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Managing Quality In Health And Social Care Social Work Essay

Managing Quality In Health And Social Care Social Work Essay

1.0 Introduction to the Case


Most women and men are at a disadvantage in areas of job and trainings, wages and salaries, and are constrained to certain occupations based on their age, colour, disability, sex, ethnicity, without reference to their capabilities and skills. Today, in some developed countries for example, women workers still earn up less than male colleagues performing the same work. According to the Equal Employment Opportunity law, workers have the fundamental human right to be free from discrimination, can choose their employment freely without bias and have the ability to develop their potentials to the fullest. Workers benefit from equality policies through training, equal wages, and overall quality of the workforce.

The aim of this essay is to explore the multifaceted problems of unequal treatment of workers as a result of diversity and gender discrimination between men and women at work (the labour market). The study will also attempt to highlight the advantages and disadvantages of diversity and equal opportunity at work, and also proffer solutions for the reduction and subsequent eradication of gender discrimination. To the society at large, bringing equality to the workplace has major financial benefits, and if employers practise equality they would have access to a pool of well organised and diverse workforce. ILO (International Labour Organisation) practices equality as a tool to eliminate discrimination at work and in the society, they also apply gender mainstreaming strategies in the field of labour.

Benefits of workplace diversity

Employees from diverse backgrounds bring individual talents and experiences into the application of work. A diverse workforce of skills, experiences, languages, cultural understanding allows a company to operate globally in providing service to customers and having a variety of viewpoints, and also improving an organization’s success and competitiveness as well as increased “efficiency and effectiveness” (Sharron and Maeve, 2007, p.157).

Diversity and equality are linked to HR practices, therefore HR professionals have a key role in the implementing of fair and favourable working conditions for employees, and this indeed is a key challenge. Managing diversity helps to control differences by creating a productive working environment in which everyone, “feels valued” (Tom and Adrian, 2009, p.346), talents are fully utilised and organisational goals are met. The CIPD definition of diversity is, “valuing everyone as an individual, valuing people as employees, customers and clients” (CIPD, 2007). However, it is also applied to social groups thereby raising awareness of ethnic and cultural diversity. We live in a multi-cultural society where contributions from different cultures are made to society and culture. Diversity should focus on the positive rather than the negative.

Equality opportunity and gender mainstreaming

Equality can be defined as combined efforts, equal participation and shared responsibilities involving both sexes in decision making, implementation of policies aimed at maximizing potential production of goods and services. The fruits of these efforts should also be shared equally and both sexes should be given opportunities to exercise their rights. Equal opportunity approaches are aimed only at the disadvantaged and therefore potentially create problems in organisations by constantly targeting the disadvantaged rather than making efforts to ensure that the organisation naturally encourages equality of opportunity for all and sundry. There are six social groups listed in the Equality and Human Rights Commission Literature, the body that regulates and monitors the UK’s equality legislation, which are gender, age, disability, ethnicity, religion and sexual orientation. These social groups are protected by law, therefore staff and customers have the legal right to be treated fairly and equally (Kirton, G and Greene, A, 2005).

Article VII of the 1964 Civil Rights Act, bans any type of discrimination based on any social group. In addition, 1963 Equal Pay Act prohibits organizations from formulating gender-based pay discrimination regarding workers who perform same work under similar conditions. Article VII of the 1964 Civil Rights as well set up the USA Equal Employment Opportunity Commission (EEOC), the commission started working in 1965 and has a duty of enforcing the federal acts which disallows workplace discrimination. The focus of Employment Opportunity is underpinned by the notion of social justice or the right to be treated fairly.

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The following are selected relevant ILO instruments on Equality:

Equal Remuneration Convention, 1951 (No. 100) This fundamental convention requires equal remuneration for all workers (men and women) for equal measure of work in ratifying countries.

Discrimination (Employment and Occupation) Convention, 1958 (No.111) This fundamental convention requires ratifying nations to declare and pursue practices of equality of opportunity and treatment in respect of employment and occupation, with a view to eliminating any distinction, exclusion or preference made on the basis of race, colour, sex, religion, political opinion, national extraction or social origin.

Workers with Family Responsibilities Convention, 1981 (No. 156)

The convention requires ratifying states to make it a goal of national policy to enable working men and women with family responsibilities to exercise their right without being subject to discrimination and, as much as possible, without conflict between their employment and family responsibilities. The convention also requires governments to take into account of the needs of the workers in community planning and to develop or promote community services, public or private, such as childcare and family services and facilities.

