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The importance of development of the service user base is not a need that has been recently realised, but it is recently that literature has come up with a plethora of material in order to realise that importance. Inevitably, in the research regarding quality control and inquiry into the systematic changes that an organisation needs to make has been concentrating on the perspectives of the service user base. This has becomes especially important in the light of funding bodies requiring extensive and exhaustive research in this area, before delving into investment for an organisation.
The following section will elucidate the methods and practices which a team undertakes in order to ensure the rights and responsibilities and promote diversity in healthcare practice. This will be done in the context of team development theories in the theory of choice, for the purposes of critical inquiry.
Of late, there has been significant literature that has been developing on the satisfaction of users in the service industry. Leatherman et al (2010) has done a comprehensive study on the effect of service health industry in developing countries, where the issue of quality service in the healthcare sector is a problem. Even though there exists some or the other form of guidelines for the operation of the health sector. In a 2020 report by the World Health Organisation, some general guidelines for the organisation of the health sector was elucidated. According to that report, one way to improve quality of healthcare establishments is to start early, as soon as the institution/nation realises that there is a glaring gap in services in the industry. Secondly, a method of improving healthcare infrastructure in the best economically sound way possible is to build on already existing structures and strive to improve them. Another important aspect that healthcare services should understand is the importance of supporting the healthcare workers. Often, healthcare workers work in bad conditions and compromised situations, and are remunerated poorly often (WHO, 2020).
The service industry is one of the fastest growing industries in the world. In the United Kingdom, the growth of the service industry has been particularly strong, especially compared to other nations. For the last 25 years, the service industry’s growth in the UK has been remarkable. The progress is so far-reaching, that UK has entered a phase of gradual transfer from a manufacturing economy to a service economy (Julius and Butler, 1988).
Team performance is essential in a growing sector like this. Because most of the growth in industrial economy of UK is because of big firms, the importance of team management becomes irreplaceable. The core values that a team is made of is partnership, cooperation and performance. This is especially important in the healthcare industry where teams need to work together in order to achieve maximum customer satisfaction. Team are part of organisations which employ a large number of people, usually. Hence, the central organisation of the organisation has a deep impact on the team dynamics and ultimately the performance of the organisation. Boone et al (2019) discover that team entrepreneurial performance (TEP) is severely affected by several factors, one of them being passion for the job. This re-asserts the WHO guideline which suggests that one of the factors contributing to the improved performance of healthcare workers will be the better provision of the workers with benefits and establishing a welcoming environment for the workers to work in. Boone et al (2019) also discover that relationship between a team is affected by the relationship conflict between the team members. A similar conclusion was reached by Steffens et al (2012) who argue that conflict between the team members, even if the conflict was of a personal nature and not strictly related to professional concerns, could affect the relationship between team members to the extent that team members may choose to leave the organization.
It an a given for anyone who is availing a service from an organisation that the service people owe the customer certain things, including the right to good service, the responsible undertaking of the duties of the service people and finding proper representation for themselves within the service givers too. In the UK, where the service sector is becoming increasingly important with each progressing year, it is of paramount importance that service industries, especially in the healthcare sector develop some form of structure which ensures sustainable development of teams. The method through which team structures in an organisation can be developed is through building teams within the said organisations.
However, building a solid base for a sound team structure isn’t an easy task, for the managers or the team members themselves. There have been various faux pas in the pursuit of that, most famously, a particular incident in a an organisation in 2008 where a manager waterboarded a team member. The incident ended up damaging the reputation of the company and gaining a lawsuit (Vick, 2008). Hence, there is a unanimity in scholars in the view that the building of a team structure is a scientific and methodical procedure, one that cannot be done without any guidelines. Teamwork is different from a simple, individual level-task as it needs attitudes and cognitive behaviours which are compatible with all members of the team (Salas, Cooke and Rosen, 2018). The formal training that goes into team development involves imparting the required expertise and skill set that the team members individually and as a collective need to exercise.
