Author: Andre Coleman

1.0 Introduction

This report will explore on mental health and community care within the historical view of community care and the impact of ideological perspectives that have influenced it. It will further analyse the benefits and shortfalls since its implementation, taking into account the impact of the 1990 NHS Community Care Act and current reforms will be considered. Again, the effects of poverty and social exclusion for those accessing community Care will be discussed. The author will further consider key aspects of mental health and the gradual transition from insitutionalisation to deinstitutionalisation (community care) since the early 1950s will be discussed. Recommendations shall be made regarding, especially, how the mental health system (including community care) could be improved.

HISTORY

In the pre-medieval period people believed that mental illness was a result of the possession of the human body (patient) by evil spirits. In order to get these perceived evil spirits out they drilled holes in the skull of such people. Andreasen (2001) tries to give credence to this by mentioning that scientists have found fossils of drilled skulls that are about 10,000 years old. During the middle ages a belief in Europe was that witchcraft was the reason for mental illness. As a punishment such people with mental illness were killed by burning, hanging or drowning. Some were put in government institutions called poorhouses. By the 1500s many European nations had built special institutions to separate the mentally ill from the rest of society. One of the most famous of such institutions was the St. Mary of Bethlehem in London which was built in 1247 and declared a hospital exclusively for the insane by 1547 It is widely known widely known as Bedlam. According to Butcher et al (2009), inmates suffered from unsanitary conditions, beatings and other harsh treatment. This included violent patients being used for shows display shows for the public to pay and watch, while gentler patients were sent to beg for charity on the streets.

A lot has changed in the United Kingdom especially with the relative improvement in the mental health institutions or hospitals and also with the emphasis on community care since the 1950s. In fact some see care in community, usually referred to as community care in as a replacement for hospitalization and any other form of institutionalization of people with mental ill health. However, these historical perspectives of mental illness can stick in people’s minds, and can still cause stigma today. Goffman(1961)

Community Care

Skidmore (1997) describes community care to be the various services available to help individuals manage their physical and mental health problems in the community with dignity and independence in order to avoid social isolation. Similarly, Clough and Hadley (1996) explained that community care can be means of providing the right level of intervention and support to enable people to attain utmost autonomy and control over their own lives. The author notes that in order for these to be achieved, it will require support by formal and informal carers input

The development of community mental health care has evolved over a period of years as opposed to institutional care. Goffman (1961) stated that social and political changes influenced the movement away from isolation of mentally ill in old Victorian asylums towards their integration into the community. Currently, there are various services that have been put in place to support people who have mental health problems and are leaving in the community. These services includes (Sainsbury centre of mental health 2003)

HISTORY

Community care has historically always been financed through a mixed economy financed by both the state and by user’s charges, and provided by voluntary sector organisations, commercial profit organisations, the state and the family (Lewis. J). Social scientist have made an association with informal care to family member participation. Informal care has historically been the origins of the present day community care. The origins of the term community care appear too traced back to the Royal Commission on Mental Health and Mental deficiency (1957) which notes ‘The Development of Community Care’ (Bulmar 1987). However community care has a ‘multiple meaning’ (Bulmar 1987) and historical official use failed to distinguish these differences.

problem as it is a product in part of at least, the impact of political process and policy development.

According to Levites et al (2007), Social exclusion is a difficult and multi-dimensional process which involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. Similarly, Townsend (1979) defines poverty as “the absence or inadequacy of those diets, amenities, standards, services and activities which are common or customary in society”. I will argue from the above definition that, social exclusion and poverty are linked. Pierson (2009) argues that government likes to use the term to hide poverty. Barker (2003) stated that in recent years the government has launched a range of initiatives to help tackle social exclusion and reduce inequalities which has specific objectives relating to education health, employment, crime prevention and wider social well being. These initiatives include the need for communities to put into action; supportive and innovative approaches in order to promote local involvement to support people with mental health problems, as this will minimize exclusion. The structure of care in the community (in relation with mental health) can lead to poverty because many people who experience mental distress, experience stigma and discrimination as well. These issues may make it hard for them to find adequate housing or access employment. As a result, people can become seriously isolated and excluded from society. If this also includes being excluded from working life, then this may lead to poverty. Social Exclusion Unit (2004).

Usual Mental Health Professional Team

There is now a range of more specialist community mental health teams (CMHTs) in the United Kingdom (UK) these includes: Home treatment, Crisis intervention, Early Intervention, First episode psychosis, ABT (assessment and brief treatment), Continuing care, Rehabilitation, Assertive Outreach and Forensic services. These teams are as a reform to government policy to promote community care. They work with people with mental health problems by helping them to become independent, working with them to develop their strengths, working together to resolve problems and many other supports that enables the promotion of wellbeing. A typical mental health professional team include the psychiatrists who prescribe medication, the psychologists who administer and interpret psychological tests, the psychiatric nurses who administer prescription medication and give injections, and the social workers who have specialized knowledge in assessing and planning treatment (Suppes and Wells, 2000).

Conclusion/Recommendations

The gradual transition from institutionalisation to community care since the 1950s is certainly not unhealthy. It only would yield no positive results if, borrowing the words of Skidmore (1994), people with mental health problem are not just decanted into the community without an identification of the informal carers.

Social exclusion is a major concern in promoting recovery for those experiencing mental health problems and if not tackled on time will discourage and lead to relapse for those who have experienced or facing these difficulties. Promoting social inclusion will usually includes promoting equal opportunities for those who are excluded and experiencing discrimination so I can therefore say there is a clear link between promoting social inclusion and promoting equality and diversity to alleviate poverty. I also believe that the Mental health practice which is currently driven by the National Service Framework which aims at reducing discrimination and social exclusion to improve mental health of the population should be supported by mental health professionals to build social inclusion into clinical practice by including in the care plans of users their aspirations for work, education, relationship and other chosen journeys of ‘recovery’.

The following recommendations are worthy of consideration in the bid to improve the current mental health system in the United Kingdom.

Research concerning how institutional and community care can be improved

Reduction of stigma against people with mental illness since that can jeopardize their speedy recovery whilst in the community.

Involvement of informal carers in decision-making regarding treatment of patients

Attend to the health needs of informal carers

Informal carers should be trained on how best they can take care of patients.

The British government should invest more in community care especially with the needs of patients in communities.

Deinstitutionalization should be done more gradually and carefully especially in the case of people with chronic mental illness.

Poverty is generally understood to mean a condition in which people are deprived in some way, such that they lack the basic requirements for sustaining well-being, and ultimately, life. These basic requirements are understood as such things as food, water, shelter (as may be understood, for example, in a developing country context) or access to education or political power (as might be understood, for example, in the context of a developed nation). Poverty is an absolute within itself, as people are termed to be in poverty, but poverty can also be understood in relative terms, when, for example, poverty of different resources is considered: poverty of education is obviously not as fundamental a level of poverty as poverty of food, for example, as, obviously, without food, a person would die, but a person can manage to live without education, even if this would mean a life of continuing poverty, through lack of opportunity.

Poverty can be measured in many different ways, and indeed, there are many indicators of poverty, which are used to assess year-on-year changes in poverty. Obviously, as with definitions of poverty, measurements of poverty are relative, with different measures being used in developed vs. developing nations, for example, or between nations of the developed, or developing, world. In general, one overall measure of poverty which has gained ground in recent years is the income inequality scale, which shows that income inequality has, recently, worldwide, become less of a problem, with the world becoming more equitable in terms of income levels across the world’s nations. This does not belittle the problems of poverty, however, as poverty is still a major issue that the world has yet to deal with in a satisfactory manner.

As with the definitions and measurement of poverty, the causes of poverty are many and varied, with environmental and geographical factors creating poverty in many developing countries, and with disease and lack of natural resources also causing poverty in these regions. Indeed, it is difficult to attribute one cause to poverty in any situation, especially poverty in developing countries. In developed nations, however, poverty is perhaps best understood as a product of society’s failure to act to avoid the situation, and, as such, policies are in place to prevent poverty in these situations^[1]. It is a moot point, however, amongst politicians, social workers and philanthropists as to how far policies can actually prevent poverty, and, indeed, some people suggest that current policies do not go far enough to act to prevent poverty.

The effects of poverty are, again, many and varied, with poverty leading, ultimately, to death, in many developing nations, and with poverty leading to lack of opportunity and social exclusion in developed nations. In developed nations, policies are in place to avoid such poverty, such as subsidised housing, education and health care^[2], although these are not always effective, as we have seen, leading to undesirable effects, such as crime (Jones, 2001; Muncie, 2004). It is hypothesised, for example, that in extreme poverty situations, people turn to crime in order to provide basic necessities, and this has been supported by much original research on the subject (see Muncie, 2004).

The next section of the paper will look at levels of poverty in the UK, and following this, the paper will then proceed to assess poverty in the UK from a Marxist viewpoint. Poverty in the UK is still at shockingly high levels, with the problem seeming, on the face of it, to be mainly caused by low pay levels; indeed, it is suggested by recent research that in low-income households, both members of the family need to work in order for the family to earn enough to cover basic expenses^[3], and that, of these low income families, many are at a disadvantage in terms of receiving health care and the achievement of minimum educational standards. It seems, also, that this trend, rather than decreasing, is actually increasing, with the number of families claiming children’s tax credits increasing year-on-year and the proportion of workers classed as ‘low paid’ increasing year-on-year^[4].

It is shocking, therefore, to see that much of the UK, and a large proportion of the children living in the UK, live in poverty. This is despite the fact that policies have been in place for many decades to try to curtail, and avoid altogether, the issue of poverty. As we have seen, however, these policies are often not effective, and can take years to come to fruition, by which time a new generation of infants have grown up in poverty, leading to what is known as ‘the poverty trap’. We have seen, therefore, how successive UK governments have attempted to deal with the issue of poverty: by creating policies to deal with each ‘strand’ of poverty individually, and not attacking the whole problem of poverty as a whole.

This leads on to thinking about how Marxists understand poverty, which is essentially in a more holistic, if idealistic, manner. Marxists do not make any distinction between class, poverty and disadvantage; for Marxists, members of any class, they argue, can fall into poverty through unemployment, for example, and that, as such, ‘the poor’ can be best be viewed as part of a continuum from those in society who have a lot of material wealth to those who do not. This definition using the idea of a continuum, however, stands in direct contrast to the situation of class inequality which, obviously, Marxists attempt to fight against by their calls for equality in society, for all.

Perhaps the issue of poverty can be best understood in terms of the dependency theory of Marxists: this theory suggest, essentially, that lifting the poor out of poverty is not enough, they need to be given tools to be able to sustain themselves out of poverty. True Marxists would add that this can never be achieved under a capitalist system, as this system is built to achieve successes at the expense of the failure of others; as such, poverty is a consequence of the capitalist system, and something which Marxists fight against, in their search for equality, or, rather, in terms of poverty, in their quest for a situation in which underdevelopment is not an option.

Assessing poverty in terms of a purely socio-political approach as we have done, and then within the framework of Marxism as we have also attempted, provides two different frameworks with which to understand the issue of poverty. One framework aims to treat poverty as something that can be solved by implementing policies and by watching those policies take effect, the other attempts to understand poverty as a societal achievement, which can only be solved by changing the very foundations of society.