Diversity in the workplace is responsible for and sensitive to the different types of individual who make up an organisation (Sharron and Maeve, 2007, p.159). Organisations need to study the cultures, people and societies they work in, so they can understand and provide for the diverse needs of their customers/consumers. When organisations ‘manage diversity’ properly, they get excellent results from employees and meet the varying needs of their customers, which is recognised as a factor in business excellence. International Business Machines (IBM) has a long-standing commitment to equality to ensure everyone is allowed to compete on an equal basis. Workforce diversity at IBM ‘excludes no one and serves as the bridge between the workplace and the marketplace’.

The main issue for diversity management is that managers need to empower all staff to realize their full potential. Companies like Microsoft have had as much as 90% of their market value represented by intellectual capital, human talent, reputation, and leadership. The ability to attract and retain diverse talented people rates more highly, therefore the Government is driving initiatives to encourage diversity and persuade business that there are real advantages to be gained from embracing diversity in the workplace. Diversity focuses on improving opportunities for all staff, respecting and valuing people as they are, rather than expecting them to conform to a stereotype. The global nature of business markets can be seen as a driving force for diversity initiatives. If a company’s business is international, its staff must be able to work across cultures, speak the customer’s language and address any barriers that might exist. A Company’s reason for adopting diversity policies are;

1. It is the right thing to do,

2. It is in compliance with equal opportunities and anti antidiscrimination laws and

3. It generates financial benefits that exceed implementation costs (Rebecca, 2005).

British Telecom’s (BT) recognises that it is crucial for its staff to reflect the diversity of its customers and is able to meet their ever-changing needs. It has introduced a number of initiatives to ensure that more women are recruited and progress in their careers with the company. Diversity policies are used by companies to gain access to talent. BT reports that equal opportunities and diversity policies have resulted in the company attracting 37% of female graduate applicants. By creating a working environment where all employees feel included, valued and rewarded on the basis of their talents and skills, companies increase employee morale leading to improvement in the quality and motivation of the workforce which in turn leads to an improved company performance.

Effects of gender discrimination in the work place

Learning about sex-roles takes place among men and women during the early phases of their lives, and this can translate itself into an attitude that creates difficulties later in work life, (Larwood and Wood, 1979). A lot of people would concur that these issues and discrimination of women is improper and unlawful and should not be tolerated. Nonetheless, many women have continued to be discriminated in their workplace.

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As rational people, employers seek to put the right person for the right jobs e.g. when the work demands public relations, appearing on advertisements, employers prefer attractive women as marketers to sell their products. For technical, manual and production work however; they prefer to hire a man, (Tom and Adrian, 2009, p.351). Some employers believe that the cost of employing women is higher and that the productivity of female workers is low due to truncated and intermittent breaks for child bearing and rearing. Women for example are questioned if the family responsibilities could hamper their performance at work and at times questioned about their competency. These beliefs pose particular challenges in decision to employ women at work. The choice of an individual to accept work in a particular occupation or an employer’s choice to employ either mainly men or mainly women, are decisions influenced by learned cultural and social values that often discriminate against women (and sometimes against men). The “preference” is largely determined by learned, gender-related factors which stereotype occupations as “male” and “female”.

Occupational segregation by sex and Stereotyping

The resultant segregation of occupations by sex places a limitation on what jobs male and female can do. The early stereotyping of certain occupations as ‘male’ and ‘female’ is one factor that influences the subject choices of children and adults (Archer, 1992). Miller and Hayward (1992) examined children’s perceptions of who should, and who actually does, perform a range of jobs. Both Miller and Budd (1999) and Miller and Hayward (1992) found that individuals’ preferences remained largely restricted to those jobs that were viewed as gender-congruent (i.e. in keeping with stereotypes about the jobs that are appropriate for their own sex). Boys gave significantly higher preference ratings than girls for nine masculine occupations (airplane pilot, air traffic controller, architect, carpenter, fire fighter, lorry driver, police-officer, scientist and TV repairer). Conversely, girls gave higher preference ratings for seven feminine occupations (dancer, hairdresser, librarian, nursery school teacher, secretary, school teacher and shop assistant).

In the UK, research conducted for the Department for Education and Skills (DFES) indicated that parental attitude was one factor which influenced the decisions of young people regarding whether to remain in education or training, or to leave (Payne, 1998). In the USA, Farmer, Wardrop, Anderson and Risinger (1995) have identified parental support as a key factor influencing subject choice. Firstly, the mother’s attitude is a key factor in developing the child’s own view of the importance of the subject itself; this then influences the development of favourable attitudes towards the occupational area. Secondly, the child’s perception of the extent to which their mother believes in the importance of doing well has a positive influence on the child’s belief that their success is dependent upon their own efforts, which in turn impacts on their achievement and thereafter on their attitudes (Miller, Lietz and Kotte, 2002). Parental aspirations are usually viewed as an important influence on career decisions in general (Erikson and Jonsson, 1996). Schoon and Parsons (2002), also using a path modelling approach has shown that high parental aspirations are strongly correlated with high aspirations in their children and with good academic achievement.

