Quality in the context of health care and social services can be defined as working together in partnership with clients understanding their needs and meeting their needs for a mutual relationship. (Donabedian, 1980)
Characteristics of quality health care
- Safety – this means that the services provided are free from injuries to the client because they are geared towards helping.
- Effectiveness – provision of services based on scientific knowledge by avoiding overdose and underdose.
- Client – centered-the services should respectful to the clients, needs preferences, values and all decisions should be in line with the clients’ values
- Time factor – the service provider should not lead to delays to the clients and the providers. Rooney, (1988)
The style adopted by the management in health care and social services is fundamental to ensuring that there is quality. The management being in charge of the services is responsible for controlling nearly all the operations in an organization. There are a number of things that are worth mentioning that make management the major determinant and contributor of quality in an organization.
First of all, it is vital to mention that the management is in charge of all the resources that are supposed to bring quality. (Stephen,2007)
Resources in an organization are in different forms and categories.
- Financial resources
- Human resources
These two major resources are the ones that need to be managed well so as to improve quality in healthcare and social services.
Other resources such as working materials and equipment are all under the control of the management team.
Management styles in health care and social services are similar to styles that can be found in any other organization.
Two management styles are common in organizations:
- Autocratic
- Democratic.
- Leizer faire
Management of health care and social services does not just entail making the correct decisions but the services or the care of the people. This is because there are a number of issues that cause worry and a feeling of anxiety amongst the service users, carers and other stakeholders.
These issues include:
- The long waits at the various health care stations
- Insufficiency of information
- Poor facility
- Insensitivity to the needs of patients
The structure of health care systems
The systems which were established earlier after the second world war were intended to achieve stability. This has never been the case since most healthcare and social structures have ended up being more rigid ad normative. They have tended to serve the interests of the managers and providers instead of improving the welfare of the intended beneficiaries. Issues to do with public dissatisfaction and the ever-increasing costs of healthcare cannot be overlooked and that is why governments have come up with changes strategies and mechanisms of supplying healthcare to their citizens.Decentralization of the management to the local level is an issue that has been considered by various countries. This aims at decentralizing decision-making to the local level so as to address the need for the public health care needs to be included in the decision making process. This also means greater accountability at local levels with the local citizens accounting for what they spend on healthcare and social services.
The issue of rigidity in the management structures has often been noticed by the public who seek services. These rigid structures are the ones responsible for the insensitivity by the managers to the needs of the public. (Garner, 1989)
The management structures are also lacking efficiency because of lack of competent IT systems. Most healthcare and social service providers have not fully utilized the necessary IT systems in their operations. This has often led to delays and poor quality of services.
Changes have been considered by countries on management structures to improve on efficiency of services.
This has included departmentalization whereby the various departments of healthcare services are given autonomy but are under the same manager.
A department such as purchasing is detached from the accounting and other departments. This has been a move to ensure accountability for each department. In terms of authority in the structures there has been a trend towards decentralized authority and power in healthcare services. This is because centralized authority can prove to be frustrating to caregivers especially when it comes to cases of emergency. Decision making in health care systems is still in the hands of the managers but the lower cadre staff have a significant contribution to the process. Top–down management structures have dominated private healthcare facilities. With such structures the head offices, health boards and private providers dominate decision-making process and finance. These type of structure has no room for consultation from the low levels of the system and has been subject to rebellions and other undesirable results both directly and indirectly. Much of the problem of this structure affects the purported beneficiaries of the health care system. With top-down organizational structures , managers can be viewed to have become subordinates to politicians and other senior policymakers especially in public funded health projects. This type of leadership in healthcare rarely gives a thought towards the bottom-up ideas that are desired by the majority in the workforce. This means that most of the great ideas are just wasted because of the unwillingness of the managers to seek advice from the workforce. (Donabedian,1980)
In terms of management styles, there are very few managers who exercise autocratic rule in managing healthcare and social services. The spirit of democracy and participatory management has been embraced by majority of successful health providers that have been recommended to many clients. The role of the client in the management process has also begun to be recognized by the caregivers. Lack of participatory management in healthcare services has often led to negligence of duty by staff. This is a factor that has led to poor services especially in public health facilities and the blame ends to the management for failing to address the agent issues in a democratic manner. Some nurses being forced to work in bad conditions or even under pressure is a common phenomenon in health facilities where democracy has not prevailed and it is actually dictatorship that rules everything. Without participatory management that staff is not even in a position to bargain for better remuneration because they work under fear and intimidation.Such factors have quite often undermined the integrity of the staff and it is indeed the cause of poor services.
Priority areas in health care and social services are also a concern of this paper. It is vital to note that with top-down management systems it is unlikely that the management would understand the exact areas that need urgent attention in the system. Cases of misplaced priorities in health care services are a common phenomenon. This is especially the case when the policymakers are not in touch with the reality on the ground.