Social workers are some of societies most valuable professionals, who, in concert with families, teachers, and the police can put children, and families, back on track before they reach an irreversible moment in which damage has been done which cannot be corrected. Children are valuable members of society, and it is the responsibility of all society to look after them: perhaps this is what Marx was implying when he talked of societal equality. Children deserve equality of opportunity, in terms of access to basic requirements, and, above these, to health care and education and information provision. Without these basic requirements, without basic care, children live in poverty. It is a travesty that in this day and age there are many children who live in poverty in the UK, but with the approach outlined here applied on a daily basis by social workers, it is hoped that poverty will soon be a thing of the past, at least in the UK.

References

Best, S. (2005) Understanding Social Divisions, London, Sage

Cree, V. E. (2000) Sociology for Social Workers and Probation Officers, London, Routledge.

Dominelli, L. (1997) Sociology for Social Work, London, MacMillan

Glennerster, H. et al. (2004). One hundred years of poverty and policy. Joseph Rowntree Foundation.

Iceland, J. (2003). Poverty in America. A Handbook of the University of California Press.

Jones, S. (2001) Criminology, Trowbridge, Cromwell Press

Layder, D. (2005) Understanding Social Theory, London, Sage

Muncie, J. (2004) Youth and Crime, 2nd edition, London, Sage,

Ritzer, G. (2000) Sociological Theory, London, McGraw-Hill

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These effects have a negative bearing on children and mothers since they affect self-confidence and ability to meet life goals. Separation, substance abuse, mental disorders and divorce are effects which adversely affect children’s development stages (Johnson & Ferraro, 2004). Abused children may replicate abuse as adults, which lengthen the violence cycle. This paper will discuss family violence in Canada including marital rape. Statistics which reveal extent of abuse will be disclosed and various dynamics of abuse discussed, including relevant laws. Since family violence is normalized, processes of normalizing the vice will be evaluated. Brief recommendations on how abuse can be discouraged will be discussed, with a summary given at the end.

Statistics

There are more than five hundred shelters for children and women in abusive households in Canada (Gannon, 2006). Newfoundland and Labrador, New Brunswick, Prince Edward Island and Manitoba have among the highest number of shelters. In 2007 over 40,000 cases of domestic violence were reported to law enforcers. This comprised over 11% of the overall crime in Canada, which is a significant proportion. In addition to this, over 80% of victims were female, which shows that wives bear the brunt of violence in households. In most cases, assault was reported in family violence, with stalking, criminal harassment and threats being other forms of abuse committed. In over 80% of abuse cases, people familiar to victims performed abuse. More than 40% of women are also reported to have experienced marital rape.

Law enforcers were also blamed for abuse, with over fifty thousand cases involving youth and children being committed by them (Wallace, 2009). Amongst adults, law enforcers reportedly abused over 1900 people, with this representing a third of abuse cases amongst adults (Gannon, 2006). Generally, these statistics reveal that both law enforcers and the public are responsible for abuse. Children and women suffer the largest proportion of abuse, with this being performed by men they are in relationships with. Domestic abuse comprises over 10% of the overall crime committed which reveals the severity of the issue. It is imperative that abuse is analyzed in further detail and prevention measures developed to stem this rising crime.

Canadian rape laws

Initially, rape was regarded as an offense in common law. Common law is borrowed from England and it initially treated rape as abduction. It was regarded as an offense greater to fathers or husbands than to female victims. Marital rape was unheard of during this period and was not considered criminal. The society then, also marginalized women and their testimony alone could not prove evidence of rape. Their previous sexual conduct was heavily relied on in proving rape. However, this crime was unreported despite its rampancy. In 1983, weaknesses in existing laws led to changes which redefined nature and punishment for rape. There needed to be stricter punishment and higher convictions to encourage women to report rape. Changes included abolishing analysis of previous sexual history of victims, repealing of corroboration laws and redefining of rape to assault. Further legislation changes in 1992 outlined the shield on use of historical sex lives of victims in questioning their credibility.

Reasons for domestic abuse
Power and domination

The quest for power contributes highly to cases of domestic violence. Some people need to dominate others to feel they have power. These people use oppression and abuse as tools to attain power. Physical abuse enables them to make victims powerless over them. Economic abuse ensures that victims are dependent and cannot escape abuse. Mental disorders, low esteem or stress may drive offenders who use violence to attain power. Such abuse may be reversed through medication and therapy with support from family (Babcock et. al., 2004).

Drug abuse

When people use drugs, they may be unaware of consequences of actions. They are unable to reason rationally and may resort to abuse. People who live with drug abusers suffer most from effects of drugs including increasing irritability, delusions, stress and other effects (Dutton, 2006). These may lead to domestic violence and can be treated through medication and therapeutic interventions.

Socialization process

Research reveals that children who undergo abuse when young may replicate the abuse as adults (Kitzmann et. al., 2003). Abused children have higher chances of practicing family violence as adults compared to those not abused. This is explained by the sociological theory where children practice things imparted on them during the sociological process. When they are abused, they may view it as part of socialization and they may commit the same to their families as adults.

Normalization of family violence

The widespread nature of family violence has created a perception of normalization, where violence against women is “acceptable” by society. Normalization of violence is seen in low reporting rates of violence at home. In Canada, over 50% of cases of violence in family settings are unreported, according to research. Since family violence is widespread, there are emerging trends where batterers are offered sympathy at the expense of victims. This trend began in the 1980s in US where intervention and support programs for batterers were created. These programs rationalize domestic violence and perceive batters as victims. The society is thus sympathetic to abusers and they become tolerable to certain degrees.

In some cases, victims view themselves as having provoked abusers, hence rationalizing the crime. Since batterers are close family members, victims may also avoid reporting battery due to consequences on family units, especially if they are dependent on the batterer (Ellsberg et. al., 2001). Others fear societal perception of the abuse especially if it leads to divorce. They see it as shame and allow violence to be perpetuated against them. This gives the abuser leeway to commit abuse and normalization of abuse occurs as a result. Victims view it as normal and learn to live with violence.

Weak laws governing violence also normalize violence since victims will not report abuse if there are few and light convictions. In addition to this, barriers to reporting, investigating and prosecuting abusers may lead to normalization of abuse. The laws governing rape in Canada in 1980s can illustrate this phenomenon. As was discussed, the society marginalized women, and their testimony alone could not prove evidence of rape. Their previous sexual conduct was also heavily relied on in proving rape. In addition to this, marital rape was unheard of. Weaknesses in such laws discouraged reporting of rape, and this normalized the crime. When changes were realized in 1983, reporting rates increased and rape cases decreased.

Weaknesses and strengths of research sources

There are different research used and these have diverse weaknesses and strengths. Most works used are journals and books which are scholarly in nature. Scholarly works are credible information sources since they are written by professionals in diverse fields. These works are sourced from the Internet, which is readily available and cheap, which is a strength of these sources. They also cover diverse topics and give various dimensions on topics discussed, which makes them accurate and credible. However, weaknesses include inability to corroborate information gathered due to difficulty in tracing the authors. This may create ambiguity or inaccuracy in research done. Duplication of error is another weakness which arises from use of inaccurate scholarly works. If works used are inaccurate, the research findings will be erroneous. Finally, these works may be outdated which makes research inaccurate.

Conclusion

Various aspects of family violence and marital rape have been evaluated. Marital rape and domestic violence is rampant, with 40,000 cases of domestic violence being reported to law Canadian enforcers in 2007. This comprised over 11% of the overall crime in Canada. Various reasons for violence including socialization process, power and domination and drug abuse have been advanced as reasons for abuse. However, there is no rational reason for commission of violence. Recent trends have also revealed normalization of violence in the current society. Weak laws, fear by victims and societal perceptions are to blame for normalization of abuse. This is dangerous for society as it encourages commission of crime. The statistical evidence also shows that law enforcers also practice abuse, and this is intolerable in society. This paper used scholarly works and books, and these are valid sources. The evidence provided is therefore accurate and several measures which discourage abuse should be taken. Some of these will be discussed in recommendations provided below;

Recommendations on reducing family violence
Legislation

Legislation plays a crucial role in acting as deterrent to crime. Many people cannot commit crime due to fear of repercussions. In tackling domestic abuse, a similar approach is effective since harsh repercussions will deter offenders. The Canadian parliament should develop harsher legislation to deal with marital rape and domestic abuse since it is a significant societal problem. This will reduce instances of abuse through long sentences to abusers.

Rehabilitation

Although Canada has over five hundred rehabilitation shelters for abuse victims, this figure is still inadequate (Taylor-Butts, 2007). More shelters for abuse victims should be constructed and stocked with necessary facilities and staff to help victims. This will enable victims to achieve their life potential through pursuance of individual dreams and goals.

Public education

According to Hamel and Nicholls (2007), education is very effective in reducing abuse. The public should be educated at individual, society and family levels on domestic abuse. Abuse signs and cooperation with law enforcers will help eradicate this vice. In addition, shelters for victims should be publicized to ensure victims seek justice. Education on abuse will prevent the normalization of abuse in families.

Interpersonal skills, majority of the managers chose interpersonal skills as their greatest strength. Managers must have a good communication skill in dealing with their stakeholders. In Catherine Lodge, our manager has effective communication skills in dealing with the entire situation with regards to resident’s needs if it is being met, staff, and resident’s families.

A good company wouldn’t have a very strong foundation without a team that helps in problem-solving. Care workers must be careful in recognising a problem by assessment, know the possible cause and effect, and plan for the procedure thoroughly. Team work will set in, as the person who recognises the problem will report to the team, to assess, collect all the data, and to plan the best action. Communication is still there as they are following a process of solving a problem, and in decision-making. (http://www.jstor.org/discover/10.2307/2629217?uid=3738032&uid=2129&uid=2&uid=70&uid=4&sid=21101226337883)

The aim of the policy is to ensure that the effective channels of communication are established, supported and maintained. It believes that the communication of good information promotes quality care, offers client’s assistance in making informed choices and plays a vital role in motivating and supporting staff.

aˆ?To enable us to fulfil our statutory responsibilities to provide information.

aˆ? To communicate effectively with staff about ongoing issues, policies and procedures.

aˆ? To provide opportunities to consult with staff and for them to express their

Views and offer ideas and suggestions.

aˆ? To communicate effectively with client’s and their representatives.

aˆ? To promote the quality of service that we provide to our clients.

Technology is moving so fast nowadays that we have many electronic aids to help us communicate. For example, smart phones can used to make calls, send text messages and emails; can used to make video call where you can see the person on the other line, can leave a voice message if it’s not available.

There are many factors that affect communication. They are:

aˆ? Sensory deprivation – when someone cannot receive or pass information because of visual and hearing disabilities.

aˆ? Foreign language – when someone has different accent, different pronunciations, and/or uses sign language that the other person does not speak, or understand.

aˆ? Jargon – Using of medical terminology to a patients, service users, and family members that they may not understand, it is better to explain things according to the level of their understanding because understanding the facts can make something appear less scary.

aˆ? Slang – when a care worker uses a language that is not everyone uses, or familiar with.