Stereotyping against women at work is either due to employers’ attitude or to what women bring into the labour market in terms of qualification, family demands and feminine differentials.

Cultural restrictions

Cultural restrictions contribute to the establishment of what is acceptable work and how some countries signify sexual differences for certain occupations. In Moslem countries, ‘Purdah’ (kirton, G and Greene, A, 2005) effectively forbids women interacting with unknown men in public, as a result, many Muslim women are strongly discouraged from taking sales jobs except in shops where the customers are all women.

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Women are usually stereotyped to their traditional and cultural roles of child bearing, rearing and home-keepers and are usually disadvantaged in preferences for occupations and promotion. In societies where women are at a disadvantage by sex segregation, parents tend to give their daughters less education than the male thereby adversely affecting the future generation of women and limiting them to the traditional ‘female Occupations’ (teaching, child-care, nursing, catering). Until recently, Nigerian parents believed that it was a waste to invest in the girl-child because they would eventually end up in the ‘kitchen’ and were therefore not given formal education but were groomed to attract suitors. Several women are constrained to ‘female jobs’ in certain sectors either through custom or through the prejudice and discrimination of employers. Some other factors like early marriages affect the education of the female, the role of the woman as “helper” and not the “breadwinner” also impedes their aspiration for higher challenges. Many women are unable to improve themselves educationally after marriage and childbearing.

Glass ceiling

Masculine stereotype play a role in determining the occupations which become typically “male occupations” (engineer, police officer, construction worker, security guard) and of course the “breadwinner. There are fewer men in “female occupations” and when men move into typically female areas of work, there is no equivalent ‘glass ceiling’ – in fact, the opposite almost seems to apply. Examples of areas in which women constitute the majority of the workforce are education and health. In secondary schools, women hold the majority of teaching positions in schools, yet men constitute the majority of head teachers (68 per cent) Source: Department for Education and Skills (DfES) (2003e), Statistics of Education: School Workforce in England. Male nurses were found to have poorer qualifications at both pre-registration and post-registration levels, yet to advance more quickly into senior posts, the average time for male nurse to reach a senior post was 8.4 years, compared with 14.5 years for a female nurse who took no career breaks (Davies and Rosser, 1986). Similarly, male nurses were twice as likely to be found in higher grade nursing posts, although females had better post-basic qualifications (Finlayson and Nazroo, 1998).

Women also feel there is relatively poor career progression in male dominated occupations, in terms of pay and status but UBS Investment Bank has a group called ‘Raising the Bar’ which looks at the glass ceiling and whether women are treated differently and how they progress in their careers. Women find it difficult to break through this ceiling because of the ways in which they are viewed by the society and the individual organization (Stephen Linstead, Liz fulop and Simon Lilley, 2004) as being emotional, irrational, less committed, under-educated and not strong enough to earn top managerial positions. This creates vertical segregation where men predominate in top ranked positions of the organisations. Also because women sometimes prefer to work part time with flexible working conditions, it is therefore difficult to reach senior management positions. However, the role of women in society is radically changing in most countries and even in Nigeria. Vast numbers of women are beginning to work full-time and to aspire to climb the same “organisational ladders” as their male counterparts (Davidson and Cooper, 1984). Women are attaining higher levels of education and they are competing favourably with the men especially in occupations which were formerly reserved for the men.

Female – Male pay differentials

Income inequalities between men and women from all backgrounds still persists, despite the equal opportunities legislation as women’s annual salaries are 25 per cent lower than men’s even when overtime and bonuses are taken into account (Sharon and Maeve, 2007, p.163). Women are making progress, but it is still relatively slow, Sean O’ Grady (2007), states that “women working part-time earn 38 per cent less than their men counterparts working part-time as well. Even full-time female employees earn 17 per cent less than men”. Hence, it makes it difficult to find women at the top of any business, political career or even the law.

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It is true that the pay gap among women and men is becoming much smaller than it used to be, even though there are still restrictions for women in top managerial positions and politics. Women are more confident because they are enlightened and have role models like Margaret Beckett who became the first U.K female foreign minister, Dora Bakoyannis the first women ever appointed to a senior cabinet position in Greece, Nigeria’s Ngozi Okonjo-Iweala the finance minister to foreign affairs. More women are willing to stand up to the law, even if men are still reluctant to give up power to women as a result of the ‘Masculine’ perception (it’s a man’s world).