A good example is when drugs have developed resistance to a certain disease , it can take the management of healthcare services a long time to realize. This can be realized after a number of deaths have been reported at an alarming rate. Instances of conflicts of interest in the leadership of healthcare and social services have often resulted in the most important areas being neglected at the expense of other less important areas. Client–centered approaches in social services have led to better prioritization in the provision of the services. This is so because both healthcare and social services should be client-based because they clients understand better the problems that deserve attention. Lack of consultation of the clients in policy formulation in healthcare services has ended up escalating the problems of healthcare systems. (Garner, 1989)
Priority is now being given to research and information than was the case in the past.
Primary health care providers in the event of tackling issues such as drug abuse and HIV and AIDS, attention have been given to research and information as compared to other priority areas. Financially more funds being directed to these areas is a clear indication of priority shift. Health care providers in the United States have also been noted to pay more attention to the older generation in their services as compared to child health care. Demographics indicate an increasing number of old people in the United States and hence this calls for a priority change since more old people seek healthcare services than the other ages. The independent private sector is now providing long stay care for the elderly people. This has therefore led to changes in the supplies and other essentials for the provision of their social and healthcare services. (Donabedian,1980)The increase in the rate of crime and drug abuse has also shifted the attention of social services providers. This is geared towards addressing the urgent issues of the day according to the changing patterns of life.
The pursuit for quality in the provision of healthcare and social services calls for a number of measures to be undertaken by both the managers and the workforce.This approach all the stakeholders to work in close partnership and association towards achieving overall satisfaction in customers. This should be taken as an ultimate measure of quality performance in the healthcare and social services. Most managers talk from a financial position in their pursuit of quality in healthcare and social services. It has been argued that it is lack of adequate funding that leads to poor service provision especially in public health facilities.
This is because finances contribute a major percent towards running all activities in health and social facilities. Without finance all operations would be paralyzed. The doctors and the rest of the workforce cannot do their work well to satisfy clients if they lack adequate compensation.Managers also argue that motivation is a major challenge towards quality services.
The main problem is maintaining motivation within the workforce so as to achieve the desired quality results.From a managerial point of view, if resources are not adequate, then quality service provision would remain a challenge to the management. Managers believe that with adequate resources, the employees should have no excuse but work towards achieving quality results by satisfying the needs of clients who seek healthcare and social services. That most of the employees fail to meet the expectations of the clients due to inadequacies in supplies and other important resources that are fundamental towards improved quality services.
Managers have also argued that in places where there are enough resources and facilities, poor services have resulted because the users of the facilities have failed to take the required maintenance measures to keep the facilities in top performance position. Failure of equipment to deliver quality services to clients can be blamed on the operators or the users. They therefore believe that if quality is to be achieved, then the employees must take full responsibility in their areas of specialization.When a health facility fails to deliver quality services the immediate person is to be blamed by the managers in the workforce who is directly in touch with the clients. Most managers hold the view that it is the will of the personnel to deliver quality to the clients since they believe that their part has been played well. Because it is actually the managers who are involved in the selection and recruitment of qualified personnel , then it is not expected that they can contradict themselves by claiming that the personnel is not competent enough to deliver quality to the clients.All managers believe in the ability of those whom they manage to contribute significantly towards quality and customer satisfaction. So if the personnel is not delivering quality then it is argued that they have just refused or they lack the goodwill to deliver the desired quality results. (Shamil, 2001)
Professional on the other hand is of the opinion that poor services in health care and social facilities are not realized because of lack of proper structures that can deliver quality to the clients.Professionals argue that policy formulation is fundamental towards delivering quality results to the clients seeking healthcare and social services. They believe that it is the policies that drive healthcare and social facilities into achieving the desired results. If the policies are not addressing what is required for quality then it cannot be expected that the systems would achieve client satisfaction. Therefore from a professional point of view healthcare and social service providers fail to satisfy their clientele needs because of failing policies and institutions. (Clerly, 1997)Therefore for anything of quality to be realized in the healthcare and social service provision, it all starts from the policymakers. By them including the beneficiaries and the implementers it can be a major move towards achieving quality services in both public and private healthcare facilities.Professionals also argue that lack of capacity among the workforce to achieve the desired results is a major challenge in service provision. It seems like the pursuit for quality results in healthcare and social services require qualified, experienced and competent workforce to deliver quality. Organizations lacking this capacity cannot deliver quality to their clients.
Professionals have also been observed to assert that resources are fundamental towards quality. With facilities that are not performing well then quality results cannot be expected no matter what effort is put in by the personnel.