Cultural differences – there are some things that has the same meaning but could mean different in two cultures. For example, keeping an eye contact whilst communicating is seen as being respectful, and being truthful, but for some culture like in East Asia for them it is a sign of being rude and defiant.

aˆ? Distress – everyone can experience distress, this can be difficult for them to clearly understand what is being said due to lack of focus.

aˆ? Emotional difficulties – every one of us has emotional difficulties at times and can make us upset. The negative effect is not to hear or understand clearly what the other person is is telling you and can lead to misunderstanding.

aˆ? Health issues – when the person is ill, he/she cannot be an effective communicator, especially service users that suffering from Parkinson’s disease or Multiple Sclerosis affect an individual’s ability to communicate properly, care worker should be trained and aware on how to work with these people.

Communication Audit it is a method use to identify the Strengths and Weakness of your current and external communications.

Organisations recognise the benefit of keeping their customers, clients, investors, partners and/or members aware of happening with in their organisation. The techniques they choose are varied, ranging from the “tried and true “e.g. e-mailings, and website postings, variant of high technology tools. Placing a suggestions box at the front door gives the resident’s family to write their comments and suggestions anonymously or they can name their names, and/or they can even go straight to the managers, seniors for their comments. Making quarter year survey that requires family member of clients to answer a questionnaire, and they are free to add their comments.

When Stakeholders reach out: developing and implementing a promotion plan We go into developing a promotion plan. We offer steps and examples. From there we look at what a communication plan entails. Emerging from this we look at relating to the media. We highlight the importance of identifying key messages and who your target audience is for different promotion work. Finally, we offer lots of suggestions for nervous speechmakers.

Promoting your organisation: when people reach in: A large part of an organisation’s work happens through telephone contact and with visitors coming to your office. If you put people off with a negative attitude when people phone in or visit, you will probably end up having an organisational image not to your liking. So, we look at promoting your organisation’s image in this context. We give ideas about your reception area, how you receive people, handling phone calls and e-mails. And we end off looking at how you can monitor and evaluate your organisat ion.

Task 2 – Report

Catherine Lodge is a residential care home that aims to provide continuous professional care to all its residents within a safe, friendly and relaxed environment. It caters up to 39 elderly residents providing each individual with a personal form of service derived from a carefully formulated care plan that meets their needs. This is provided both in short and long term basis depending on each individual. Since each resident has specific needs that range from physical, psychological, social or spiritual needs on a 24 hour basis it requires a certain level of personnel to facilitate this.

“Show me the money!” Well, that’s what financial data do. They show you the money. They show you where a company’s money came from, where it went, and where it is now.

There are four main financial data. They are: (1) balance sheets; (2) income statements; (3) cash flow statements; and (4) statements of shareholders’ equity. Balance sheets show what a company owns and what it owes at a fixed point in time. Income statements show how much money a company made and spent over a period of time. Cash flow statements show the exchange of money between a company and the outside world also over a period of time. The fourth financial statement, called a “statement of shareholders’ equity,” shows changes in the interests of the company’s shareholders over time.

A balance sheet provides detailed information of company’s asset, liabilities and shareholders’ equity.

Assets are things that company owns that have value. They can either be sold or used by the company to provide services that can also be sold. It also includes physical property of the residents that can/can’t be touched but nevertheless exist and have value.

Liabilities are amounts of money that a company owes to others e.g. all kinds of obligations like borrowed money from a bank, payroll a company owes to its employees, environmental costs, taxes owed, and obligations to provide good quality of services.

Shareholders’ equity or capital

Income statements is a report that shows how much revenue a company earned over a specific period, it also shows the company’s net earnings and losses.

Cash flow statement report a company’s inflows and outflows of cash. This is important because a company needs to have enough cash on hand to pay its expenses and purchase assets. While an income statement can tell you whether a company made a profit, a cash flow statement can tell you whether the company generated cash. It shows the net increase or decrease in cash for a period.

In Residential home, we have enough staff to work in the morning, in the afternoon and at night. We have a monthly staff meeting to raise our concern at work, problems with our colleagues, and suggestions on resident/s care plan, and we also have a separate Senior Carers meeting, the Manager/Owner and the Deputy Manager always presents the Carers the needs of good communication, and team work. We have supervision every 3 months, the manager is giving feedback to identify our strengths and weaknesses, and if they think the staff needs to be trained, and appraisal every 6 months in which we rate ourselves, and the Deputy Manager is rating the staff as well in our performance, we can voice out our own opinion, about the job, colleagues and if we are getting support from the Managers. The company also provided us mandatory training, manuals, booklets, presentation from the lecturer and a questionnaire that we need to answer at the end of the training. Catherine Lodge has a seasonal newsletter where they introduce new staff member, residents who celebrated their birthday, and about the achievements of the company.

A good communication skill is very important, specially working in care settings. Working with vulnerable adults requires more understanding, must have different techniques and strategies use in supporting communication between the individual with specific communication needs. Good communication with vulnerable adult is essential. This includes identifying behaviour triggers, by means of visual prompts and speaking in short, clear sentences. I considered that the social workers used verbal and non-verbal forms of communications and applied the principles of active listening. Some people with disabilities are not able to use speech as their principle means of communication. They may however be able to use an alternative method of communication such as symbols and symbolic languages. It is vital to recognise that symbols are different from pictures. Pictures generally convey a lot of information at once but their focus is often unclear. Symbols, on the other hand, are often designed to convey a particular meaning. Symbols or symbolic languages can be applied to signify many aspects of verbal communication. Symbols can be presented through visual, auditory and/or tactile media and can take the form of gestures, photos, manual signs, printed words, objects, ‘reproduced’ spoken words or Braille. Symbols help understanding which can increase involvement, choice and confidence. It helps support creativity and self expressions. Using mobile phones at work is strictly prohibited, as it may interfere in whatever the carer is doing or it may cause accident e.g if the Carer is feeding, doing morning care. Some residents may have challenging behaviour that sometimes affects the carer itself, they best react in a calm, quiet environment, Carer must consider the Residents preference, cultural difference, language and environment, assumptions, judging, noise, and distraction.

The use of technology helps the care workers by having an easy access by just typing the resident’s name all his/her information daily report will come out in one click, comparison graph of residential’s weight incomparable from past to present will easily available in one click, not unlike if it is just written and filled you have to search for it and check the book where you filed it. Make work a lot easy, report will neat and tidy, because it is easy to edit if you accidentally misspelled.

Disadvantage of it is if the computer got virus and/or the system got hacked all the information will wipe out, that will give an extra work for the manager, care workers, and andmin.

Code of Practice sets out the minimum standards and guidelines for hygiene, fire building safety, and the level of care required , which aims at ensuring that residents in the homes receive services of acceptable standards that are of benefit to them physically, emotionally and socially. (http://www.swd.gov.hk/doc/downsecdoc/code_rchpd.pdf)I will assess the workplace strategies, policies and procedures that should be in place to ensure good practice in relation to all forms of communication in health and social care setting. The health and social care industry mainly focuses on the heart of care. Since it involves people, communication takes a very important role. Effective communication is not only significant to the health care professionals in ensuring the improvement of clients’ quality of life by addressing their needs. It is also the client’s and support systems’ right in the promotion of their equality and diversity as people.

Workplace strategies, policies, and procedures for good practice in communication focus on ensuring privacy, and confidentiality, disclosure, protection of individuals, rights and responsibilities, and equal opportunities. Moreover, a practice on disciplinary procedures, complaints policy, and flexible working also benefit the entire health care team. If all these flow efficiently, there will be no hindrance in the system of communication. For example, one of our residents had a GP appointment and I escorted her. When we arrived in the GP surgery, the receptionist asks the residents loudly for the reason that I am in the GP surgery in which other patients can hear, there is a break in the policy of ensuring privacy. Whenever I start expressing my concerns at her pace, then I will definitely not have my privacy. It establishes a barrier between us personally and professionally. As a patient, I might start complaining with regards to her action.

Effective communication is a key factor in success may it be in work or association. It is always a part of personal and professional progress. Therefore, to master communication skills and techniques is a very important area to develop in each individual. In the given scenario its implication is to render a quality health care service which benefits the service providers and the service users.

Data Protection is designed for person responsible for safeguarding the confidentiality of information and of the person giving his or her own information. One of its purposes is to safeguard “the fundamental rights of individuals”.

This act governs the right storage and processing of personal data held in manual records and on computers. Under this act, the rights of the individual are protected by forcing organisations to follow proper and sound practices, known as data principles (DPP). Reporting and recording of information is a vital form of communication needed to ensure the safety of vulnerable adults. Parts of a carer’s daily routine should include making notes in a care file, as well as using communication books, forms and documents. Make sure that the writing is legible and clear, that is signed and dated, and that where necessary copies are made.

http://transparency.dh.gov.uk/dataprotection/information-charter/

Health and Safety inspections are an important monitoring tool to help ensure that workplace hazards are controlled and that risk to employees and others are eliminated or minimised. Inspections should be carried out regularly. Carers must inspect the equipment/s before using it, report and record all faulty equipment/s to the Manager e.g. heating, lightning, and ventilation. Charter is for anyone who has dealings with the Department of Health whether through correspondence, involvement in public policy consultations or if for any other reason we hold personal information about the resident.

Communication and listening gives clues to a better understanding of an individual’s preferences and wishes. Gathering information about an individual will lead to creative and supportive ways of providing care. Carers must exercised active listening and having the ability to empathise with the residents by paraphrasing what the others saying to her and understand it. So that, she will increased the trust and gain more information from the individuals. Communication itself is influenced by individual’s values and culture. Carers should always make sure of eye contact; focus on what they are saying and acknowledged what is being said to her by paraphrasing or nodding her head. Carers must also use different technique to enhance their social culture, beliefs and values. Like for instances, I usually greets and chat with the individuals by smiling , Carers must apply the sense of touch in her communication. I believes that by means of touch can be a very positive form of communication in that it can provide comfort and re-assurance when someone is distressed making them feel safe and secure, it can also be a signed of love, respect and affection to somebody or it may calm someone who is agitated. In this case carers show that they met the desires of the human beings to their client which are love, purpose and self expression.

Carers should be warm and caring in nature and she has the ability to connect well with others. Fine qualities and having a good communication skill plays important role in the delivery of care in whatever ethnicity, sex, education or social care they may be.

Saving face is saving your credibility, dignity and ethics by means of being honest, getting out of the situation by means of good explanation.

Theories of Organisational communication

Attraction- selection attrition framework; In Attraction, everyone is different, people are differently attracted to a career for different reasons, this could be their passion, helping and/or looking after people could make them happy and fulfilled, even if they just want to try different job, and this is depending on their personality to choose the organization they want. In Selection, in organization the Manager chooses who she thinks will qualified for the job, with the same interest, goals, and personal reasons. Attrition, this is the complete opposite of attraction, where the people who didn’t qualify, or found that they are not happy with the organization, management, job tend to leave, only those people who have the same ideas, interest, fits in the job chose to stay. A very good example is in the residential home I used to work, I’d chose that residential home to apply because of a good reputation. The manager hired me because she thinks have got the qualification they are looking for, and I can contribute to the organization. I and the other lady started working as a Induction carer, 3 days after the manager talked to me, and told me my colleagues are happy working with me and I can start working as a regular carer, working on my own. The sad part was, the new lady didn’t appear two days after.

http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Public%20Relations,%20Advertising,%20Marketing%20and%20Consumer%20Behavior/Attraction-Selection-Attrition_Framework(ASA).doc/

There are many types of organizational communication. Individuals communicate with peers, superiors, and subordinates within the organization. Managers manage through communication. Employee communication departments attempt to inform and/or secure “cooperation”; from employees. Labour relations specialists deal with labour unions. Formal and informal communication takes place between departments and role occupants throughout the organization. Public relations specialists communicate to external audiences about the organization in general,and advertising departments communicate to consumers about the organization’s products and services. Change agents; and other organizational representatives communicate with clients and community representatives. Finally, organizations communicate with other organizations which generally share common problems or values. In groupthink or team work, a manager or team leader should be sensitive, open to accept suggestions from your subordinates in order to meet the target goal. Working in groups are building blocks for meeting organization goals. Managers should also consider ways to develop leadership in team members. Training for versatility in leadership styles through workshops could encourage this growth. Encouraging self-growth through concept of motivation.