Child bearing and family responsibilities

The debate on work and family life still tends to be focused on working mothers (Esther and Katherine, 1988). Mothers make significant changes to their working lives to accommodate their family and just a small minority of fathers make major changes that enable them to be more involved in family life (Suzanne, John and Melissa, 2006). Many employers view pregnant women as someone who is about to leave them hanging for a couple of month, instead of seeing them as professionals who are competent and can perform. Some employers deny pregnant women the opportunity to advance in their careers by assigning them menial jobs since they feel that they cannot handle challenging problems. These are just attitudes which do not have any basis. For example, it is believed that women typically leave their careers following the birth of children often in their thirties, some women may return after a period of maternity leave or after early years of child rearing, many do not return at all. Some reasons for not returning are work-life balance issues such as, wanting extended maternity leave, part-time working not being possible for some jobs and the cost of children.

Organisations have the feeling that the society is fast moving and when maternity break is taken, technology moves on to such an extent that it is difficult for returners to keep up and a lot of re-training would be required when they return. Therefore, when the women return, companies may have progressed and maybe their previous job has changed to such an extent they have to trade places or move out. Some organisations therefore offer flexible working hours for women who indicate that they would like greater flexibility at work. Flexibility has its own loop holes; it could lead to career death in terms of promotional opportunities (Jerry and kathleen, 2004). Women choose such career comfort in order to balance work with their family life responsibilities.

Recommendations to curb gender and diversity discrimination in the workplace

Gender Discrimination

The use of gender equality mainstreaming strategy will enhance the management of gender diversities in the workplace; it will address the specific and often different needs of women and men. Targeted interventions should be taken which is aimed to overcome sex discrimination, empower women in the world of work and advocate equitable sharing of care responsibilities between both sexes. This approach will help to prevent gender-blind interventions that perpetuate inequality, by ensuring that both women and men benefit equally from management policies. The use of “good practices” as well as ILO strategies and tools such as the Action Plan on Gender Equality are encouraged in promoting gender equality in the workplace. Gender Audits could also be carried out at intervals.

Research and publications, training courses on upgrading mainstreaming skills, and mobilizing gender network should be encouraged in the workplace. Women workers should be given assistance in getting organised and being represented in various sectors especially sectors where they form the minority. There should be a Human Resources specialist to oversee and support the Managing Gender Policy.

Diversity Discrimination

In the area of Diversity, to attract and retain staff from diverse backgrounds, companies may need to revise existing employment contracts, benefits packages and working conditions to accommodate measures, such as flexible working programmes, maternity/paternity benefits and leave, and childcare schemes. Companies should set up some form of monitoring and reporting processes, by warding off change resistance with the inclusion of every employee in formulating and executing diversity initiatives in the workplace. Leaders and managers within organizations must show commitment by introducing diversity policies amongst organisational functions. The overall participation and the cooperation of management as well as training are essential to the success of an organization’s plan.

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Conclusion – Gender, Diversity and Equal opportunity

In this essay, findings indicate that gender should be managed in organisations in such a way as to minimise any differences between the employment chances available to men and those available to women. Equal opportunity should aim at allowing women the same level of access to and participation within every level and area of the organisation. As employees gain the benefits of increased equal opportunity for men and women in the workplace, all family members gain from an easing of the strain of juggling work and caring responsibilities and some children will gain the social and development benefits of quality childcare facilities. There is also the danger of promoting such case because equality of opportunity may not be seen as a case of social justice but that of organisational self interest.

The benefits of diversity in the work place has its challenges which workers have to put up with, such challenges include prejudices, cultural and language barriers that employees bring into the lime light of work. Such challenges need to be overcome for diversity programs to succeed. There are always employees who will refuse to accept

In this assignment I am going to use a nursing home for elderly residents, both male and female with both dementia and different medical conditions like diabetes, Parkinson’s disease and hypertension. Some of the service users in this nursing home are bed bound while others are mobile or self dependant. It has two floors with 42 bed capacity.

1.1 What quality means to the following stakeholders

Service users – These are residents or clients in our Nursing home. Quality to our service users means any service that is offered to their satisfaction for example:

Respect: Most of our residents prefer to be addressed by the names while some prefer to be addressed as Mr. or Mrs. We respect their wishes and this makes them happy. Also when we are offering personal care like washing or bathing we ensure that doors are shut for privacy and dignity purposes we also respect their age as adults and treat them as adults according to their wishes

Choice: Residents choices in our nursing home are usually observed as this makes them to have their freedom of choice in whatever they want to have for example we have different menu choices for foods and drinks and before we serve them we ask them what they prefer to have. The same applies to the way they prefer to dress and so we offer them a choice on their own clothes and activities that they would like to participate in and at the end of it all they are happy and the quality of service offered is satisfactory to them and everybody else.

