Measure the impact of recent changes on health and social care services against set criteria
FC Sept Teaching Team Internal Verifier Name
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Outcomes and assessment requirements
Learning outcomes UNIT 26
On successful completion of
this unit a learner will:
Assessment criteria for PASS
The learner can:
LO1 Understand the factors that drive change in health and social care services
1.1. Explain the key factors that drive change in health and social care services
1.2. Assess the challenges that key factors of change brings to health and social care services
LO2 Be able to evaluate recent
changes in health and social care services
2.1. Devise a strategy and criteria for measuring recent changes in health and social care
2.2. Measure the impact of recent changes on health and social care services against set criteria
2.3. Evaluate the overall impact of recent changes in health and social care
2.4. Propose appropriate service responses to recent changes in health and social care services
LO3 Understand the principles of change management 3.1. Explain the key principles of change management
3.2. Explain how changes in health and social care are planned
3.3. Assess how to monitor recent changes in health and social care services
Merit descriptors Indicative characteristics Contextualized Indicative characteristics
M1 Identify and apply strategies to find appropriate solution
Effective judgements have been made and complex problems with more than one variable have been explored
To achieve the Merit Descriptor M1, you must make effective judgments made and complex problems with more than one variable have been explored when you Measure the impact of recent changes in the organisation against set criteria and explain the key principles of change management in your chosen organization LO 2.2 and 3.2
M2 Select /design apply appropriate method /techniques
(Relevant theories, methods and techniques have been applied
To achieve Merit Descriptor M2, you must ensure that Relevant theories, methods and techniques have been applied when you explain the key factors that drive change in the health and social care organisation and explain the key principles of change management that can be applied when managing change in the organisation (AC 1.1 and AC 3.1).
M3 Present and communicate appropriate findings
The appropriate structure, approach and range of sources of information has been used.
To achieve the Merit Descriptor M3, you must ensure that the appropriate structure approach and range of sources of information has been used when applying your chosen case study to your answers in each of the Assessment Criteria in Section A, B and C.
Distinction Descriptors Indicative characteristics Contextualized Indicative characteristics
Use critical reflection to evaluate own work and justify valid conclusions
Conclusions made through the synthesis of ideas, validating results against criteria.
To achieve Distinction Descriptor D1, you must ensure that conclusions have been arrived at through synthesis of ideas and justified when you evaluate the overall impact of recent changes in health and social care ( AC 2.3).
Take responsibility for managing and organizing activities
Substantial activities, projects or investigations have been planned, managed and organised
To achieve Distinction Descriptor D2, you must ensure that you have demonstrated your own autonomy / independence of thought and Substantial activities, projects or investigations have been planned, managed and organised when you devise a strategy and criteria for measuring recent changes in health and social care and propose the appropriate responses to these changes in your chosen case study (LO 2.1 and 2.4)
D3 Demonstrate convergent /lateral/creative thinking
Innovation and creative thought have been applied and problems solves
To achieve Distinction Descriptor D3, you must demonstrate that Innovation and creative thought have been applied and problems solves when you Assess the challenges that key factors of change brings to health and social care and Assess how to monitor recent changes in your chosen organisation (AC 1.2 and 3.3)
Summary of grades
In order to achieve a pass in a unit ¢ all learning outcomes and associated assessment criteria have been met
In order to achieve a merit in a unit ¢ pass requirements achieved
¢ all merit grade descriptors achieved
In order to achieve a distinction in a unit ¢ pass and merit requirements achieved
¢ all distinction grade descriptors achieved
For this assignment you must effectively demonstrate your understanding and skills in facilitating change in Health and Social Care Organisations. To do so you must carry out the tasks below in relation to the CQC report for Royal United Hospital Bath NHS Trust (RUH) and Whistable Nursing Home (WNH). By carefully and systematically researching and reading about your chosen context and relevant online literature, you should be much better equipped to answer the task instructions below.
Format: Written REPORT which will be in three sections A, B and C with each Assessment Criteria as a subheading.