It is very important to have an effective communication at shift turnover; Care workers should give this a high priority. Shift turnover should be included in the safety-critical topics supervised and audited periodically by management. They should identify its importance in policy and procedures, assign responsibilities and set minimum standards. A description of how to conduct an effective handover should be available so individuals can assess and improve their own practice. High risk handovers needing extra attention should be flagged up.

The importance of effective communication skills during shift handover and throughout other work activities suggests this attribute should be amongst the selection criteria for key posts. Furthermore, opportunities should be available for existing staff to develop their communication skills if required.

To be able to motivate a care worker is to identify his strengths and weaknesses, and by giving him feedback. Being open to accept negative feedback is the key for being productive by improving, and being eager to learn, and update skills. Team work and good communication with one another will make each other’s work easy.

Task 3 – Interpersonal communication

How the use of ICT in health and social care benefits service users? The Information Communication Technology aims to the efficiency of the health care services. This means to b a better outcome for the same or a lesser use of resources. ICT also helps and empowers the health and social care staff, it improves positive patient’s experiences and facilities research and development relevant to health and social care, the legal consideration in the use of ICT is the Health and Safety. How the ICT supports and enhances the activities of care workers and care organisations? As aforementioned, the ICT supports and enhances health and social care activities of care workers and care organisations. It is through administrative, financial, clinical, infrastructure applications, etc. That the needs of staff are met; and there is a high regard innovation in business administration, efficiency and quality of service. It also helps in meeting requirement of other agencies, accountability, and audit. For example, the use of a computer screen is an indication of a patient’s arrival makes the work of the receptionist lighter and easier. Imagine if there was no such thing then the receptionist will have to entertain every person coming in a queue. She will not have enough have time to do other things.

Working with vulnerable adult, Professionals must shows different techniques and strategies used in supporting communication between the individual with specific communication needs. Good communication with people with vulnerable adult is essential. This includes identifying behaviour triggers, by means of visual prompts and speaking in short, clear sentences. I considered that the carers must use verbal and non-verbal forms of communications and applied the principles of active listening. Some people with disabilities are not able to use speech as their principle means of communication. They may however be able to use an alternative method of communication such as symbols and body language. It is vital to recognise that symbols are different from pictures. Pictures generally convey a lot of information at once but their focus is often unclear. Symbols, on the other hand, are often designed to convey a particular meaning. Symbols or body language can be applied to signify many aspects of verbal communication. Symbols can be presented through visual, auditory and/or tactile media and can take the form of gestures, photos, manual signs, printed words, objects, ‘reproduced’ spoken words or Braille. Symbols help understanding which can increase involvement, choice and confidence; it helps support creativity and self expressions.

Theories of Interpersonal Communication

Uncertainty reduction model People have an urge or need to reduce uncertainty about individuals that they find attractive and this motivates them to communicate In Social network theory closeness develops if people proceed in gradual and orderly fashion from superficial to more intimate levels of exchange. People consciously and deliberately weigh the costs and rewards associated with a relationship and seek relationships that reward them and avoid those that are costly. People connect with others because they believe that rewards or positive outcomes will result. Expectancy value model People believe according to their expectations, and evaluation. The behaviours they perform in response to their beliefs and values are undertaken to achieve some end. However, although expectancy-value theory can be used to explain central concepts in uses and gratifications research, there are other factors that influence the process. Attribution theory is significantly driven by motivational drives, looking at how the person constructs the meaning of an event based on the person’s motives to find cause on person’s surroundings.

Personal development planning is the lifelong process of nurturing, shaping, and updating person’s knowledge. It is about allowing individuals to improve and develop in line with the industry in which they engage or aspire to engage. It is about widening or broadening their knowledge and skills in order that they will continue to have a place in the flatter structures of today’s organisations.

The benefits of personal development planning are that it provides a schedule to work to motivate the individual and suggests a framework for monitoring and evaluating achievements. A good example is If you are currently working as a first line manager or senior administrator and aspire to the position of your manager, you may need to acquire new skills or develop your lower level skills to a higher level in, for example, budgeting, managing people, performance review, report writing and chairing meetings. You would need to planhow you are going to acquire these skills and over what time frame. Personal development planning can also be the basis for: Assessing where you want to be and how you can get there ,keeping skills up-to-date through meetings, trainings, reading the record book of the residents, updating it via computer, particularly in IT and technical areas, Continuous learning, gaining satisfaction from achievements through feedback from colleagues and management whether it is formal or informal, Building up transferable skills, such as time management, adaptability to change, self-awareness, and supporting future employability. You have to set yourself a SMART objective; they must be attainable, viable and realistic time-frame.

A good example of SMART objective is;

Within the next 12 months (time-bound), I will devise and implement a system (specific) which will enable the team to communicate more effectively with each other (achievable and realistic) through monthly group meetings and three-monthly one-to-one meetings (measurable).

Introduction

Most women and men are at a disadvantage in areas of job and trainings, wages and salaries, and are constrained to certain occupations based on their age, colour, disability, sex, ethnicity, without reference to their capabilities and skills. Today, in some developed countries for example, women workers still earn up less than male colleagues performing the same work. According to the Equal Employment Opportunity law, workers have the fundamental human right to be free from discrimination, can choose their employment freely without bias and have the ability to develop their potentials to the fullest. Workers benefit from equality policies through training, equal wages, and overall quality of the workforce.

The aim of this essay is to explore the multifaceted problems of unequal treatment of workers as a result of diversity and gender discrimination between men and women at work (the labour market). The study will also attempt to highlight the advantages and disadvantages of diversity and equal opportunity at work, and also proffer solutions for the reduction and subsequent eradication of gender discrimination. To the society at large, bringing equality to the workplace has major financial benefits, and if employers practise equality they would have access to a pool of well organised and diverse workforce. ILO (International Labour Organisation) practices equality as a tool to eliminate discrimination at work and in the society, they also apply gender mainstreaming strategies in the field of labour.

Benefits of workplace diversity

Employees from diverse backgrounds bring individual talents and experiences into the application of work. A diverse workforce of skills, experiences, languages, cultural understanding allows a company to operate globally in providing service to customers and having a variety of viewpoints, and also improving an organization’s success and competitiveness as well as increased “efficiency and effectiveness” (Sharron and Maeve, 2007, p.157).

Diversity and equality are linked to HR practices, therefore HR professionals have a key role in the implementing of fair and favourable working conditions for employees, and this indeed is a key challenge. Managing diversity helps to control differences by creating a productive working environment in which everyone, “feels valued” (Tom and Adrian, 2009, p.346), talents are fully utilised and organisational goals are met. The CIPD definition of diversity is, “valuing everyone as an individual, valuing people as employees, customers and clients” (CIPD, 2007). However, it is also applied to social groups thereby raising awareness of ethnic and cultural diversity. We live in a multi-cultural society where contributions from different cultures are made to society and culture. Diversity should focus on the positive rather than the negative.

Equality opportunity and gender mainstreaming

Equality can be defined as combined efforts, equal participation and shared responsibilities involving both sexes in decision making, implementation of policies aimed at maximizing potential production of goods and services. The fruits of these efforts should also be shared equally and both sexes should be given opportunities to exercise their rights. Equal opportunity approaches are aimed only at the disadvantaged and therefore potentially create problems in organisations by constantly targeting the disadvantaged rather than making efforts to ensure that the organisation naturally encourages equality of opportunity for all and sundry. There are six social groups listed in the Equality and Human Rights Commission Literature, the body that regulates and monitors the UK’s equality legislation, which are gender, age, disability, ethnicity, religion and sexual orientation. These social groups are protected by law, therefore staff and customers have the legal right to be treated fairly and equally (Kirton, G and Greene, A, 2005).

Article VII of the 1964 Civil Rights Act, bans any type of discrimination based on any social group. In addition, 1963 Equal Pay Act prohibits organizations from formulating gender-based pay discrimination regarding workers who perform same work under similar conditions. Article VII of the 1964 Civil Rights as well set up the USA Equal Employment Opportunity Commission (EEOC), the commission started working in 1965 and has a duty of enforcing the federal acts which disallows workplace discrimination. The focus of Employment Opportunity is underpinned by the notion of social justice or the right to be treated fairly.

The following are selected relevant ILO instruments on Equality:

Equal Remuneration Convention, 1951 (No. 100) This fundamental convention requires equal remuneration for all workers (men and women) for equal measure of work in ratifying countries.

Discrimination (Employment and Occupation) Convention, 1958 (No.111) This fundamental convention requires ratifying nations to declare and pursue practices of equality of opportunity and treatment in respect of employment and occupation, with a view to eliminating any distinction, exclusion or preference made on the basis of race, colour, sex, religion, political opinion, national extraction or social origin.

Workers with Family Responsibilities Convention, 1981 (No. 156)

The convention requires ratifying states to make it a goal of national policy to enable working men and women with family responsibilities to exercise their right without being subject to discrimination and, as much as possible, without conflict between their employment and family responsibilities. The convention also requires governments to take into account of the needs of the workers in community planning and to develop or promote community services, public or private, such as childcare and family services and facilities.

Diversity in the workplace is responsible for and sensitive to the different types of individual who make up an organisation (Sharron and Maeve, 2007, p.159). Organisations need to study the cultures, people and societies they work in, so they can understand and provide for the diverse needs of their customers/consumers. When organisations ‘manage diversity’ properly, they get excellent results from employees and meet the varying needs of their customers, which is recognised as a factor in business excellence. International Business Machines (IBM) has a long-standing commitment to equality to ensure everyone is allowed to compete on an equal basis. Workforce diversity at IBM ‘excludes no one and serves as the bridge between the workplace and the marketplace’.

The main issue for diversity management is that managers need to empower all staff to realize their full potential. Companies like Microsoft have had as much as 90% of their market value represented by intellectual capital, human talent, reputation, and leadership. The ability to attract and retain diverse talented people rates more highly, therefore the Government is driving initiatives to encourage diversity and persuade business that there are real advantages to be gained from embracing diversity in the workplace. Diversity focuses on improving opportunities for all staff, respecting and valuing people as they are, rather than expecting them to conform to a stereotype. The global nature of business markets can be seen as a driving force for diversity initiatives. If a company’s business is international, its staff must be able to work across cultures, speak the customer’s language and address any barriers that might exist. A Company’s reason for adopting diversity policies are;

1. It is the right thing to do,

2. It is in compliance with equal opportunities and anti antidiscrimination laws and

3. It generates financial benefits that exceed implementation costs (Rebecca, 2005).

British Telecom’s (BT) recognises that it is crucial for its staff to reflect the diversity of its customers and is able to meet their ever-changing needs. It has introduced a number of initiatives to ensure that more women are recruited and progress in their careers with the company. Diversity policies are used by companies to gain access to talent. BT reports that equal opportunities and diversity policies have resulted in the company attracting 37% of female graduate applicants. By creating a working environment where all employees feel included, valued and rewarded on the basis of their talents and skills, companies increase employee morale leading to improvement in the quality and motivation of the workforce which in turn leads to an improved company performance.