Confidentiality: Anything concerning a resident in our Nursing home is private and confidential unless for medical reasons like consultation and to those who are concerned like family and relatives.

Friends and family: They usually appreciate when they are involved in care plans of their relatives and they are satisfied when what they have agreed on is followed through.

Safety they are always appreciative and supportive when they know that their parents and friends (residents) are free from harm by the care they are provided with for example safe from falls, abuse and infections within the nursing home. They like their relatives to be treated equally like other residents without discrimination because of either their conditions, disabilities or ethnicity.

Carers: These are the major service providers in our nursing home and quality to them means:

Equity- all service providers should be treated equally regardless of their race, ethnicity, gender and knowledge and skills they have on their job when this is put into consideration they are motivated and tend to offer the best quality of care to residents which in turn leads to customer satisfaction.

Safety – all service providers in our Nursing home ensure they are safe on the environment they work on for their sake, residents, relatives and friends and anyone concerned. We ensure proper procedures are followed such as moving and handling by using proper equipment on residents like hoists and slings to avoid accidents to ourselves and to residents. Carers are always happy when they are not abused either by residents, relatives and friends or their fellow carers.

We have four different models of quality

Total quality management: a way of managing people and business processes to ensure complete customer satisfaction at every stage internally and externally (Department of Trade and Industry, DTI 2010). Although different quality experts emphasize different experts of this methodology, its major components can be summarised as follows: processes, people, management systems and performance measurement. According to Ross and Perry (1999), in addition to creating delighted customers through empowered employees, total quality management processes also lead to higher revenue and lower cost. In our Nursing home, every department is involved in implementing quality management to offer the best quality of service; we always work as a team and ensure we have offered the best quality of care that our residents need.

Continuous quality improvement: is a system that seeks to improve the provision of services with an emphasis on future results (Marshall, 2003). In our nursing home, the manager ensures that every service provider receives training, implements what they have learnt and they are supervised if there is need for retraining again we are retrained this ensures that we receive updated information to offer the best quality of service.

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Quality standards: The Care Quality Commission for England has produced a guidance to help providers of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 (CQC, 2010b). This guide contains the regulations and the outcomes that the CQC expects people using a service will experience if the provider complies. This forms the basis for the quality standards in care homes. There are 16 core ones range from respecting people receiving the services to safety and suitability of premises and staffing levels just to mention a few. In my care setting, we get an annual inspection from UKAF over and above inspections from CQC and have been given a star rating of three. All activities this year are geared towards a rating of four.

Quality cycles: According to QCC (2010b) quality cycles represent periods within which care homes should be reviewed to determine compliance in its service provision. This may be annually. However private organisations like the United Kingdom Accreditation service also offers a quality cycle inspection called the Residential and Domiciliary care Benchmarking (RDB). The RDB annual ‘quality cycle’ supports strategic planning by providing comparative feedback on a home’s care provision and enables the identification of performance gaps and cost/benefit assessments to be made (UKAF, 2010). In this model we have four major aspects to be looked into namely: planning, doing, checking and acting.

Quality and principles of care

Legislation -these are laws and rules set by the government on how the provision of care should be for example protection of vulnerable adults. In our nursing home, every service provider should be ready to protect all residents from any form of abuse we attend mandatory trainings such as safeguarding vulnerable adults according to regulations by the CQC (2010b).

Safety- in our nursing home we always do risk assessment on every service user and put measures in place like using bed rails to prevent falls by doing this we have protected residents from accidents and this ensures quality service to our residents.

Independence-service users should be made in control of their lives by allowing them to do some of the things like arranging their wardrobes, making and tidying their rooms by themselves because some of the residents are very active and would like to do what they used to do before and we always encourage them to do while we supervise them and this makes them happy hence promoting the quality of service as they are satisfied.

Rights- service users should continue to enjoy the same rights when in nursing homes like they used to when they were living independently. Every service user supported in nursing homes has the right to say “NO”, right to have a relationship and the right to have a say in their care plan. Service providers always tend to balance service users rights against their responsibilities whether both are at risk or not.

1.4) External agencies: These are bodies that regulate quality of care including:

The Care Quality Commission – an independent regulator for health and social care in England (CQC 2010a; 2010b). They regulate care provided by NHS, local authority, private company and voluntary organisations. Their aim is to make sure better care is provided for everyone. In our nursing home Care Quality Commission makes a minimum of three inspections annually (two announced and one unannounced) on such things as how we provide care in terms of cleanliness of the home and to service users.. It has a wide range of enforcement powers to take action on behalf of service users if services are unacceptably low.