Every organisation at some point has to engage in team development strategies, and that holds more true that ever for the healthcare industry. It is of paramount importance for the healthcare industry to develop working strategies for properly structuring or re-structuring team initiatives because the outcome of these operations are literal life and death. It is similar to a highly methodical airplane journey operation, any misstep could result in something akin to the PSA Flight 182 disaster, where a commercial airplane collided with a private airplane due to a lack of clear communication (NTSB, 1978). Shuffler et al (2014) elucidated, after reviewing relevant literature, the steps involved in the structuring of a team strategy. However, they warn that at the very offset, managers and trainers need to possess the necessary tools for the making of the structure. Additionally, they must also be aware of the fact that each stage in the structuring process is not separate from the other, the stages all work together and are co-dependent on each other.
In the healthcare sector, there has been an emerging trend of user-centred developmental planning. Anthony and Crawford (2000), speaking from the perspective of mental health healthcare workers, elucidate that overwhelming clues suggest that the involvement of service users in the planning the health sector. They suggest that the existence of ‘consumerist ethos’ relates to the existence of values and ethics that come from the perspective of the user themselves. Such an approach is essential in healthcare because research has suggested that health care service availers are woefully unaware of the nature of health care they needed to undertake, the planning and decision making strategy that goes into the making of a health care structure and why certain kinds of organisation principles are followed. In short, they are unaware of the implications of the health care structure that they are an integral part of.
However, when it comes to ensuring rights, ethical responsibilities and promoting diversity, the main job lies with the team who are delivering healthcare services. They hold the definitive responsibility as they are the ones with the control over the whole process. It is important to realise that in healthcare, the paramount importance is assigned to the administration. The responsibility changes when one speaks of it in terms of a team as a team represents an institution which is bigger than the sector itself. While there has been a lot of academic work with respect to the responsibility of individual healthcare workers and the responsibility of corporates in the healthcare sector (Kinley and Tadaki, 2003). The issue of responsibilities of individual healthcare workers fall under the micro understanding of the issue and the responsibilities of the corporate healthcare sector is concerned with the macro part of the issue. The meso level of the understanding has been poorly explored and presents a great scope for research.
Kleef et al (2008) discover that the positive addressing of diversities within teams significantly affects the performance of the team. They relay that between two teams with the same level of diversity within them, most pronounced in the gender difference, the team which addresses the diverse elements in their team has a better chance of performing better. Kearney et al (2009) postulate that the effect of addressing the diversity within teams inevitably lead to better performance. This is because there are several different varieties of duties that teams have to perform. Organisations needs to utilise the diverse pool of employees they have, diverse in both the educational and functional sense, in order to assign them tasks which are relevant to their talents and education. By this rationale, it can be understood that in the healthcare sector, addressing and re-structuring teams based on their diverse properties will only work to enhance the performance of the teams. Additionally, they discover that such an arrangement is intimately linked with cognition as well, hence teams which are relatively more open to the differences, whether socio-cultural or educational, with respect to their team members are more likely to form a structure which promotes greater rights and shoulders more responsibility in the healthcare sector.
Continuous Quality Improvement (CQI) is a process which every organisation and every sector goes through during their operation. CQI consists of several tools which organisation use in their improvement. This section will critically analyse two of these tools which are used by organisations in CQI and try to understand how service industry organisations make use of these tools in order to improve the experience of the service users. The purpose of inquiring into this is to find the gaps in the tools which are being examined, in order to better understand how to improve upon those tools, especially with regards to the organizations in the service sector.
The prospect of CQI is especially relevant in the service sector because it is a highly dynamic sector, where organisations are constantly competing with each other. As we examined in the earlier sections, UK is one of the nations where organisations in the service sector is rapidly taking over the manufacturing sector. In this scenario, it is important for companies to examine and re-evaluate the tools they use in their continuous improvement process. Additionally, organisations must also take care to choose the right tools for their improvement process as there are several hundred tools available in the CQI process. However, the most popular tools which are most widely used by organisations in the service sectors are called the 7QC tools. The following sections will elucidate on two tools which have the most prospect for improving the process of an organisation. The section will try to be representative of the CQI process in the sense it will discuss one identification tool and one analysis tool and how organisations use them to improve their performance.