Effects of gender discrimination in the work place

Learning about sex-roles takes place among men and women during the early phases of their lives, and this can translate itself into an attitude that creates difficulties later in work life, (Larwood and Wood, 1979). A lot of people would concur that these issues and discrimination of women is improper and unlawful and should not be tolerated. Nonetheless, many women have continued to be discriminated in their workplace.

As rational people, employers seek to put the right person for the right jobs e.g. when the work demands public relations, appearing on advertisements, employers prefer attractive women as marketers to sell their products. For technical, manual and production work however; they prefer to hire a man, (Tom and Adrian, 2009, p.351). Some employers believe that the cost of employing women is higher and that the productivity of female workers is low due to truncated and intermittent breaks for child bearing and rearing. Women for example are questioned if the family responsibilities could hamper their performance at work and at times questioned about their competency. These beliefs pose particular challenges in decision to employ women at work. The choice of an individual to accept work in a particular occupation or an employer’s choice to employ either mainly men or mainly women, are decisions influenced by learned cultural and social values that often discriminate against women (and sometimes against men). The “preference” is largely determined by learned, gender-related factors which stereotype occupations as “male” and “female”.

Occupational segregation by sex and Stereotyping

The resultant segregation of occupations by sex places a limitation on what jobs male and female can do. The early stereotyping of certain occupations as ‘male’ and ‘female’ is one factor that influences the subject choices of children and adults (Archer, 1992). Miller and Hayward (1992) examined children’s perceptions of who should, and who actually does, perform a range of jobs. Both Miller and Budd (1999) and Miller and Hayward (1992) found that individuals’ preferences remained largely restricted to those jobs that were viewed as gender-congruent (i.e. in keeping with stereotypes about the jobs that are appropriate for their own sex). Boys gave significantly higher preference ratings than girls for nine masculine occupations (airplane pilot, air traffic controller, architect, carpenter, fire fighter, lorry driver, police-officer, scientist and TV repairer). Conversely, girls gave higher preference ratings for seven feminine occupations (dancer, hairdresser, librarian, nursery school teacher, secretary, school teacher and shop assistant).

In the UK, research conducted for the Department for Education and Skills (DFES) indicated that parental attitude was one factor which influenced the decisions of young people regarding whether to remain in education or training, or to leave (Payne, 1998). In the USA, Farmer, Wardrop, Anderson and Risinger (1995) have identified parental support as a key factor influencing subject choice. Firstly, the mother’s attitude is a key factor in developing the child’s own view of the importance of the subject itself; this then influences the development of favourable attitudes towards the occupational area. Secondly, the child’s perception of the extent to which their mother believes in the importance of doing well has a positive influence on the child’s belief that their success is dependent upon their own efforts, which in turn impacts on their achievement and thereafter on their attitudes (Miller, Lietz and Kotte, 2002). Parental aspirations are usually viewed as an important influence on career decisions in general (Erikson and Jonsson, 1996). Schoon and Parsons (2002), also using a path modelling approach has shown that high parental aspirations are strongly correlated with high aspirations in their children and with good academic achievement.

Stereotyping against women at work is either due to employers’ attitude or to what women bring into the labour market in terms of qualification, family demands and feminine differentials.

Cultural restrictions

Cultural restrictions contribute to the establishment of what is acceptable work and how some countries signify sexual differences for certain occupations. In Moslem countries, ‘Purdah’ (kirton, G and Greene, A, 2005) effectively forbids women interacting with unknown men in public, as a result, many Muslim women are strongly discouraged from taking sales jobs except in shops where the customers are all women.

Women are usually stereotyped to their traditional and cultural roles of child bearing, rearing and home-keepers and are usually disadvantaged in preferences for occupations and promotion. In societies where women are at a disadvantage by sex segregation, parents tend to give their daughters less education than the male thereby adversely affecting the future generation of women and limiting them to the traditional ‘female Occupations’ (teaching, child-care, nursing, catering). Until recently, Nigerian parents believed that it was a waste to invest in the girl-child because they would eventually end up in the ‘kitchen’ and were therefore not given formal education but were groomed to attract suitors. Several women are constrained to ‘female jobs’ in certain sectors either through custom or through the prejudice and discrimination of employers. Some other factors like early marriages affect the education of the female, the role of the woman as “helper” and not the “breadwinner” also impedes their aspiration for higher challenges. Many women are unable to improve themselves educationally after marriage and childbearing.

Glass ceiling

Masculine stereotype play a role in determining the occupations which become typically “male occupations” (engineer, police officer, construction worker, security guard) and of course the “breadwinner. There are fewer men in “female occupations” and when men move into typically female areas of work, there is no equivalent ‘glass ceiling’ – in fact, the opposite almost seems to apply. Examples of areas in which women constitute the majority of the workforce are education and health. In secondary schools, women hold the majority of teaching positions in schools, yet men constitute the majority of head teachers (68 per cent) Source: Department for Education and Skills (DfES) (2003e), Statistics of Education: School Workforce in England. Male nurses were found to have poorer qualifications at both pre-registration and post-registration levels, yet to advance more quickly into senior posts, the average time for male nurse to reach a senior post was 8.4 years, compared with 14.5 years for a female nurse who took no career breaks (Davies and Rosser, 1986). Similarly, male nurses were twice as likely to be found in higher grade nursing posts, although females had better post-basic qualifications (Finlayson and Nazroo, 1998).

Women also feel there is relatively poor career progression in male dominated occupations, in terms of pay and status but UBS Investment Bank has a group called ‘Raising the Bar’ which looks at the glass ceiling and whether women are treated differently and how they progress in their careers. Women find it difficult to break through this ceiling because of the ways in which they are viewed by the society and the individual organization (Stephen Linstead, Liz fulop and Simon Lilley, 2004) as being emotional, irrational, less committed, under-educated and not strong enough to earn top managerial positions. This creates vertical segregation where men predominate in top ranked positions of the organisations. Also because women sometimes prefer to work part time with flexible working conditions, it is therefore difficult to reach senior management positions. However, the role of women in society is radically changing in most countries and even in Nigeria. Vast numbers of women are beginning to work full-time and to aspire to climb the same “organisational ladders” as their male counterparts (Davidson and Cooper, 1984). Women are attaining higher levels of education and they are competing favourably with the men especially in occupations which were formerly reserved for the men.

Female – Male pay differentials

Income inequalities between men and women from all backgrounds still persists, despite the equal opportunities legislation as women’s annual salaries are 25 per cent lower than men’s even when overtime and bonuses are taken into account (Sharon and Maeve, 2007, p.163). Women are making progress, but it is still relatively slow, Sean O’ Grady (2007), states that “women working part-time earn 38 per cent less than their men counterparts working part-time as well. Even full-time female employees earn 17 per cent less than men”. Hence, it makes it difficult to find women at the top of any business, political career or even the law.

It is true that the pay gap among women and men is becoming much smaller than it used to be, even though there are still restrictions for women in top managerial positions and politics. Women are more confident because they are enlightened and have role models like Margaret Beckett who became the first U.K female foreign minister, Dora Bakoyannis the first women ever appointed to a senior cabinet position in Greece, Nigeria’s Ngozi Okonjo-Iweala the finance minister to foreign affairs. More women are willing to stand up to the law, even if men are still reluctant to give up power to women as a result of the ‘Masculine’ perception (it’s a man’s world).

Child bearing and family responsibilities

The debate on work and family life still tends to be focused on working mothers (Esther and Katherine, 1988). Mothers make significant changes to their working lives to accommodate their family and just a small minority of fathers make major changes that enable them to be more involved in family life (Suzanne, John and Melissa, 2006). Many employers view pregnant women as someone who is about to leave them hanging for a couple of month, instead of seeing them as professionals who are competent and can perform. Some employers deny pregnant women the opportunity to advance in their careers by assigning them menial jobs since they feel that they cannot handle challenging problems. These are just attitudes which do not have any basis. For example, it is believed that women typically leave their careers following the birth of children often in their thirties, some women may return after a period of maternity leave or after early years of child rearing, many do not return at all. Some reasons for not returning are work-life balance issues such as, wanting extended maternity leave, part-time working not being possible for some jobs and the cost of children.

Organisations have the feeling that the society is fast moving and when maternity break is taken, technology moves on to such an extent that it is difficult for returners to keep up and a lot of re-training would be required when they return. Therefore, when the women return, companies may have progressed and maybe their previous job has changed to such an extent they have to trade places or move out. Some organisations therefore offer flexible working hours for women who indicate that they would like greater flexibility at work. Flexibility has its own loop holes; it could lead to career death in terms of promotional opportunities (Jerry and kathleen, 2004). Women choose such career comfort in order to balance work with their family life responsibilities.

Recommendations to curb gender and diversity discrimination in the workplace
Gender Discrimination

The use of gender equality mainstreaming strategy will enhance the management of gender diversities in the workplace; it will address the specific and often different needs of women and men. Targeted interventions should be taken which is aimed to overcome sex discrimination, empower women in the world of work and advocate equitable sharing of care responsibilities between both sexes. This approach will help to prevent gender-blind interventions that perpetuate inequality, by ensuring that both women and men benefit equally from management policies. The use of “good practices” as well as ILO strategies and tools such as the Action Plan on Gender Equality are encouraged in promoting gender equality in the workplace. Gender Audits could also be carried out at intervals.

Research and publications, training courses on upgrading mainstreaming skills, and mobilizing gender network should be encouraged in the workplace. Women workers should be given assistance in getting organised and being represented in various sectors especially sectors where they form the minority. There should be a Human Resources specialist to oversee and support the Managing Gender Policy.

Diversity Discrimination

In the area of Diversity, to attract and retain staff from diverse backgrounds, companies may need to revise existing employment contracts, benefits packages and working conditions to accommodate measures, such as flexible working programmes, maternity/paternity benefits and leave, and childcare schemes. Companies should set up some form of monitoring and reporting processes, by warding off change resistance with the inclusion of every employee in formulating and executing diversity initiatives in the workplace. Leaders and managers within organizations must show commitment by introducing diversity policies amongst organisational functions. The overall participation and the cooperation of management as well as training are essential to the success of an organization’s plan.

Conclusion – Gender, Diversity and Equal opportunity

In this essay, findings indicate that gender should be managed in organisations in such a way as to minimise any differences between the employment chances available to men and those available to women. Equal opportunity should aim at allowing women the same level of access to and participation within every level and area of the organisation. As employees gain the benefits of increased equal opportunity for men and women in the workplace, all family members gain from an easing of the strain of juggling work and caring responsibilities and some children will gain the social and development benefits of quality childcare facilities. There is also the danger of promoting such case because equality of opportunity may not be seen as a case of social justice but that of organisational self interest.