The CQC makes sure that the voices of service users are heard by asking people to share their experiences of care services. It makes sure that users’ views are at the heart of its reports and reviews. The CQC takes action if providers do not meet essential quality standards, or if there is reason to think that people’s basic rights or safety are at risk (CQC, 2010) through a wide range of enforcement powers, such as fines and public warnings, and can be flexible about how and when to use them. It can apply specific conditions in response to serious risks. For example, it can demand that a hospital ward or service is closed until the provider meets safety requirements or is suspended.

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The National Institute for Health and Clinical Excellence (NICE)- this is an independent organisation responsible for providing national guidance on promoting good health preventing and treating ill health (NICE, 2010). In our Nursing home, residents who have anxiety, panic attacks request for sedatives in order for them to sleep they are usually reassured and instead a government practitioner is consulted to review and advice them accordingly. Service providers take NICE guidelines trainings on different medical conditions for example diabetic foot (identification and care of the foot).

2.1) Quality Standards

Benchmarks: According to Philip B. Crosby (1999) benchmarks are indicators of best practice including access to care environment and the culture of a home. The Benchmarks is one of the most comprehensive sets of social and environmental criteria and business performance indicators available (Daniels et al 2000). Our nursing home is accessible publically, to wheel chairs, a spacious car park and a section for activities for residents and relatives. We also have a signing in visitors’ book stating whom they are visiting.

Code of practice for social care workers and employers for social care workers

This document is developed by General Social Council and it contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work ( GSCC, 2002). Employers use this set of code of practice to make decisions about the conduct of staff and support social care workers to meet their code of practice. Service users and members of the public use the codes to help them understand the behaviour of social workers (how they should behave towards them) and also how employers should support social care workers to do their job well. It is the responsibility of social care workers to make sure that their conduct does not fall below the standards set in the code of practice and no action or omission harms service users (NCSC, 2010). Social care workers must protect the interests of service users, maintain confidence, respect rights, promote independence, be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills. The general social council expect social care workers to meet the codes and may take actions (deregistering) if registered workers fail.

2.2) Different approaches to implementing quality

Communication is a means of passing information from one person to another. In our nursing home we have different ways of communication like when doing care plans we always document what we have done for a resident so that whoever takes over knows what to do next to ensure continuity of care. Also when handing over is done during change of shifts information about residents is shared and everyone is aware of any changes in care plans in accordance to CQC guidelines (CQC, 2010). We also have staff meetings where certain information is passed on and in cases where staffs have a problem it is addressed and solutions are given out. For effective communication systems there should be a language that everyone understands.

Policies and procedures

These are guidelines set on how to do things often informed through regulations as outlined in various government documents (GSCC, 2002; NICE, 2010; CQC, 2010a. 2010b). In our Nursing home we have different policies and procedures for example in cases of accidents to residents we are required to fill a resident incident report and pass it on to the supervisor families, friends and relatives are informed about the accident then precautions are put into place walking frames, to avoid future occurrences of similar accidents.

Infection control policy helps to prevent spread of infections within our nursing home. We always use personal protective equipment when offering personal care to residents, handling of any infectious wastes. We also use the proper technique for hand washing. There are also hand gels in each resident’s room, in public toilets and at the entrance of the building for sanitation purposes and all wastes like clinical and kitchen wastes are usually put in the bins ready for collection. In cases of disease outbreaks like diarrhoea and vomiting residents are isolated and managed separately and proper hand washing techniques are used to prevent further spread of the infection.

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Whistle blowing policy is designed to deal with issues that do not directly affect the employee and their employment but are a cause for concern in relation to the harm that may be done to other employees, residents or the wider community. Any employee who is concerned about their personal situation should raise their concern with their line supervisor or manager. This policy is for reporting issues like elderly abuse, misuse of drugs, faulty machinery that may cause accidents, illegal dumping of waste. The policy protects not only employees but the wide community.

Confidentiality- all residents or service users’ information is private and confidential. It is not a proper practice to discuss residents’ information in public like their conditions and behaviours by doing that is breaching the policy and legal action should be taken. In nursing homes all information is kept safely and only accessible to relevant persons. This promotes quality of service

2.3) Quality systems

ISO 9001 involves a set of procedures that cover all key processes in the business, monitoring processes to ensure they are effective, keeping adequate records and facilitating continual improvement. They have certain requirements like internal regulations, claims and procedures for residents, suggestion box and contract with uses. It also covers the importance of understanding and meeting customer requirements, communication, resource requirements, training and products, Leadership, Involvement of people, Process approach, and System approach to management and Continual improvement (Tricker and Sherring- Lucas, 2001).