Flow charts are one of the most important tools that are used in both the manufacturing and the service industry to holistically look at the process of production and to find out if there are any problems which need to be remedied or some gaps which need to be filled.
In the service industry, the purpose of CQI tools is not just to expose the cracks in the workings of the organisation, but also to achieve that purpose in the most easiest way possible. A flow chart is a a helpful tool because it helps in breaking down very complicated information in easy digestible bits and represents it very clearly. The quality of flowcharts different from organisation to organisation, from the level of simplicity to complexity of the issue or process they are trying to represent (Newman, April 26 2019).
The usage of flowchart is done in order to achieve three major goals; firstly if the manager discovers that the product or the service that is being given out is defective and it needs to be changed/improved upon. Secondly, when the manager feels like the complete potential of the labour force is not being realised. Flow charts can be used to find out the bottlenecks of certain processes and understand where time is being lost needlessly, and eliminate that. Thirdly, apart from looking at sectional and departmental excesses, this tool can be applied holistically to the entire organisation to understand where the overall wastage is taking place. Often times, managers will concentrate on the production process to zero in on and identify waste. Other departments like accounting and transportation are overlooked as being contributors to increasing productivity (QualityInspection.org). Flowcharts can either be of a simple, three step level or they can be of a highly complex nature, involving up to twelve steps.
However, apart from being a useful tool, a flow chart can be a problematic tool as well. Sometimes, with the objective of representing large operations in a few simple steps, flow charts run the risk of oversimplifying the entire operation and misrepresenting key elements. This could lead to mis-diagnosing of the problems in an organisation and wrong issues could be addressed.
Histograms are useful visual representations of the data that is produced after the analysis is done by the organisation. Histograms are also known as bar graphs and they are commonly used in several academic and industrial sectors to represent facts and figures. While it is generally used for companies to lucidly put forward groups of specific data in an easy to understand format, usually for large amounts of data, histograms are not used. The Pareto chart is used when the organisation wants to represent a large amount of data (Muhammad, 2015).
A histogram is useful because, unlike the flow chart, it doesn’t show the one time occurrence of a certain hindering factor in production. It shows the frequency of the hindrance and also elucidates how much a certain phenomenon has affected the organisation historically. This is useful especially in large organisations as they do not have the time to examine each department separately and devise strategies specifically.
A histogram is different from a Pareto chart as the Pareto chart is more specific with its message. A Pareto chart concentrates on the causes of the problem and strategises which measures need to be taken in order for the problem to be resolves. However, by this logic, a Pareto chart is incomplete without the Histogram, as the Histogram provides the context on the basis of which the Pareto chart will recommend its findings and solutions (izenbridge.com). Histograms are essential tools in the implementation of organisational methodologies as well. Organisational methodologies like Six Sigma would make use of Histogram in its very first step. This is because the beginning of this tool is the collection of data. It is also useful when implementing Lean strategies on a company’s organization. Lean and Six Sigma methodologies are being used by companies to increase productivity and deliver faster levels of productivity increase increasingly (Sokovic et al, 2009).
The Histogram, however, is not a tool without its faults. It relies heavily on the primary data which is collected from the field and hence, the representation is a mirror of the data. It has no mechanism of understanding the kinks of the data and it can in no way weed out the faulty data, like biased data. Additionally, it can only represent the problem in its frequency in a very quantifiable fashion. Because it relies on empirical data, it cannot accurately represent figures which are not derived empirically. For example, in the service sector, if consumers are asked what the don’t like about Company A’s service, the answers may be multi-faceted, rendering them difficult to be admitted into a quantifiable frame that the Histogram follows. When dealing with consumers in the service sector, this becomes a problem, especially if the company is trying to understand why people act a certain way. Additionally, it is incapable of handling large amounts of data and must rely on the Pareto graph to represent large amounts of data.
The central idea behind a user-oriented approach to establishing a social order of service is to make sure that the individual is at the centre of it. A good way of ensuring that the individual is the prime beneficiary of the policies that service providers put forwards is to ensure that they come directly or indirectly from the people themselves, this is referred to as user involvement.