Professionals are also of the opinion that lack of in-service training and continuous learning in the health care sector is the course of low performance and poor quality services. From a client perspective, best management of the health care and social services depends on the goodwill of the management and the personnel. As much as the employees can be trying their best to offer quality, if the management is not supportive then quality cannot be realized. The management can be frustrating the personnel in many ways. For instance in most healthcare facilities one physician is made to attend to more than enough clients who seek the services. This is a clear sign of being overworked yet they are still paid the same amounts for the job. The long waits that clients go through before accessing healthcare services in some regions account for this belief that indeed the workforce is sometimes overworked and overpowered by the number of clients. Best practice in the workplace calls for employees to be given only what they can handle. This is not normally the case in social and healthcare. With an increasing number of clients, the personnel have no options but to attend to all.Goodwill and a supportive environment are essential for achieving quality in the management of healthcare and social services. Therefore the point is that the management has to understand the requirements of the employees for them to fulfill their quality targets. (Agazio et al, 2005)
Clients have also argued that the cost of healthcare services is also important in determining the quality. Some clients have attended private facilities and received excellent results but when they visit low-cost facilities the services were poor. However this has not always been the case as some healthcare providers are out to exploit clients with their high-cost services yet some of them are not of quality.
Clients believe that they are the ones who understand better what it means by quality service provision. Therefore it is actually not involving them in the policy formulation that leads to poor services in social and healthcare facilities. Studies have shown that most managers do not consult consumers of their healthcare and social services. This has made them miss out on important issues that are fundamental in satisfying the client’s needs as they seek healthcare services. This is because clients are the main stakeholders and the targets for healthcare facilities.
Clients also believe that the goodwill of the personnel in charge of handling their cases is vital for quality services. People who have a passion for their job , do it with all their heart despite the conditions.Lack of this goodwill has led to provision of poor quality services since the employees demonstrate a less caring attitude whether the clients achieve satisfaction or not it is not their business as long as duties have been undertaken. This is very common in social care services especially where the elderly people go to seek personalized services. (Clerly, 1997)
This therefore means that the answer to quality services lies in the hands of the people who are in charge of interacting with the clients as they give them the services. Health care services can be managed better if there is commitment by the workforce towards achieving quality standards in their work. However this needs to be supported by the management by also trying to understand the needs of the workforce and making sure that they are also met.
If the two sides do not support each other , then a conflict of interest is likely to occur and it is the cause of poor services.
Key concepts in people management
Team building
This refers to the concept of bringing people together under simple rules to achieve the organization’s objectives.
Through teams leadership roles are shared amongst the employees. The issue of individual and mutual accountability is also well tackled using teams in an organization like a health care facility.
Teams have specific purposes for which they are supposed to fulfill by delivering the anticipated results. This concept is supposed to approach the problems facing an organization from a mutual and active approach through the discussions. (Shamil, 2001)
Contemporary approaches to management are indeed promoting the spirit of building workable teams that are supposed to assist in quality improvement and problem-solving.Most managers in health care and social services advocate for team spirit in their strategies. For instance in trying to solve a behavior problem amongst a client taking a team approach can prove to be fruitful to the organization.In the current system theory where managers look at things in their organizations from a system point of view, teamwork can be greatly affected if the systems of the organization do not give priority to development of team activities. Current approaches to management can prove to be frustrating to the team building process if teamwork is not well integrated within the organizational systems and structures. This can at times be viewed by the employees as waste of time if they are not well organized to address the very problems for which they are created to address. (Vroom, 2001)
Motivation
This refers to the drive towards the anticipated behavior in an organization. Herzberg described it as hygiene factors and the satisfiers. Hygiene factors have been studied not to be motivating but their inadequacy leads to de-motivation amongst the people in the organization. These hygiene factors in healthcare and social services include the work environments, salary, working relations, supervision and many others. The satisfiers are the ones that motivate the employees and they include the work itself, achievement, recognition and many others. For any organization in pursuit of quality to achieve its objectives, motivation is a key concept in the management of its workforce.
Contemporary management theories tend to focus more on the hygiene factors. This has been depicted in a scenario whereby the professionals are well paid and work under good conditions but they fail to satisfy the needs of the clients. This can be interpreted to mean that their services are not of quality to the clients. This has quite often led to poorly motivated workforce that is not in a position to deliver the quality work to the clients. This kind of approach to management therefore affects motivation of the workers and it is the cause of quality problems in healthcare and social services. This means that managers have to be very careful with their approaches towards managing people in their organizations to prevent de-motivation that results in poor quality of work. (Shamil, 2001)
Appraisal
This is a concept that applies to personal learning and achievement of the organization’s objectives.This is because employees are a great asset to the organization and they therefore require performance evaluation on regular basis.
The concept of appraisal can be integrated into teamwork and can really be of significance in improving the performance of people both at individual level and at team and organizational level.