In our nursing home for the provision of all these elements and reporting them on day to day basis for example there is a clear procedure for residents’ complains. Carers, residents and relatives are informed and logged in a special complaints book and complains are followed up. When all this are put into practice, there is employee and customer satisfaction, resulting from better defined and implemented business processes. As a result of this we have motivated staffs, who understands their roles and how their work affects quality, improved product and service quality, happier customers, and improved management and operational processes, resulting in less waste (both time and materials)

Business excellence is a widely used framework that helps companies to review their performance and practices in a number of areas and identify targets and actions for improvement based on principles of customer service stakeholder value and process management ( British Quality Foundation, BQF 2010). Managers develop the mission, vision and values and are role models of a culture of Excellence. Studies in Taiwan have shown that in care homes where this model is applied, managers are personally involved in ensuring the organisation’s management system is developed, implemented and continuously improved are involved with customers, partners and representatives of society and also motivate, support and recognise the organisation’s people (Cheng B, Chang, C and Sheng L. 2005). In our nursing home we use a balanced score card to keep track of activities by staff and measure consequences arising based on the British Quality Foundation model ( BQF, 2010).Service users families and relatives measure in a scale of 1-5 where one is poor and five is excellent. We work hard in poorly rated areas to improve the quality of service. At the same time managers set a number of targets on key areas of each staff members roles which are then assessed on monthly review and awards are given to the best. This motivates other team members to work hard and best to attain the best and by doing so they provide best quality and we excel.

2.4) Trainings this refers to a learning process that involves the acquisition of knowledge, sharpening of skills and concepts (Stevens, 2004. In our nursing there are mandatory trainings offered to service providers before commencing to work like basic food hygiene, manual handling

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Healthy and safety is ensuring that the environment where we are working is safe for service users, other staff and others in general by our actions and omissions. It is a responsibility to all staff to ensure that the environment is safe to work on. For safety purposes in our nursing home we do not use equipment unless it has been checked and serviced. Also default equipments are labelled “DO NOT USE” to prevent and avoid accidents. We also have controlled cupboards where substances that are hazardous to health are stored and locked away. When there is a defect on the environment like chipped floors, loose hanging electricity wires we report to the maintenance coordinator and they are rectified immediately to avoid accidents. Again when housekeeping team are doing cleaning they always display cleaning boards and everybody is aware that cleaning is on progress or the floor is wet and they avoid using it until it is dry by doing this they minimise chances of accidents like falls

2.5) According to Marshall (2003) and Stevens (2004), external and internal barriers to delivering quality are any obstacle which prevents a given policy instrument being implemented or limits the way in which it can be implemented. They include:

Resources: lack of adequate resources hinders quality of service for example inadequate or shortage of staff affects the quality of services offered and this leads to unsatisfaction of service users as they get services that are not adequate and for service providers because they are overworked. In nursing homes when there are staffs shortages they arrange cover shifts earlier by either bank staff or some agencies registered with the home. Financial barriers include budget restrictions like food supplies and other supplies like incontinent products limits the overall expenditure and this leads to inadequate provision of quality services to residents

Personal Appearance: Hygiene and grooming, eating habits and attire can vary from country to country and culture to culture. For example, some people may wear attire such as a headdress as part of their custom and beliefs. To remain true to their beliefs, some workers may want to continue to wear this dress at their workplace. Employers may view this as inappropriate or unsafe. It is particularly problematic in workplaces where workers wear uniforms.

Religion: In many cultures, religion dominates life in a way that is often difficult for employers to understand. For example, workers from some cultures may want to pray while at work times in accordance with their values and beliefs. There may also be religious holidays on which people of certain religions are forbidden to work. These differences need to be respected, where possible, and not ignored and they affect the quality of service.

Language barriers often go hand-in hand with cultural differences, posing additional problems and misunderstandings in the workplace. When people cannot communicate properly they are frustrated when communicating with supervisors, co-workers and residents this can be dangerous because people may end up performing poorly in their work thus affecting quality of service offered.

Legal and institutional barriers -these include lack of legal powers to implement a particular instrument and responsibilities which are split between agencies limiting the ability of an institution. Like the law states that students should work for twenty hours only which creates shortages at work affecting quality of services.

3.1) According to Business (2010), policies are principles, rules and guidelines formulated or adopted by an organization to reach its long term goals. They are designed to influence and determine all major decisions, actions and activities take place within the boundaries set by them and procedures are specific methods employed to express policies in action in day to day operations of the organization. For example, in nursing homes the National Care Standards Commission for England, NCSC (2010) has outlined requirements that these homes must meet which in effect guide their policies and principles. These policies include, but not limited to: manual handling procedures, Risk assessment and Infection control.