Carefully read the CQC report for Royal United Hospital Bath NHS Trust (RUH) and Whistable Nursing Home (WNH). The CQC reports showed a need for urgent changes in the Hospital and Nursing Home. After reading the reports, select one that really interests you. Then, imagine that you are a Team Leader or Manager and you are responsible for facilitating change. You are required to identify and make required changes before the next CQC inspection. To carry out this task, you must carry out research on relevant available literature / data sources to answer the tasks below. Please note that you can, and are encouraged to, relate this to your own work experiences in health and social care where applicable, although this is not compulsory. It is advisable that you consult relevant sources of literature and data (e.g. free NHS or CQC online reports and texts) on your chosen type of organisation to fully understand the context of change.
Please note: CQC report for Royal United Hospital Bath NHS Trust (RUH) and Whistable Nursing Home (WNH) is uploaded on stponline and can be found in the folder titled Royal United Hospital Bath and Whistable Nursing Home case study for FC assignment
Section A (1000 words +- 10% )
In relation to your chosen CQC report
¢ Explain the key factors that drive change in health and social care ( AC 1.1, M2, M3)
¢ Assess the challenges that key factors of change brings to health and social care services (AC1.2, M3, D3)
[To answer the above assignment criteria use any or all these: PEST Analysis, SWOT Analysis or Force Field Analysis, to depict the factors driving change in your chosen organisation. You should be able to show the potential Challenges of these factors for service users, staff and the organisation, why you identified these factors and some potential priorities for change. The PEST Analysis sample table, the SWOT Analysis and Forces Filed Analysis sample is found on stponline week 2]
Section B (1000 Words +- 10% )
In relation to your chosen CQC report
¢ Devise a strategy and criteria for measuring recent changes in health and social care ( LO2.1, D2)
¢ Measure the impact of recent changes on health and social care services against set criteria (LO2.2 M1,)
¢ Evaluate the overall impact of recent changes in health and social care (LO 2.3, D1)
( M3 to be met in all the above criteria)
[To answer the above assessment criteria, you have to devise own criteria and strategies to show how you will measure the impact of recent changes which could be either plan or unplanned for all the different stakeholders. You need to read and research extensively into the background of your chosen type of organisation to understand the context of change and how change might be measured and evaluated]
¢ Propose appropriate service responses to recent changes in health and social care services ( LO 2.4, M3, D2 )
[To answer the above criterion you have to propose how your chosen organisation could respond to the recent changes you evaluated above. You should reflect on possible impacts both negative and positive of your suggestions on service users, professionals and the organisation to compare the options]
Section C (1000 words +- 10% )
In relation to your chosen CQC report
¢ Explain the key principles of change management (LO 3.1, M2, M3)
(To answer the above assessment criteria you need to explain the key principles of change management e.g. Reducing Resistance, Creating ownership, Kulber Ross, Lewins model, Kotter, etc., to be considered for successful planning, implementation and monitoring of change in your chosen context.
¢ Explain how changes in health and social care are planned (LO3.2,M1,M3)
¢ Assess how to monitor recent changes in health and social care services (LO3.3, M3,D3)
[To answer the above assessment criteria, explain how change could be planned to meet the change priorities you identified earlier, and assess how the changes could be monitored during / after implementation. You may wish to include a project timeline diagram/chart to represent your change plan and monitoring/measurement process, although this is optional. This diagram is found on stponline in week 8].
FC Assessment criteria breakdown : GUIDE:
LO 1.1 Explain the key factors that drive change in health and social care services
ï¶ What is meant by any of these factors of change management
ï¶ Give a detail account of how and why these factors occur.
ï¶ In your explanation you should write clearly in such a way that the complex procedure and sequences of these principles can be understood at the same time relate it to your organization
To explain consider the following factors:
ï¶ Discuss on the Factors that drive change using SWOT analysis, PEST or force Field analysis. This should include both internal and external factors.
Factors such as:
ï¼ The Legislation: NHS and Community Care Act 1990, Health and Social Care Act 2001; changes of government; funding issues
ï¼ Demographic Issues/Cultural: ageing population, minority ethnic community needs, lifestyle factors, public awareness (perceptions) and news media, human factors.
ï¼ Technological issues such as electronic record keeping; electronic communication; assistive technology
ï¼ Internal factors include the following: Skills, Staff, structure, systems and shared values
ï¶ Relate the above factors to your work place or chosen case study.