The benefits of diversity in the work place has its challenges which workers have to put up with, such challenges include prejudices, cultural and language barriers that employees bring into the lime light of work. Such challenges need to be overcome for diversity programs to succeed. There are always employees who will refuse to accept change and the fact that the workplace is changing as a result of the diverse nature of workers. The preconception of following “the rules” outlooks new ideas and hinders progress. “The profits of a globalized economy are more fairly distributed in a society with equality, leading to greater social stability and broader public support for further economic development”, (ILO, 1996-2010).

Total quality management: a way of managing people and business processes to ensure complete customer satisfaction at every stage internally and externally (Department of Trade and Industry, DTI 2010). Although different quality experts emphasize different experts of this methodology, its major components can be summarised as follows: processes, people, management systems and performance measurement. According to Ross and Perry (1999), in addition to creating delighted customers through empowered employees, total quality management processes also lead to higher revenue and lower cost. In our Nursing home, every department is involved in implementing quality management to offer the best quality of service; we always work as a team and ensure we have offered the best quality of care that our residents need.

Continuous quality improvement: is a system that seeks to improve the provision of services with an emphasis on future results (Marshall, 2003). In our nursing home, the manager ensures that every service provider receives training, implements what they have learnt and they are supervised if there is need for retraining again we are retrained this ensures that we receive updated information to offer the best quality of service.

Quality standards: The Care Quality Commission for England has produced a guidance to help providers of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 (CQC, 2010b). This guide contains the regulations and the outcomes that the CQC expects people using a service will experience if the provider complies. This forms the basis for the quality standards in care homes. There are 16 core ones range from respecting people receiving the services to safety and suitability of premises and staffing levels just to mention a few. In my care setting, we get an annual inspection from UKAF over and above inspections from CQC and have been given a star rating of three. All activities this year are geared towards a rating of four.

Quality cycles: According to QCC (2010b) quality cycles represent periods within which care homes should be reviewed to determine compliance in its service provision. This may be annually. However private organisations like the United Kingdom Accreditation service also offers a quality cycle inspection called the Residential and Domiciliary care Benchmarking (RDB). The RDB annual ‘quality cycle’ supports strategic planning by providing comparative feedback on a home’s care provision and enables the identification of performance gaps and cost/benefit assessments to be made (UKAF, 2010). In this model we have four major aspects to be looked into namely: planning, doing, checking and acting.

Quality and principles of care

Legislation -these are laws and rules set by the government on how the provision of care should be for example protection of vulnerable adults. In our nursing home, every service provider should be ready to protect all residents from any form of abuse we attend mandatory trainings such as safeguarding vulnerable adults according to regulations by the CQC (2010b).

Safety- in our nursing home we always do risk assessment on every service user and put measures in place like using bed rails to prevent falls by doing this we have protected residents from accidents and this ensures quality service to our residents.

Independence-service users should be made in control of their lives by allowing them to do some of the things like arranging their wardrobes, making and tidying their rooms by themselves because some of the residents are very active and would like to do what they used to do before and we always encourage them to do while we supervise them and this makes them happy hence promoting the quality of service as they are satisfied.

Rights- service users should continue to enjoy the same rights when in nursing homes like they used to when they were living independently. Every service user supported in nursing homes has the right to say “NO”, right to have a relationship and the right to have a say in their care plan. Service providers always tend to balance service users rights against their responsibilities whether both are at risk or not.

1.4) External agencies: These are bodies that regulate quality of care including:

The Care Quality Commission – an independent regulator for health and social care in England (CQC 2010a; 2010b). They regulate care provided by NHS, local authority, private company and voluntary organisations. Their aim is to make sure better care is provided for everyone. In our nursing home Care Quality Commission makes a minimum of three inspections annually (two announced and one unannounced) on such things as how we provide care in terms of cleanliness of the home and to service users.. It has a wide range of enforcement powers to take action on behalf of service users if services are unacceptably low.

The CQC makes sure that the voices of service users are heard by asking people to share their experiences of care services. It makes sure that users’ views are at the heart of its reports and reviews. The CQC takes action if providers do not meet essential quality standards, or if there is reason to think that people’s basic rights or safety are at risk (CQC, 2010) through a wide range of enforcement powers, such as fines and public warnings, and can be flexible about how and when to use them. It can apply specific conditions in response to serious risks. For example, it can demand that a hospital ward or service is closed until the provider meets safety requirements or is suspended.

The National Institute for Health and Clinical Excellence (NICE)- this is an independent organisation responsible for providing national guidance on promoting good health preventing and treating ill health (NICE, 2010). In our Nursing home, residents who have anxiety, panic attacks request for sedatives in order for them to sleep they are usually reassured and instead a government practitioner is consulted to review and advice them accordingly. Service providers take NICE guidelines trainings on different medical conditions for example diabetic foot (identification and care of the foot).

2.1) Quality Standards

Benchmarks: According to Philip B. Crosby (1999) benchmarks are indicators of best practice including access to care environment and the culture of a home. The Benchmarks is one of the most comprehensive sets of social and environmental criteria and business performance indicators available (Daniels et al 2000). Our nursing home is accessible publically, to wheel chairs, a spacious car park and a section for activities for residents and relatives. We also have a signing in visitors’ book stating whom they are visiting.

Code of practice for social care workers and employers for social care workers

This document is developed by General Social Council and it contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work ( GSCC, 2002). Employers use this set of code of practice to make decisions about the conduct of staff and support social care workers to meet their code of practice. Service users and members of the public use the codes to help them understand the behaviour of social workers (how they should behave towards them) and also how employers should support social care workers to do their job well. It is the responsibility of social care workers to make sure that their conduct does not fall below the standards set in the code of practice and no action or omission harms service users (NCSC, 2010). Social care workers must protect the interests of service users, maintain confidence, respect rights, promote independence, be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills. The general social council expect social care workers to meet the codes and may take actions (deregistering) if registered workers fail.

2.2) Different approaches to implementing quality

Communication is a means of passing information from one person to another. In our nursing home we have different ways of communication like when doing care plans we always document what we have done for a resident so that whoever takes over knows what to do next to ensure continuity of care. Also when handing over is done during change of shifts information about residents is shared and everyone is aware of any changes in care plans in accordance to CQC guidelines (CQC, 2010). We also have staff meetings where certain information is passed on and in cases where staffs have a problem it is addressed and solutions are given out. For effective communication systems there should be a language that everyone understands.

Policies and procedures

These are guidelines set on how to do things often informed through regulations as outlined in various government documents (GSCC, 2002; NICE, 2010; CQC, 2010a. 2010b). In our Nursing home we have different policies and procedures for example in cases of accidents to residents we are required to fill a resident incident report and pass it on to the supervisor families, friends and relatives are informed about the accident then precautions are put into place walking frames, to avoid future occurrences of similar accidents.

Infection control policy helps to prevent spread of infections within our nursing home. We always use personal protective equipment when offering personal care to residents, handling of any infectious wastes. We also use the proper technique for hand washing. There are also hand gels in each resident’s room, in public toilets and at the entrance of the building for sanitation purposes and all wastes like clinical and kitchen wastes are usually put in the bins ready for collection. In cases of disease outbreaks like diarrhoea and vomiting residents are isolated and managed separately and proper hand washing techniques are used to prevent further spread of the infection.

Whistle blowing policy is designed to deal with issues that do not directly affect the employee and their employment but are a cause for concern in relation to the harm that may be done to other employees, residents or the wider community. Any employee who is concerned about their personal situation should raise their concern with their line supervisor or manager. This policy is for reporting issues like elderly abuse, misuse of drugs, faulty machinery that may cause accidents, illegal dumping of waste. The policy protects not only employees but the wide community.

Confidentiality- all residents or service users’ information is private and confidential. It is not a proper practice to discuss residents’ information in public like their conditions and behaviours by doing that is breaching the policy and legal action should be taken. In nursing homes all information is kept safely and only accessible to relevant persons. This promotes quality of service

2.3) Quality systems

ISO 9001 involves a set of procedures that cover all key processes in the business, monitoring processes to ensure they are effective, keeping adequate records and facilitating continual improvement. They have certain requirements like internal regulations, claims and procedures for residents, suggestion box and contract with uses. It also covers the importance of understanding and meeting customer requirements, communication, resource requirements, training and products, Leadership, Involvement of people, Process approach, and System approach to management and Continual improvement (Tricker and Sherring- Lucas, 2001).

In our nursing home for the provision of all these elements and reporting them on day to day basis for example there is a clear procedure for residents’ complains. Carers, residents and relatives are informed and logged in a special complaints book and complains are followed up. When all this are put into practice, there is employee and customer satisfaction, resulting from better defined and implemented business processes. As a result of this we have motivated staffs, who understands their roles and how their work affects quality, improved product and service quality, happier customers, and improved management and operational processes, resulting in less waste (both time and materials)

Business excellence is a widely used framework that helps companies to review their performance and practices in a number of areas and identify targets and actions for improvement based on principles of customer service stakeholder value and process management ( British Quality Foundation, BQF 2010). Managers develop the mission, vision and values and are role models of a culture of Excellence. Studies in Taiwan have shown that in care homes where this model is applied, managers are personally involved in ensuring the organisation’s management system is developed, implemented and continuously improved are involved with customers, partners and representatives of society and also motivate, support and recognise the organisation’s people (Cheng B, Chang, C and Sheng L. 2005). In our nursing home we use a balanced score card to keep track of activities by staff and measure consequences arising based on the British Quality Foundation model ( BQF, 2010).Service users families and relatives measure in a scale of 1-5 where one is poor and five is excellent. We work hard in poorly rated areas to improve the quality of service. At the same time managers set a number of targets on key areas of each staff members roles which are then assessed on monthly review and awards are given to the best. This motivates other team members to work hard and best to attain the best and by doing so they provide best quality and we excel.

2.4) Trainings this refers to a learning process that involves the acquisition of knowledge, sharpening of skills and concepts (Stevens, 2004. In our nursing there are mandatory trainings offered to service providers before commencing to work like basic food hygiene, manual handling

Healthy and safety is ensuring that the environment where we are working is safe for service users, other staff and others in general by our actions and omissions. It is a responsibility to all staff to ensure that the environment is safe to work on. For safety purposes in our nursing home we do not use equipment unless it has been checked and serviced. Also default equipments are labelled “DO NOT USE” to prevent and avoid accidents. We also have controlled cupboards where substances that are hazardous to health are stored and locked away. When there is a defect on the environment like chipped floors, loose hanging electricity wires we report to the maintenance coordinator and they are rectified immediately to avoid accidents. Again when housekeeping team are doing cleaning they always display cleaning boards and everybody is aware that cleaning is on progress or the floor is wet and they avoid using it until it is dry by doing this they minimise chances of accidents like falls

2.5) According to Marshall (2003) and Stevens (2004), external and internal barriers to delivering quality are any obstacle which prevents a given policy instrument being implemented or limits the way in which it can be implemented. They include:

Resources: lack of adequate resources hinders quality of service for example inadequate or shortage of staff affects the quality of services offered and this leads to unsatisfaction of service users as they get services that are not adequate and for service providers because they are overworked. In nursing homes when there are staffs shortages they arrange cover shifts earlier by either bank staff or some agencies registered with the home. Financial barriers include budget restrictions like food supplies and other supplies like incontinent products limits the overall expenditure and this leads to inadequate provision of quality services to residents

Personal Appearance: Hygiene and grooming, eating habits and attire can vary from country to country and culture to culture. For example, some people may wear attire such as a headdress as part of their custom and beliefs. To remain true to their beliefs, some workers may want to continue to wear this dress at their workplace. Employers may view this as inappropriate or unsafe. It is particularly problematic in workplaces where workers wear uniforms.

