Roundal Wright Retirement Homes

1. Perception of Quality of Service at the Roundal Wright Retirement Home
A. Definition of Quality at the Roundal Wright Retirement Home
Quality at the Roundal Wright Retirement Home is the degree to which home care services for individual residents and populations enhance chances of coveted outcomes, and are coherent with existing professional knowledge. Therefore, quality refers to services offered at the Home, evaluated and analyzed at the individual and/or population level. In either case, the major focus of quality is on improving care outcomes at the Home. Accordingly, the goal is to ensure the use of the most suitable and evidence-based forms of home care interventions and technologies in serving the elderly in relation to the existing best practices. Quality assessment at the Roundal Wright Retirement Home should be addressed in perspective of the staffs (i.e. caretakers, cook, electrician, etc.), the elderly (singles and couples), and the home community. More specifically, quality assessment should focus on the staffs’ interpersonal skills (i.e. of the housekeeper), technical knowledge (i.e. of the electrician), and amenities care (i.e. of caretaker). It should also focus on the elderly’s personal experiences against their expectations, and on the community’s access to technical, monetary, and health resources.
Based on the given case study, the key elements of high quality at the Roundal Wright Retirement Home include effective communication, shared decision making (i.e. involving the cook and housekeeper), cultural sensitivity, and delivery of appropriate and competent retirement home services. Apparently, there is a growing pressure and need to improve quality of the retirement home services. Based on the findings of Sandy’s assessment, the pressure and need arise from malpractice incidents (i.e. double-parking), high costs of home care services (i.e. extortionate cost of meals), inordinate variation in practice (i.e. cold stew and worsening taste of food), diminishing morale among staffs (i.e. of the cook), and regulatory pressures (i.e. a visit from the Area Manager). Clearly, then, the key factors causing quality issues at the retirement home are lack of ample management (including administrative), insufficient staff supply (having only a single cook), non-empowered retirees and their families, and puny performance monitoring systems as identified by Adams (2012) in his work.
Quality at the Roundal Wright Retirement Home can only be improved by solving the existing issues and delivery expected services by the retirees and associated authorities. This solution requires quality thinking and assessment to improve the delivery of home care services. Quality assessment would help the Roundal Wright Retirement Home in understanding the measurable outcomes of retirement home services, while knowledge of empirical outcomes would allow it to compare the impact of changes in service delivery. Upon assessing the relative pertinence and efficiency of retirement home services, the Home can provide optimal care to the elderly and maximize its use of limited resources, such as of money, space, and workers.
B. Quality Assessment Tools to Analyze the Situation at the Home
Quality assessment at the Roundal Wright Retirement Home would mean the systematic appraisal of home care service to determine its functioning against set standards. It is also a way of stopping mistakes in the Home and avoiding issues associated with delivering services to the single and couple elderly. Typically, the objective of quality assessment in a similar setup is to ensure whether the development process of a service is one that results in services that can satisfy the elderly needs. There are various quality assessment tools applicable to the case study at hand, including the Cause–and–Effect Diagram, which is suitable because the Roundal Wright Retirement Home experiences some quality issues currently.
Cause–and–Effect (Fishbone) Diagram
In quality assessment, the use of the Cause–and–Effect Diagram is to search all the possible or actual causes (or influences) that bring about a single effect (or outcome). In the case study at hand, the Cause–and–Effect Diagram would be applicable in identifying what cause complaints and dissatisfaction among the elderly at the retirement home. The assessor then arranges the causes according to their level of significance, resulting in a chart of connections and hierarchy of cases, sorting out ideas into valuable categories. The Cause–and–Effect Diagram is a particularly applicable tool to this situation because it helps in identifying several possible causes for problem, such as Sandy identifying the 15 causes of dissatisfaction at the retirement home.
The Cause–and–Effect Diagram assessment tool can help the Roundal Wright Retirement Home in searching for core causes, discover areas where there may be issues, and compare the proportional significance of different causes. Therefore, the Cause–and–Effect Diagram assessment tool is necessary when digging into potential causes for a problem. The other name for Cause–and–Effect Diagram is the Fishbone Diagram, based on its resemblance with a fish’s skeleton, with the major causal categories sketched as bones fixed onto the fish’s spine (Mahadevan, 2010):