1.2 Assess the challenges that key factors of change brings to health and social care services.
ï¶ The challenges that the above factor can bring to the organization, service user and professionals.
ï¶ Identify the factors and relate them to your health and social care work place.
ï¶ Include the positive and negative effects of these challenges
ï¶ Weigh up to what extent the statements are true and point out any flaws and counter argument.
ï¶ Then conclude by stating how far you are in agreement to challenges that these factors bring to HSC
2.1 Devise a strategy and criteria for measuring recent changes in health and social care.
ï¶ Identify the factor which could be measured in the organization such as waiting time, service delivery, new technology, respect of dignity and privacy etc
ï¶ Devise a principle or method either from your own idea or from existing principles to measure the recent changes. These can be performance measuring tools such as
ï¼ 360 degree cycle,
ï¼ Cost benefit analysis,
ï¼ focus groups, Structured interview.
ï¼ Fish bone analysis
ï¶ Explain how the method (s) can be used to measure these change in the organization in terms of its
ï¼ Its effectiveness and efficiency
ï¼ Customer satisfaction
ï¼ Staff satisfaction
ï¼ Access/ environment
ï¼ Cost and benefit of the change
2.2 Measure the impact of recent changes on health and social care services against set criteria
ï¶ Identify the measuring tools that will be used to measure these changes and measure the impact against criteria such as
Impact of recent changes on organizations, service users and staff:
ï¼ how services are organized
ï¼ effect on front-line staff;
ï¼ effect on service delivery
ï¼ direct users
ï¼ families of those who use services
2.3 Evaluate the overall impact of recent changes in health and social care
ï¶ To evaluate is to give a verdict or decision or findings on the above mentioned impact of the change in the organization by giving an over view of its benefit and dis- benefit to the service user, government/organization and the workers.
ï¶ Provide evidence from a wide range of resources that both agree with or contradict the above mentioned points
ï¶ Conclude by coming to a final decision on what you think its the most important factors of change and how these can be improved on.
2.4 Propose appropriate service responses to recent changes in health and social care services
Suggest ways that you think that these organization can respond to these changes that what they can do in order to correct the identified failings by CQC such as
ï¼ change of management structure,
ï¼ employment of new staff,
ï¼ change in equipment
ï¼ change in service delivery
3.1 Explain the key principles of change management
ï¶ What is meant by any of these principles such as Kotter eight steps to change, Lewis Model of Change, Kulber Ross, ADKAR, Reducing Resistance, Creating Ownership etc
ï¶ Give a detail account of how and why these change management principles occur.
ï¶ In your explanation you should write clearly in such a way that the complex procedure and sequences of these principles can be understood while explaining how you can use this model to facilitate change it to your chosen organization
3.2 Explain how changes in health and social care are planned
Explain how the methods and factors that can be considered when planning change in the organization.
What are activities that can be carried out, Consider the following
ï¼ Stakeholder analysis
ï¼ top-down or bottom-up;
ï¼ management style;
ï¼ use of informal social systems;
ï¼ managing anxiety;
ï¼ staff development needs
3.3 Assess how to monitor recent changes in health and social care services.
Identify the measuring techniques and relate them to your health and social care work place these include: evaluative research surveys; customer/staff satisfaction; measures of efficiency (cost-benefit, referral rates, and case completion, waiting and response times)
¢ Include the positive and negative effects of these techniques
¢ Weigh up to what extent the statements are true and point out any flaws and counter argument.
¢ Then conclude by stating how far you are in agreement to using these technique to monitor change in the organization.
IMPORTANT INFORMATION: ALL REPORT MUST BE WRITTEN ON THE BASE OF CASE STUDY :
We are the regulator: Our job is to check whether hospitals, care homes and care
services are meeting essential standards.
