SERVICE QUALITY : Critical part of your marketing mix

A gap between rhetoric and action will adversely affect the your business

Feedback mechanisms bridge the gap

Why Me?• Business background: Cadbury Schweppes– Cost reductions, productivity analysis, systems

analysis and other ‘stuff’ based on quality info• Business lecturer• Database & info manager:– data, quality, audit, feedback, reporting on

performance, reporting to contract, management info.

• Linemere Consultants Ltd– Care2 Improve: performance audit for Care.

Businesses are effective and generate more profit when they

:– Have a good product for which there is demand– Are well lead• Have simple systematic processes• Are people orientated• Manage their costs• Have monitoring and feedback mechanisms that

ensure they know what is happening

Important for Care

The world and his dog have a say in what the quality of your service should be.

Everyone is prepared to comment

The LA tap flows less strongly

• Council contracting practice changes• Tighter criteria for council funding• More dependence on privately funded clients

You have to

• Provide Good Quality Service• Prove you provide Good Quality Service• Maintain & improve service over time.

Increasingly CQC look for quantifiable evidence of performance and improvement.

You need feedback systems

But you know your own business, don’t you?You have your finger on the pulse?……Why focus on ‘systems’?

Perception! Who is right? An elephant is…

Thin like a rope

Thick and sturdy like a pillar

Thick, strong and flexible like a fireman’s hose

Smooth, cool and shiny

Huge like a house

Halo and Horns

• People see the same thing differently

• The last thing they saw or heard

• Prejudices

• Favouritism

• Misunderstanding

Cutting to the chase

• Loads of management models of quality.• All involve robust feedback mechanisms

• CQC have a feedback model• Local authorities have a feedback model• NHS choices have a feedback model

• LA or CQC feedback can damage your business

You need feedback mechanisms that

– Isolate and measure critical performance indicators

– Deal with perceptions and the halo / horns bias– Provide accurate, measurable results– Are objective and verifiable– Are reliable– Are a tool that will help you prioritise and make

decisions

Feedback Framework

• Any feedback should be in a framework of feedback systems that together enables you to understand the relationship between activity and achievement.

• Using an adapted version of– European Excellence Model– ISO9001

Continuous Improvement

European Excellence Model

Timeliness of Feedback Cycles

• Immediacy imperative • Short term• Medium term • Longer term

Fitting it into business routines

Example 1: Client in Domiciliary care wanted an Employee Performance Monitor

Workbook per employee:• Input sheet• Chart

Using natural opportunities for assessment

• 1:1 supervisions• QA visits• Spotchecks• Observations from the office on compliance

etc • Comments from clients (complaints or

commendations)

Critical Performance Indicators

• Punctuality• Appearance• Flexibility• Reliability• Personal care skills• Cooking skills• Client feedback• Teamwork• Confidence

Performance standards

Wanted to use marks out of 10 • 7 is a standard acceptable standard• 6 is underperforming • under 6 would be a disciplinary issue

Scoring and Use

At each assessment incident:• Date, time and nature of assessment is

recorded• 1 or more indicators are scored as

appropriate.• Comments are addedThe data is compiled over time to show average performance for each indicator

Collecting data

Embedding the process

• Accepted as part of the ongoing business process.

• Used as part of the appraisal process• Staff like it because it– Is methodical and demonstrable, not ‘opinion’– Specific incidents– Framework for discussion

Communicating

• Don’t measure and assess in a vacuum.• Engage with relevant stakeholders• Involve staff, they will have great ideas• Communicate plans• Communicate progress• Shout from the rooftops that you are good!

Gathering People Results• Absence• Sickness • Turnover • Shortages• Employee surveys

Society Results

• Families and representatives• Health care• Commissioner feedback• CQC feedback• Supplier feedback• Connections with local community:

volunteers, schools, churches, community groups

Customer Results

• Retention rate • Reasons for leaving• Client referrals • Customer satisfaction• Focus groups• Complaints

Process and Service Monitoring

Quality audit: • Maintenance and housekeeping• Stock• Client Records• Referral processes and referral quality• Data quality• Spot checks on service• Secret shopper

Outcome Monitor records QA visitsBreakfast QA Monitor DateVisit referenceQuestionPunctualityCorrect amount of time givenUniform and IDProfessional and FriendlyAppropriate PPEAll scheduled outcomes completedCare of an acceptable standardHome care records and forms completedRespecting and involving people who use our servicesCare and welfare of people who use our servicesMeeting nutritional needsSafeguarding people who use our services from abuseCleanliness and infection controlManagement of medicinesAssessing and monitoring the quality of service provision

Establishes critical performance criteria to assess each QA visit:

Outcome met: yes / no

Records % outcomes met per visit

Data distinguishes between breakfast, lunch and evening shifts

Accumulates data to give running score as a chart.

Quality Audit Approach.

Audit control document

Audit: Monthly Issues Monitor

Care2Improve Survey Cycle• Enables structured feedback from 4

stakeholder groups:– Service users / Relatives / representatives– Staff / other professional

• Data fed into a software package– an online dashboard of quantitative results– qualitative comment.

• Benchmark performance over time.

How it works:• Statements describing positive care based on

CQC standards across the 5 domains.• Responses are ‘scored’ and create:– Satisfaction index for each stakeholder group

http://www.care2improve.co.uk/

• Drill for more detail for each group

• Bar chart of responses for each question for each group

• Themed comments

What can C&SW do to help?

• Help with policies and process improvement• Registered manager’s network• Help with communication of results /

newsletters for clients, relatives, staff, other professionals

• Help putting together monitors to help measure critical performance

• Care2Improve surveys: discounts for members