Religion: In many cultures, religion dominates life in a way that is often difficult for employers to understand. For example, workers from some cultures may want to pray while at work times in accordance with their values and beliefs. There may also be religious holidays on which people of certain religions are forbidden to work. These differences need to be respected, where possible, and not ignored and they affect the quality of service.

Language barriers often go hand-in hand with cultural differences, posing additional problems and misunderstandings in the workplace. When people cannot communicate properly they are frustrated when communicating with supervisors, co-workers and residents this can be dangerous because people may end up performing poorly in their work thus affecting quality of service offered.

Legal and institutional barriers -these include lack of legal powers to implement a particular instrument and responsibilities which are split between agencies limiting the ability of an institution. Like the law states that students should work for twenty hours only which creates shortages at work affecting quality of services.

3.1) According to Business Dictionary.com (2010), policies are principles, rules and guidelines formulated or adopted by an organization to reach its long term goals. They are designed to influence and determine all major decisions, actions and activities take place within the boundaries set by them and procedures are specific methods employed to express policies in action in day to day operations of the organization. For example, in nursing homes the National Care Standards Commission for England, NCSC (2010) has outlined requirements that these homes must meet which in effect guide their policies and principles. These policies include, but not limited to: manual handling procedures, Risk assessment and Infection control.

Manual handling

These are techniques used to handle or move service users like hoisting, using belts and sliding sheets to move residents these are safe procedures for both residents and service providers as they minimise accidents to both cases and this promotes quality of service (CQC, 2010). On the other hand, they have disadvantages like time consuming when doing procedures like hoisting which requires two or three persons and also residents may not like the experiences of hoisting and thirdly it needs trainings to be carried out.

Risk assessments

According to healthy and safety at work act (1974) the Management of Health and Safety at Work Regulation (1999) states that it is the responsibilities of managers to do risk assessment to employers and employees. to reduce and prevent risks to them in future and they are included in their care plan so that quality of care can be improved for example residents with risks of falling have walking frames, falling mats and bed rails put in place to avoid falls but again things like bed rails have caused accidents in that residents are trapped and some sustain fractures which affect quality of service

3.2) factors that influence the achievement of quality of personal care

‘Quality’ is a difficult concept to capture directly. However, resident or organisational outcomes are often used as a proxy for quality (Marshall, 2003). There is considerable debate about the relationship between quality of care and quality of life as joint, but not necessarily competing, measures of quality. A study for the Joseph Rowntree Foundation indicates that residents’ perceptions of nursing staff are a good indicator of quality of care (JRF, 2008).The importance of measures of social care and of ‘homeliness’ epitomise the divide between health and social care provision in care homes. Factors influencing residents’ satisfaction with care are discussed below:

Team working

Heath care workers working in ‘teams’ has been recognised as an improving the quality of care (Stevens, 2004; Borill et al 1999). According to Stevens, the intention is for carers to share tasks and learn from each other and possibly improve based on their experiences. This can be illustrated by the quotation below:

“The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service.” (Borill et al 1999 p.6).

Stevens has for example reported from a number of surveys from UK nursing homes to suggest that there is a reduction in carer burden and significant reduction in stress when staff work in teams resulting in better coping and satisfaction. Both these studies (Stevens, 2004; Borill et al 1999) found that service users surveyed showed more satisfaction when carers and health workers worked in teams

Healthy and safety at work

The responsibilities of care home proprietors are subject to a range of health and safety legislation among them the Health and Safety at Work etc. Act 1974, the Management of Health and Safety at Work Regulations 1999 which require employers to assess the risks to employees and other who may be affected by their undertaking, (residents) and the control of Substances Hazardous to Health Regulations ( Care Quality Commission, 2010).

These regulations have led to dramatic improvements in the safety of residents and people working in care homes according to the care quality commission. For instance, guidelines requiring minimalist manual handling has significantly reduced the numbers of health workers staying off work due to illness which has a positive effect on the level of personal care of residents ( CQC, 2010a). However, a report for the Joseph Rawtree Foundation (JRF, 2008) showed that the percentage of medication errors and adverse events in nursing homes

have increased despite regular inspections by the CQC. Stevens (2004) has also reported survey results from 27 residential homes with dementia patients where 19% cases of medication errors were reported.

In my care setting, clear improvements can be seen from less harm to residents when using the hoist but not many service users like to use the hoist. Some risk assessments in care homes have made it very difficult to take residents outdoors or even for activities outside the home for fear of not meeting the Health and safety requirements and this ends up reducing the quality of care.

3.3 The following recommendation can improve the quality of care in Nursing homes

Training /education

This means acquiring knowledge and skills or new information on how to do things according to the recommended regulations and standards ( Stevens 2004). This is a very important aspect in nursing homes all trainings as it provides ongoing trainings to update service providers and equip them with relevant and current information that enables them to provide the best quality of care that will be satisfactory to service users. In our nursing home trainings are offered and need to be implemented then supervision is done and in cases where need for retraining arises, arrangements are done and they are offered for the benefits of service users, service providers and the community at large as it reduces or minimises preventable accidents and this promotes the quality of service

Review

This means going through the set of targets or planned activities to see the progress whether it is improving or getting worse. This alerts and actions or precautions are put in place to make the situation improve for better quality of service ( Stevens, 2004). For example in our nursing home there are always monthly reviews of care plans of service users this includes individual or family interviews to determine whether residents are improving or need some improved care plans like in moving and handling procedures (use of hoist or belts) and then action is taken accordingly. Also for staff there is quarterly staff meetings or when need arises and previous discussed or current issues are raised and a way forward on how to carry on is agreed. There are always individual supervisions done by allocated persons and each employee identifies areas that need improvement and good performing areas by doing this there is improvement of quality of service

Conclusion

It has been shown that in order to improve services to users in the social care sector, it is important to follow principles, guidelines and procedures set by government, industry bodies or even individual homes. There is also need for planning, doing and checking and then reviewing to assess shortcomings in order to design improvement regimes. Similarly, it has been shown that although there is legislation and care industry standards, it will require long term commitments in developing methods, instruments and communication procedures involving all stakeholders at care or residential home level.

1.0 Introduction to the Case

In this assignment I am going to use a nursing home for elderly residents, both male and female with both dementia and different medical conditions like diabetes, Parkinson’s disease and hypertension. Some of the service users in this nursing home are bed bound while others are mobile or self dependant. It has two floors with 42 bed capacity.

1.1 What quality means to the following stakeholders

Service users – These are residents or clients in our Nursing home. Quality to our service users means any service that is offered to their satisfaction for example:

Respect: Most of our residents prefer to be addressed by the names while some prefer to be addressed as Mr. or Mrs. We respect their wishes and this makes them happy. Also when we are offering personal care like washing or bathing we ensure that doors are shut for privacy and dignity purposes we also respect their age as adults and treat them as adults according to their wishes

Choice: Residents choices in our nursing home are usually observed as this makes them to have their freedom of choice in whatever they want to have for example we have different menu choices for foods and drinks and before we serve them we ask them what they prefer to have. The same applies to the way they prefer to dress and so we offer them a choice on their own clothes and activities that they would like to participate in and at the end of it all they are happy and the quality of service offered is satisfactory to them and everybody else.

Confidentiality: Anything concerning a resident in our Nursing home is private and confidential unless for medical reasons like consultation and to those who are concerned like family and relatives.

Friends and family: They usually appreciate when they are involved in care plans of their relatives and they are satisfied when what they have agreed on is followed through.

Safety they are always appreciative and supportive when they know that their parents and friends (residents) are free from harm by the care they are provided with for example safe from falls, abuse and infections within the nursing home. They like their relatives to be treated equally like other residents without discrimination because of either their conditions, disabilities or ethnicity.

Carers: These are the major service providers in our nursing home and quality to them means:

Equity- all service providers should be treated equally regardless of their race, ethnicity, gender and knowledge and skills they have on their job when this is put into consideration they are motivated and tend to offer the best quality of care to residents which in turn leads to customer satisfaction.

Safety – all service providers in our Nursing home ensure they are safe on the environment they work on for their sake, residents, relatives and friends and anyone concerned. We ensure proper procedures are followed such as moving and handling by using proper equipment on residents like hoists and slings to avoid accidents to ourselves and to residents. Carers are always happy when they are not abused either by residents, relatives and friends or their fellow carers.

We have four different models of quality

Total quality management: a way of managing people and business processes to ensure complete customer satisfaction at every stage internally and externally (Department of Trade and Industry, DTI 2010). Although different quality experts emphasize different experts of this methodology, its major components can be summarised as follows: processes, people, management systems and performance measurement. According to Ross and Perry (1999), in addition to creating delighted customers through empowered employees, total quality management processes also lead to higher revenue and lower cost. In our Nursing home, every department is involved in implementing quality management to offer the best quality of service; we always work as a team and ensure we have offered the best quality of care that our residents need.

Continuous quality improvement: is a system that seeks to improve the provision of services with an emphasis on future results (Marshall, 2003). In our nursing home, the manager ensures that every service provider receives training, implements what they have learnt and they are supervised if there is need for retraining again we are retrained this ensures that we receive updated information to offer the best quality of service.

Quality standards: The Care Quality Commission for England has produced a guidance to help providers of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 (CQC, 2010b). This guide contains the regulations and the outcomes that the CQC expects people using a service will experience if the provider complies. This forms the basis for the quality standards in care homes. There are 16 core ones range from respecting people receiving the services to safety and suitability of premises and staffing levels just to mention a few. In my care setting, we get an annual inspection from UKAF over and above inspections from CQC and have been given a star rating of three. All activities this year are geared towards a rating of four.

Quality cycles: According to QCC (2010b) quality cycles represent periods within which care homes should be reviewed to determine compliance in its service provision. This may be annually. However private organisations like the United Kingdom Accreditation service also offers a quality cycle inspection called the Residential and Domiciliary care Benchmarking (RDB). The RDB annual ‘quality cycle’ supports strategic planning by providing comparative feedback on a home’s care provision and enables the identification of performance gaps and cost/benefit assessments to be made (UKAF, 2010). In this model we have four major aspects to be looked into namely: planning, doing, checking and acting.

Quality and principles of care

Legislation -these are laws and rules set by the government on how the provision of care should be for example protection of vulnerable adults. In our nursing home, every service provider should be ready to protect all residents from any form of abuse we attend mandatory trainings such as safeguarding vulnerable adults according to regulations by the CQC (2010b).

Safety- in our nursing home we always do risk assessment on every service user and put measures in place like using bed rails to prevent falls by doing this we have protected residents from accidents and this ensures quality service to our residents.

Independence-service users should be made in control of their lives by allowing them to do some of the things like arranging their wardrobes, making and tidying their rooms by themselves because some of the residents are very active and would like to do what they used to do before and we always encourage them to do while we supervise them and this makes them happy hence promoting the quality of service as they are satisfied.

Rights- service users should continue to enjoy the same rights when in nursing homes like they used to when they were living independently. Every service user supported in nursing homes has the right to say “NO”, right to have a relationship and the right to have a say in their care plan. Service providers always tend to balance service users rights against their responsibilities whether both are at risk or not.