Royal United Hospital Bath NHS Trust
Directors Offices, Royal United Hospital, Combe
Park, Bath, BA1 3NG
Date of Inspections: 20 June 2013
19 June 2013
18 June 2013
17 June 2013
Date of Publication: October
We inspected the following standards to check that action had been taken to meet
them. This is what we found:
Respecting and involving people who use
Care and welfare of people who use services Action needed
Cooperating with other providers Met this standard
Safeguarding people who use services from
Assessing and monitoring the quality of service
Records Enforcement action
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 2
Details about this location
Registered Provider Royal United Hospital Bath NHS Trust
Overview of the
Royal United Hospital Bath is an acute hospital on the edge
of Bath just over a mile from the centre of the city. The
hospital covers a local population numbering around half a
million people in Bath and some parts of North East
Somerset and Western Wiltshire.
Type of service Acute services with overnight beds
Regulated activities Assessment or medical treatment for persons detained
under the Mental Health Act 1983
Diagnostic and screening procedures
Management of supply of blood and blood derived products
Termination of pregnancies
Treatment of disease, disorder or injury
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 3
When you read this report, you may find it useful to read the sections towards the back
called About CQC inspections and How we define our judgements.
Summary of this inspection:
Why we carried out this inspection 4
How we carried out this inspection 4
What people told us and what we found 4
What we have told the provider to do 5
More information about the provider 5
Our judgements for each standard inspected:
Respecting and involving people who use services 6
Care and welfare of people who use services 10
Cooperating with other providers 18
Safeguarding people who use services from abuse 20
Assessing and monitoring the quality of service provision 23
Information primarily for the provider:
Action we have told the provider to take 32
Enforcement action we have taken 34
About CQC Inspections 35
How we define our judgements 36
Glossary of terms we use in this report 38
Contact us 40
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 4
Summary of this inspection
Why we carried out this inspection
We carried out this inspection to check whether Royal United Hospital Bath NHS Trust had
taken action to meet the following essential standards:
¢ Respecting and involving people who use services
¢ Care and welfare of people who use services
¢ Cooperating with other providers
¢ Safeguarding people who use services from abuse
¢ Assessing and monitoring the quality of service provision
This was an unannounced inspection.
How we carried out this inspection
We looked at the personal care or treatment records of people who use the service, carried
out a visit on 17 June 2013, 18 June 2013, 19 June 2013 and 20 June 2013, observed how
people were being cared for and checked how people were cared for at each stage of their
treatment and care. We talked with people who use the service, talked with carers and / or
family members, talked with staff and reviewed information given to us by the provider. We
were accompanied by a specialist advisor.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way
of observing care to help us understand the experience of people who could not talk with us.
What people told us and what we found
This inspection visit was to follow up compliance actions from the responsive inspection that
was conducted in February 2013. At that time concerns were raised about the manner in
which some patients had been discharged without adequate information and support. At
this inspection we also reviewed governance systems and the mental capacity assessments
that took place at the hospital.
We took a nurse with us who had expert knowledge in discharge arrangements, a
psychiatrist with an expertise in the Mental Health Act 1983, who spoke with voluntary
patients who were receiving treatment for their mental health, and a manager within CQC
with expertise in Governance arrangements in acute trusts.
During our inspection we looked at three areas of care at the hospital. These were all the
older peoples wards, the emergency department and the day surgery unit (DSU). We also
visited the theatre recovery area.
We met and talked with many patients during our visit. Staff were approachable and open in
their discussions with us. Where patients were not able to talk with us for various reasons,
we spent time observing how care and support was delivered. We saw and were given
written evidence from the trust. This included patients notes, hospital records and
recordings of their clinical observations.
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 5
We met with consultant medical staff, pharmacists, therapy staff, registered nurses and
healthcare assistants. The majority of staff we met with showed a professional and caring
attitude towards their patients. We also met with hospital directors and senior management
We found the trust ensured they met patients treatment and care needs on the day surgery
unit as it was no longer being used routinely as a facility to care for inpatients from other
parts of the hospital. They had also ensured correct information and support resources were
put in place for patients discharge from the older peoples wards we visited.
We met with fifteen patients and six patients visitors. Comments included Im sleeping fine
at night¦.havent rung the bell theres no need (as they pointed to the staff around and
available to support). Four visitors on two different wards also gave us positive comments,
one of them telling us how the patient they were seeing was improving.