Most managers of public health services do not put a lot of emphasis on employee appraisal. Most of the staff are not evaluated on regular basis and this has really affected their performance. Low-quality services and dissatisfaction amongst care seekers in now common with contemporary approaches to managing people in these organizations. The concept of appraisal fits well within the contemporary management approaches but they are not well tackled by those in charge of management. This is the cause of laxity amongst the employees and hence their failure to meet the quality standards as expected by their clients. (Agazio et al ,2005)
Training and development
This can be made part of the appraisal process. In itself, training and development are a very crucial towards increasing the capacity of the workforce to perform their duties as per the expectations of the organization. The concept if well managed, has the potential of improving performance especially at individual level and overall organization. Through training and development employees in various organizations have a chance to develop their careers and achieve high-level performance in their organizations. Training and development is an aspect of employee management that is supposed to be funded and coordinated by the organization through the human resource management team.
Most organizations especially in the private sector appreciate the concept of training and development for staff in their approaches towards managing people. This is organized in such a way that resources such as books are provided in the organization’s library and training sessions are organized by the organizations. It is important to note that this concept has not been appreciated in public funded healthcare service provision. This therefore contributes to underperformance and poor quality work amongst the staff because they do not receive training and development that can improve their performance.
Ethical issues with managerial approaches
The approaches that are adopted by various managers in their organizations are subject to ethical issues. This is because the approaches apply to the management of people. Ethical Issues concern the manager to the employment relationship or the employee to employee relationship.
Fairness and equal opportunity for all is an approach that raises a number of ethical issues. This is normally the case if double standards are applied by the management. Employees tend to loose confidence with such practices in organizations and this can affect their productivity. Employees view it unethical for the managers in the organization to apply double standards especially when dealing with employees of different gender in the organization. Favoring the female workers and playing tough on their male counterparts is an ethical issue that affects management of healthcare and social facilities.
Insensitivity to the working conditions and needs of the employees by the management is also an ethical issue arising from some managerial approaches. In organizations that are fully managed by systems, it is difficult for the managers to address the individual work conditions and needs of the workers. This has contributed to low performance and compromised quality of services to the clients. (Clerly, 1997)
Authoritative managerial approaches tend to be oppressive to the employees and they even go against the values of people. It is very had for an authoritative manager to exercise accountability on his part as much as there might be pressure on the junior staff to demonstrate transparency and accountability. In most private healthcare facilities, this is the case with the managers being authoritative and engaging in unethical behavior like sexually harassing female nurses and being involved in all sorts of malpractices. It is indeed the managerial approach that propagates the unethical behavior because of lack of whom to account for their actions and governance. Such managerial approaches have resulted in low quality services and eventual collapse of such health facilities.
Managers who have also adopted leissez fair managerial approach whereby there is horizontal communication can also result in ethical issues. This is because there is so much freedom that employees might begin disrespecting one another or even the clients since they are able to manage their work without close supervision from the managers.In such a case it is hard for such a health service provider to meet the client’s needs in terms of quality services. However this managerial approach has been known to promote a lot of transparency in the system as the managers and the employees co-exist in a very good working relationship. (Vroom, 2001)
A democratic approach to management of healthcare and social services has been known to promote ethical behavior and more accountability on the part of both the staff and the managers. This is the widely adopted approach in quality healthcare and social service providers.
Conclusion
The pursuit for quality in the provision of health care and social services can only be successful if the management adopts the suitable style of leadership. This would involve good working relations and satisfaction on both the employees and the clients. If the employees are not satisfied then it is also hard for them to deliver quality that can satisfy client needs.
Bibliography
Agazio E, Salerno P, Mirabella F, Gnessi F, Mastroiacovo, Morosini P, Tarsitani G, Taruscio D.Accessibility and quality to health social services in Italy for the patients with rare diseases: the opinion of associations. Ann Ig 2005; 17:121-128.
Clerly PD, Edgman-Levitan S. Health Care Quality. Incorporating consumer perspectives. JAMA 1997; 278:1608-12.
Donabedian, A. (1980) ‘Explorations in Quality Assessment and Monitoring’, Vol 1: The Definition of Quality and Approaches to its Assessment. Ann Arbor, Mich: Health Administration Press
Dr Shamil Naoum, Thomas Telford, 2001 People and Organizational Management.
Garner, L. H. (1989.) Leadership in human services: How to articulate and implement a vision to achieve results. San Francisco: Jossey-Bass
Howarth J.(1993); ‘Giving Patients Quality Care’: Quality News Vol.19 No.11 pp 576 & 577
Rooney, E.M. (1988) ‘A proposed Quality System Specification for the National Health Service’; Journal of Quality Assurance Vol.14 No.2 pp 45-53
Stephen Robbins and Mary Coulter, 2007,Management prentice Hall.
Vroom, “Leadership and the Decision-Making Process,” Organizational Dynamics, vol. 28, no. 4 (2000), p. 84.