Mckinley and Yiannoullou (2012) examine the effect of user involvement in mental health patients and they discover that although service sectors in healthcare, like mental health, have their own experts in their own capacities, working towards an end, involving people in the process greatly enhanced not just the service production process but also the overall positive impact on the people themselves.
The social care sector is a sector where examining the effect of people’s involvement becomes important as social care employees directly deal with people. Unlike the manufacturing industry, they aren’t simply producing a good that is being made after market research into the demographic and their target audience. Their relationship with the people is dynamic and it changes accordingly whenever they interact with the people they are catering to. Hence, understanding the needs of people becomes very important. One way to achieve that is through the usage of motivational theory, specifically the theory of Maslow’s hierarchy of needs.
Maslow’s hierarchy of needs is a theory which has been increasingly used over the years in a variety of disciplines, but understanding the service sector from its perspective is especially profitable as it centres around the different levels of needs an individual has.
Maslow put forwards many ideas, but his central tenets argued that individuals are always wanting for something or the other. It is true with every human being, no matter how much or how little they have. Hence, human wants depend on how much they already possess. If human beings satisfy one need, they usually move on to the next and then the next. The needs progress in a hierarchy, from basic to complex needs (Maslow, 1943).
Maslow argues that at the bottom rung of the pyramid are basic needs like food and shelter, basic physiological things that an individual needs to survive. When these needs are met, the individual moves on to the next need which is the freedom to survive without any threats to one’s safety, in a stress-free manner (Maslow, 1943). This is relevant when it comes to members of a team as well. In the earlier sections where the paper examined the satisfaction of the users and the team’s contribution to it, it concluded that in order to completely be of help to the users, the team members themselves need to feel that their needs are being met. This is precisely what the WHO guidelines were speaking of, when they declared that quality ensuring measures in a nation are incomplete without ensuring that the needs to the healthcare workers are being met (WHO, 2020).
The very first step that any organisation must take, when they are trying to ensure that all the needs of their service users are being met is to precisely understand what are exactly the needs that they should strive to meet.
Maslow’s theory provided an insight into what is it that really motivates people, against the backdrop of a service industry, the first thing that needs to be ensured is the survival of the service providing employees. The salaries that the employees get should be enough to meet their basic needs for survival (Maslow, 2000). However, that is not nearly enough to sustain the needs of service workers. Benson and Dundis (2003) argue that if workers feel like their basic needs are not being met or they are struggling with meeting their daily needs through their wages, more time will be spent in contemplating their dissatisfaction with the system, rather than working towards the improvement of this system. The first level, in our contemporary world, is also intimately connected to the second level. Once an individual has proper wages to meet their basic needs of food and shelter, they will automatically feel more sheltered and will be secure with their individual selves.
Even though work environment may seem like a seemingly minor concern when compared to the other aspects of employee needs, it plays a major role in determining the happiness of the employee in the team and the workplace and subsequently, their service. All employees want to be a part of a work environment where the co-workers get along with each other, where the work is conducive to their growth and the team leaders and encouraging and supportive. Working in a toxic work environment with uninterested and domineering leaders and co-workers who are indifferent does not inspire workers to be very forthcoming (Maslow, 2000). Benson and Dundis (2003) acknowledge that in highly in-demand sectors, like the service sectors, employees are under severe pressure to perform. They would probably not have time to establish bonds and harbour a good working environment. In this case, they argue, there should be ample opportunities for the individual to participate in training programmes, so that they can develop their skills and also meet additional people who can constitute a good environment for them.
This is intimately related to an individual’s self-esteem; better training will enable workers to move up the ladder faster and provide them with the opportunities to improve the lower levels of their hierarchy of needs. Individual’s self-esteem improves when they have the opportunity to better themselves and their work and that is an essential part of satisfaction. Finally, a more specialised and developed tangent in the worker’s career allows them the luxury of making their own choices in the workplace, on the basis of their skill. It allows them to break out of the mundane and achieve their full potential. When they are ensured that they have the best education available, they are able to innovate and make creative progress in their job and provide quality service to the service users.
Hence, the needs of the service team and the needs of the service users are intimately connected, at several levels. When working teams get the opportunity to improve themselves and their performance, they improve the possibility of improving the service they provide to the service users as well.
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