regulations, percentages of the staff showing improved work on delivering quality performance and person-centred care Table 1: Improvement Plan on Stakeholder Perspectives (Source: Created from the report) Reflection using Gibb’s Reflective Cycle For the reflection purpose of analysing the improvement tools chosen and stakeholder analysis, I am using Gibb’s reflective cycle (ed.ac.uk. 2020). This is a famous model of reflection which is comprised of six stages namely description, feelings, evaluation, analysis, conclusion and action plan. Figure 4: Gibb’s Reflective Cycle (Source: ed.ac.uk. 2020) Description An unannounced inspection took place at the Richard House Care Home in March 2020 under section 60 of the Social Health Care Act as a part of the social regulatory functions. They identified multiple breaches in the health regulation policy. The team handed the provider an action plan to improve the treatment, staffing and leadership. In the follow-up, the experts have discovered three major breaches in services related to safety, effectiveness and management which were the direct violation of the regulation 12 (1), regulation 19 (2) and 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 respectively (legislation.gov.uk. 2022). The administration often failed to manage the medicines safely. The staff did not keep a consistent record of administering the medicines. The proper storage of the medicines was not followed. The organization even ignored the proper Disclosure and Barring Service (DBS) checks (Butler et al., 2018, p373-383) for the safe recruitment of the staff. During the current visit, experts noticed the improvements in managing risk management and the Personal Emergency Evacuation Plan was properly outlined but no measure was present to assess the environmental risks. The staff received their training for the recognition and the protection of people from self-harm and self-abuse. They also accurately demonstrated the protocol to follow for accidents. They have a proper electronic care system to record the incidents and accidents. The staff training process from the previous encounter was improved. The organization made mandatory criteria for the staff selection procedure. But the induction and supervision programmes were underused. The staff were working with the community GP, nurses and other agencies without any issues. They also sought consent before giving support and treatment to the people that lack mental capacity adhering to the Mental Capacity Act 2005 (MCA) (Harding 2018, p533-535).In line with the previous inspection, the current management lacked effective governance. With some little improvements, the provider still demonstrated the shortfalls in environmental safety measures. At the time of the inspection,