Figure 1: Cause-and-Effect Diagram
To chart and apply this assessment tool, the management of the Roundal Wright Retirement Home has to follow and ensure the following steps:
1. The management and staff will need to agree on a problem statement—that the elderly are dissatisfied with service delivery at the retirement home. The will need to write the problem statement at the center right of, say, a whiteboard. The assessor will then need to draw a box around the statement and draw a horizontal arrow running towards it.
2. In this phase, the team will have to brainstorm the main categories of causes of dissatisfaction. The team can decide categorize the causes as Methods, Equipment, Manpower, Material, and Environment, or narrow down as Food, Parking, Space, Landscaping, etc.
3. The assessor will need to label the causal categories as branches from the main horizontal arrow.
4. The management and staff will then brainstorm all the potential causes of the problem, asking questions such as “Why does X happen?” Each idea is labeled as a branch of a relevant category.
5. In this step, the assessor will continue inquiring about the possible reasons for a given cause, and writing sub–causes forking off the causes. The facilitator will need to continue asking why the effect result, generating deeper levels of causes. Levels of branches suggest causal relationships.
6. Finally, when the management and staff run out of ideas, it will then have to concentrate on places on the diagram where ideas are few.
The management and staff at the Roundal Wright Retirement Home will work on each cause, solving every bit to iron out the main problem.
2. Quality Improvement Models
Since the Roundal Wright Retirement Home offers services rather than goods, and because of the partially identified causes of a major problem, ServQual and Six-Sigma qualify as the most appropriate quality improvement methods in the retirement home. However, these models can be more effective if used after applying the Cause–and–Effect (Fishbone) Diagram assessment tool.
I. SERVQUAL
In the case study at hand, SERVQUAL means measuring the level of quality of service at the Roundal Wright Retirement Home. This scale would help in assessing elderly perceptions of service quality at the retirement home. It is a representation of service quality as the variance in the elderly’s expectations for home care services and the elderly’s perceptions of the services delivered. Using this model would require additional resources in the production and distribution of assessment materials. For instance, the Roundal Wright Retirement Home would need questionnaires to collect the elderly’s expectations of service quality in terms of Reliability, Assurance, Tangibles, Empathy, and Responsiveness dimensions, against their perceptions of the service they actually receive (Lages & Fernandes, 2005). Compared to the directness of the responses collected, the cost of distributing questionnaires in the 55 homes will be largely insignificance. However, to improve service quality through this method will demand an increased in staffs to ensure efficient service delivery.
After collecting and analyzing responses through questionnaires, this model categorizes the required quality improvement actions into Gaps, and assigns each gap to the relevant staff or department in an organization, which will be accountable for that action (Grigoroudis & Siskos, 2010). The following table provides examples of such measures as they apply to the Roundal Wright Retirement Home.
Table 1: Roundal Wright Retirement Home’s perception-expectation gap
GAP ACTION REQUIRED TO ENSURE HIGH PERCEIVED QUALITY ACCOUNTABLE ORGANIZATIONAL DEPARTMENT
GAP 1 Ensure consistency between internal quality specification and the expectations of the single and couple elderly. Marketing
Operations
Service Development
GAP 2 Ensure internal specification meets its intended concept of design. Marketing
Operations
Service Development
GAP 3 Ensure actual service conforms to its internally specified quality level. Operations
GAP 4 Ensure that promises made to customers concerning the service are fulfilled Marketing

Following implementation, each department should report to the management for further evaluation whether the module helped in solving the main problem (Hernon & Altman, 2010).
II. Six Sigma
Although the Roundal Wright Retirement Home is a service provider rather than a manufacturer, the Six Sigma quality assessment model will be important in the retirement home’s efforts in improving home care services. This model is specifically relevant because of the identified problems within the Home and the need to identify and remove the associated causes to minimize variability in organizational processes. This model is significant because of its assertion that for an organization to become and remain successful, it needs incessant efforts to attain stable and anticipated process results. The model also evangelizes that to sustain quality improvement, everyone in an organization—particularly top-level management—must be committed to the cause (Harry & Mann, 2011). The Roundal Wright Retirement Home can accomplish these through the DMAIC (Define, Measure, Analyze, Improve, Control) (George, 2002) and DMADV (define, measure, analyze, design, verify) (Vootukuru, 2008) processes. The DMAIC process perfectly fits this case study because the process focuses on improving the existing actions that brings worse outcomes than expected. Improving quality of the Roundal Wright Retirement Home using the DMAIC process will follow through the steps in the following chart (Figure 2:














Depending on the method used, the Sigma Six quality improvement model may require additional resources, such as for collecting and analyzing data. The model may not require additional human resources, but it comprehensively helps in solving quality problems at the Roundal Wright Retirement Home by preventing the cause.

References
Adams, J. (2012). Good Products, Bad Products Essential Elements To Achieving Superior Quality. New York: McGraw-Hill.
George, M. L. (2002). Lean Six Sigma combining Six Sigma Quality with Lean Speed. New York: McGraw-Hill.
Grigoroudis, E., & Siskos, Y. (2010).Customer Satisfaction Evaluation Methods for Measuring and Implementing Service Quality. New York: Springer.
Harry, M. J., & Mann, P. S. (2011).Practitioner's Guide to Statistics and Lean Six Sigma for Process Improvements. Hoboken: John Wiley & Sons.
Hernon, P., & Altman, E. (2010).Assessing Service Quality: Satisfying the Expectations of Library Customers (2nd ed.). Chicago: American Library Association.
Lages, L. F., & Fernandes, J. C. (2005). The SERPVAL scale: A Multi-Item Instrument for Measuring Service Personal Values. Journal of Business Research, 58(11), 1562–1572.
Mahadevan, B. (2010). Operations Management: Theory and Practice (2nd ed.). Upper Saddle River: Pearson.
Vootukuru, A. S. (2008). DMARC a Framework for the Integration of DMAIC and DMADV. Orlando, Fla.: University of Central Florida.