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Manual handling

These are techniques used to handle or move service users like hoisting, using belts and sliding sheets to move residents these are safe procedures for both residents and service providers as they minimise accidents to both cases and this promotes quality of service (CQC, 2010). On the other hand, they have disadvantages like time consuming when doing procedures like hoisting which requires two or three persons and also residents may not like the experiences of hoisting and thirdly it needs trainings to be carried out.

Risk assessments

According to healthy and safety at work act (1974) the Management of Health and Safety at Work Regulation (1999) states that it is the responsibilities of managers to do risk assessment to employers and employees. to reduce and prevent risks to them in future and they are included in their care plan so that quality of care can be improved for example residents with risks of falling have walking frames, falling mats and bed rails put in place to avoid falls but again things like bed rails have caused accidents in that residents are trapped and some sustain fractures which affect quality of service

3.2) factors that influence the achievement of quality of personal care

‘Quality’ is a difficult concept to capture directly. However, resident or organisational outcomes are often used as a proxy for quality (Marshall, 2003). There is considerable debate about the relationship between quality of care and quality of life as joint, but not necessarily competing, measures of quality. A study for the Joseph Rowntree Foundation indicates that residents’ perceptions of nursing staff are a good indicator of quality of care (JRF, 2008).The importance of measures of social care and of ‘homeliness’ epitomise the divide between health and social care provision in care homes. Factors influencing residents’ satisfaction with care are discussed below:

Team working

Heath care workers working in ‘teams’ has been recognised as an improving the quality of care (Stevens, 2004; Borill et al 1999). According to Stevens, the intention is for carers to share tasks and learn from each other and possibly improve based on their experiences. This can be illustrated by the quotation below:

“The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service.” (Borill et al 1999 p.6).

Stevens has for example reported from a number of surveys from UK nursing homes to suggest that there is a reduction in carer burden and significant reduction in stress when staff work in teams resulting in better coping and satisfaction. Both these studies (Stevens, 2004; Borill et al 1999) found that service users surveyed showed more satisfaction when carers and health workers worked in teams

Healthy and safety at work

The responsibilities of care home proprietors are subject to a range of health and safety legislation among them the Health and Safety at Work etc. Act 1974, the Management of Health and Safety at Work Regulations 1999 which require employers to assess the risks to employees and other who may be affected by their undertaking, (residents) and the control of Substances Hazardous to Health Regulations ( Care Quality Commission, 2010).

These regulations have led to dramatic improvements in the safety of residents and people working in care homes according to the care quality commission. For instance, guidelines requiring minimalist manual handling has significantly reduced the numbers of health workers staying off work due to illness which has a positive effect on the level of personal care of residents ( CQC, 2010a). However, a report for the Joseph Rawtree Foundation (JRF, 2008) showed that the percentage of medication errors and adverse events in nursing homes

have increased despite regular inspections by the CQC. Stevens (2004) has also reported survey results from 27 residential homes with dementia patients where 19% cases of medication errors were reported.

In my care setting, clear improvements can be seen from less harm to residents when using the hoist but not many service users like to use the hoist. Some risk assessments in care homes have made it very difficult to take residents outdoors or even for activities outside the home for fear of not meeting the Health and safety requirements and this ends up reducing the quality of care.

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3.3 The following recommendation can improve the quality of care in Nursing homes

Training /education

This means acquiring knowledge and skills or new information on how to do things according to the recommended regulations and standards ( Stevens 2004). This is a very important aspect in nursing homes all trainings as it provides ongoing trainings to update service providers and equip them with relevant and current information that enables them to provide the best quality of care that will be satisfactory to service users. In our nursing home trainings are offered and need to be implemented then supervision is done and in cases where need for retraining arises, arrangements are done and they are offered for the benefits of service users, service providers and the community at large as it reduces or minimises preventable accidents and this promotes the quality of service


This means going through the set of targets or planned activities to see the progress whether it is improving or getting worse. This alerts and actions or precautions are put in place to make the situation improve for better quality of service ( Stevens, 2004). For example in our nursing home there are always monthly reviews of care plans of service users this includes individual or family interviews to determine whether residents are improving or need some improved care plans like in moving and handling procedures (use of hoist or belts) and then action is taken accordingly. Also for staff there is quarterly staff meetings or when need arises and previous discussed or current issues are raised and a way forward on how to carry on is agreed. There are always individual supervisions done by allocated persons and each employee identifies areas that need improvement and good performing areas by doing this there is improvement of quality of service


It has been shown that in order to improve services to users in the social care sector, it is important to follow principles, guidelines and procedures set by government, industry bodies or even individual homes. There is also need for planning, doing and checking and then reviewing to assess shortcomings in order to design improvement regimes. Similarly, it has been shown that although there is legislation and care industry standards, it will require

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