We discussed patients with staff on all of the wards. We made observations of patients who
were too unwell or frail to talk to us. We saw some warm and kind interactions between staff
We visited four older peoples wards. On three of these wards we found the systems in place
for the assessment, planning and delivery of care were not fully effective in ensuring patients
care needs were met. We also found records were not being completed in a consistent
manner, including records of patients fluid intake and output on these wards. Patients
privacy and dignity were respected. However, on two of the four older peoples wards, at the
time of the inspection visit, we saw instances where patients were not having their privacy
and dignity maintained.
On one older peoples ward we found there were not suitable arrangements in place to
protect people against the risk of excessive control. This was related to the use of assistive
technology (tagging) patients with cognitive impairment who were at risk if they left the
We saw there was a system in place to regularly assess and monitor the quality of service
that people receive and to identify, assess and manage risks to the health, safety and
welfare of patients and others. These internal quality assurance mechanisms had not been
effective in ensuring improvements required as a result of our last inspection had been
implemented. We saw a number of improvements had been made and were in the process
of being implemented.
You can see our judgements on the front page of this report.
What we have told the provider to do
We have asked the provider to send us a report by 19 October 2013, setting out the action
they will take to meet the standards. We will check to make sure that this action is taken.
Where we have identified a breach of a regulation during inspection which is more serious,
we will make sure action is taken. We will report on this when it is complete.
Where providers are not meeting essential standards, we have a range of enforcement
powers we can use to protect the health, safety and welfare of people who use this service
(and others, where appropriate). When we propose to take enforcement action, our decision
is open to challenge by the provider through a variety of internal and external appeal
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 6
processes. We will publish a further report on any action we take.
More information about the provider
Please see our website www.cqc.org.uk for more information, including our most recent
judgements against the essential standards. You can contact us using the telephone
number on the back of the report if you have additional questions.
There is a glossary at the back of this report which has definitions for words and phrases we
use in the report.
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 7
Our judgements for each standard inspected
Respecting and involving people who use services Action needed
People should be treated with respect, involved in discussions about their care
and treatment and able to influence how the service is run
The provider was not meeting this standard.
Patients privacy and dignity were respected. However, on two of the four older peoples
wards, at the time of the inspection visit, we saw instances where patients were not having
their privacy and dignity maintained.
We have judged that this has a minor impact on people who use the service, and have told
the provider to take action. Please see the Action section within this report.
Reasons for our judgement
At our last inspection on 4 to 6 February 2013, we found inpatients accommodated on the
day surgery unit (DSU) were not having their privacy and dignity maintained. At this
inspection we visited the DSU and spoke with seven patients, three relatives and four staff.
We also looked at the trusts action plan following our last inspection and what actions it had
taken. To establish if there were any inpatients who had stayed overnight in the unit we
started our inspection of the DSU at 10:20 on Monday 17 June 2013. The DSU had
re-opened at 7:30 am that morning because it had been closed over the weekend. We saw
there was no evidence of any inpatients being cared for on that ward and that the only
patients were those arriving for day surgery that day We also returned to the DSU at 14:00
on 20 June 2013 to review the situation. We found all of the patients on the DSU had been
admitted for day surgery only and so there were no inpatients on the DSU on either of the
occasions we visited.
We saw the trust had completed the actions in their action plan dated May 2013. For
example they had reviewed DSU admission criteria and reinforced with staff the use of DSU
for 23 hour patients. Staff told us this meant it was much easier for them to ensure
patients privacy and dignity were maintained. A registered nurse told us the changes have
made everything better for patients. Patients are here for much shorter periods now. The
trust had also reviewed DSU admission criteria to ensure patients needs could be met on
DSU. Staff confirmed this had taken place and staff were clearer who the ward was actually
At our last inspection patients reported disturbed sleep due to the amount of night time
activity on the ward and there was a lack of washing facilities. We saw the hospitals action
plan stated they were in the process of providing an additional shower. This was to stop
mixed gender shower rooms on the unit. We saw building works to provide a second shower
| Inspection Report | Royal United Hospital Bath NHS Trust | October 2013 www.cqc.org.uk 8
room were nearly complete when we visited. Patients on the DSU were positive about the
environment and the staff team. Comments included staff are always nice when I come
In the action plan, the trust stated DSU staff were made clear of DSU function when the trust