1.4) External agencies: These are bodies that regulate quality of care including:

The Care Quality Commission – an independent regulator for health and social care in England (CQC 2010a; 2010b). They regulate care provided by NHS, local authority, private company and voluntary organisations. Their aim is to make sure better care is provided for everyone. In our nursing home Care Quality Commission makes a minimum of three inspections annually (two announced and one unannounced) on such things as how we provide care in terms of cleanliness of the home and to service users.. It has a wide range of enforcement powers to take action on behalf of service users if services are unacceptably low.

The CQC makes sure that the voices of service users are heard by asking people to share their experiences of care services. It makes sure that users’ views are at the heart of its reports and reviews. The CQC takes action if providers do not meet essential quality standards, or if there is reason to think that people’s basic rights or safety are at risk (CQC, 2010) through a wide range of enforcement powers, such as fines and public warnings, and can be flexible about how and when to use them. It can apply specific conditions in response to serious risks. For example, it can demand that a hospital ward or service is closed until the provider meets safety requirements or is suspended.

The National Institute for Health and Clinical Excellence (NICE)- this is an independent organisation responsible for providing national guidance on promoting good health preventing and treating ill health (NICE, 2010). In our Nursing home, residents who have anxiety, panic attacks request for sedatives in order for them to sleep they are usually reassured and instead a government practitioner is consulted to review and advice them accordingly. Service providers take NICE guidelines trainings on different medical conditions for example diabetic foot (identification and care of the foot).

2.1) Quality Standards

Benchmarks: According to Philip B. Crosby (1999) benchmarks are indicators of best practice including access to care environment and the culture of a home. The Benchmarks is one of the most comprehensive sets of social and environmental criteria and business performance indicators available (Daniels et al 2000). Our nursing home is accessible publically, to wheel chairs, a spacious car park and a section for activities for residents and relatives. We also have a signing in visitors’ book stating whom they are visiting.

Code of practice for social care workers and employers for social care workers

This document is developed by General Social Council and it contains agreed codes of practice for social care workers and employers of social care workers describing the standards of conduct and practice within which they should work ( GSCC, 2002). Employers use this set of code of practice to make decisions about the conduct of staff and support social care workers to meet their code of practice. Service users and members of the public use the codes to help them understand the behaviour of social workers (how they should behave towards them) and also how employers should support social care workers to do their job well. It is the responsibility of social care workers to make sure that their conduct does not fall below the standards set in the code of practice and no action or omission harms service users (NCSC, 2010). Social care workers must protect the interests of service users, maintain confidence, respect rights, promote independence, be accountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills. The general social council expect social care workers to meet the codes and may take actions (deregistering) if registered workers fail.

2.2) Different approaches to implementing quality

Communication is a means of passing information from one person to another. In our nursing home we have different ways of communication like when doing care plans we always document what we have done for a resident so that whoever takes over knows what to do next to ensure continuity of care. Also when handing over is done during change of shifts information about residents is shared and everyone is aware of any changes in care plans in accordance to CQC guidelines (CQC, 2010). We also have staff meetings where certain information is passed on and in cases where staffs have a problem it is addressed and solutions are given out. For effective communication systems there should be a language that everyone understands.

Policies and procedures

These are guidelines set on how to do things often informed through regulations as outlined in various government documents (GSCC, 2002; NICE, 2010; CQC, 2010a. 2010b). In our Nursing home we have different policies and procedures for example in cases of accidents to residents we are required to fill a resident incident report and pass it on to the supervisor families, friends and relatives are informed about the accident then precautions are put into place walking frames, to avoid future occurrences of similar accidents.

Infection control policy helps to prevent spread of infections within our nursing home. We always use personal protective equipment when offering personal care to residents, handling of any infectious wastes. We also use the proper technique for hand washing. There are also hand gels in each resident’s room, in public toilets and at the entrance of the building for sanitation purposes and all wastes like clinical and kitchen wastes are usually put in the bins ready for collection. In cases of disease outbreaks like diarrhoea and vomiting residents are isolated and managed separately and proper hand washing techniques are used to prevent further spread of the infection.

Whistle blowing policy is designed to deal with issues that do not directly affect the employee and their employment but are a cause for concern in relation to the harm that may be done to other employees, residents or the wider community. Any employee who is concerned about their personal situation should raise their concern with their line supervisor or manager. This policy is for reporting issues like elderly abuse, misuse of drugs, faulty machinery that may cause accidents, illegal dumping of waste. The policy protects not only employees but the wide community.

Confidentiality- all residents or service users’ information is private and confidential. It is not a proper practice to discuss residents’ information in public like their conditions and behaviours by doing that is breaching the policy and legal action should be taken. In nursing homes all information is kept safely and only accessible to relevant persons. This promotes quality of service

2.3) Quality systems

ISO 9001 involves a set of procedures that cover all key processes in the business, monitoring processes to ensure they are effective, keeping adequate records and facilitating continual improvement. They have certain requirements like internal regulations, claims and procedures for residents, suggestion box and contract with uses. It also covers the importance of understanding and meeting customer requirements, communication, resource requirements, training and products, Leadership, Involvement of people, Process approach, and System approach to management and Continual improvement (Tricker and Sherring- Lucas, 2001).

In our nursing home for the provision of all these elements and reporting them on day to day basis for example there is a clear procedure for residents’ complains. Carers, residents and relatives are informed and logged in a special complaints book and complains are followed up. When all this are put into practice, there is employee and customer satisfaction, resulting from better defined and implemented business processes. As a result of this we have motivated staffs, who understands their roles and how their work affects quality, improved product and service quality, happier customers, and improved management and operational processes, resulting in less waste (both time and materials)

Business excellence is a widely used framework that helps companies to review their performance and practices in a number of areas and identify targets and actions for improvement based on principles of customer service stakeholder value and process management ( British Quality Foundation, BQF 2010). Managers develop the mission, vision and values and are role models of a culture of Excellence. Studies in Taiwan have shown that in care homes where this model is applied, managers are personally involved in ensuring the organisation’s management system is developed, implemented and continuously improved are involved with customers, partners and representatives of society and also motivate, support and recognise the organisation’s people (Cheng B, Chang, C and Sheng L. 2005). In our nursing home we use a balanced score card to keep track of activities by staff and measure consequences arising based on the British Quality Foundation model ( BQF, 2010).Service users families and relatives measure in a scale of 1-5 where one is poor and five is excellent. We work hard in poorly rated areas to improve the quality of service. At the same time managers set a number of targets on key areas of each staff members roles which are then assessed on monthly review and awards are given to the best. This motivates other team members to work hard and best to attain the best and by doing so they provide best quality and we excel.

2.4) Trainings this refers to a learning process that involves the acquisition of knowledge, sharpening of skills and concepts (Stevens, 2004. In our nursing there are mandatory trainings offered to service providers before commencing to work like basic food hygiene, manual handling

Healthy and safety is ensuring that the environment where we are working is safe for service users, other staff and others in general by our actions and omissions. It is a responsibility to all staff to ensure that the environment is safe to work on. For safety purposes in our nursing home we do not use equipment unless it has been checked and serviced. Also default equipments are labelled “DO NOT USE” to prevent and avoid accidents. We also have controlled cupboards where substances that are hazardous to health are stored and locked away. When there is a defect on the environment like chipped floors, loose hanging electricity wires we report to the maintenance coordinator and they are rectified immediately to avoid accidents. Again when housekeeping team are doing cleaning they always display cleaning boards and everybody is aware that cleaning is on progress or the floor is wet and they avoid using it until it is dry by doing this they minimise chances of accidents like falls

2.5) According to Marshall (2003) and Stevens (2004), external and internal barriers to delivering quality are any obstacle which prevents a given policy instrument being implemented or limits the way in which it can be implemented. They include:

Resources: lack of adequate resources hinders quality of service for example inadequate or shortage of staff affects the quality of services offered and this leads to unsatisfaction of service users as they get services that are not adequate and for service providers because they are overworked. In nursing homes when there are staffs shortages they arrange cover shifts earlier by either bank staff or some agencies registered with the home. Financial barriers include budget restrictions like food supplies and other supplies like incontinent products limits the overall expenditure and this leads to inadequate provision of quality services to residents

Personal Appearance: Hygiene and grooming, eating habits and attire can vary from country to country and culture to culture. For example, some people may wear attire such as a headdress as part of their custom and beliefs. To remain true to their beliefs, some workers may want to continue to wear this dress at their workplace. Employers may view this as inappropriate or unsafe. It is particularly problematic in workplaces where workers wear uniforms.

Religion: In many cultures, religion dominates life in a way that is often difficult for employers to understand. For example, workers from some cultures may want to pray while at work times in accordance with their values and beliefs. There may also be religious holidays on which people of certain religions are forbidden to work. These differences need to be respected, where possible, and not ignored and they affect the quality of service.

Language barriers often go hand-in hand with cultural differences, posing additional problems and misunderstandings in the workplace. When people cannot communicate properly they are frustrated when communicating with supervisors, co-workers and residents this can be dangerous because people may end up performing poorly in their work thus affecting quality of service offered.

Legal and institutional barriers -these include lack of legal powers to implement a particular instrument and responsibilities which are split between agencies limiting the ability of an institution. Like the law states that students should work for twenty hours only which creates shortages at work affecting quality of services.

3.1) According to Business Dictionary.com (2010), policies are principles, rules and guidelines formulated or adopted by an organization to reach its long term goals. They are designed to influence and determine all major decisions, actions and activities take place within the boundaries set by them and procedures are specific methods employed to express policies in action in day to day operations of the organization. For example, in nursing homes the National Care Standards Commission for England, NCSC (2010) has outlined requirements that these homes must meet which in effect guide their policies and principles. These policies include, but not limited to: manual handling procedures, Risk assessment and Infection control.

Manual handling

These are techniques used to handle or move service users like hoisting, using belts and sliding sheets to move residents these are safe procedures for both residents and service providers as they minimise accidents to both cases and this promotes quality of service (CQC, 2010). On the other hand, they have disadvantages like time consuming when doing procedures like hoisting which requires two or three persons and also residents may not like the experiences of hoisting and thirdly it needs trainings to be carried out.

Risk assessments

According to healthy and safety at work act (1974) the Management of Health and Safety at Work Regulation (1999) states that it is the responsibilities of managers to do risk assessment to employers and employees. to reduce and prevent risks to them in future and they are included in their care plan so that quality of care can be improved for example residents with risks of falling have walking frames, falling mats and bed rails put in place to avoid falls but again things like bed rails have caused accidents in that residents are trapped and some sustain fractures which affect quality of service

3.2) factors that influence the achievement of quality of personal care

‘Quality’ is a difficult concept to capture directly. However, resident or organisational outcomes are often used as a proxy for quality (Marshall, 2003). There is considerable debate about the relationship between quality of care and quality of life as joint, but not necessarily competing, measures of quality. A study for the Joseph Rowntree Foundation indicates that residents’ perceptions of nursing staff are a good indicator of quality of care (JRF, 2008).The importance of measures of social care and of ‘homeliness’ epitomise the divide between health and social care provision in care homes. Factors influencing residents’ satisfaction with care are discussed below:

Team working

Heath care workers working in ‘teams’ has been recognised as an improving the quality of care (Stevens, 2004; Borill et al 1999). According to Stevens, the intention is for carers to share tasks and learn from each other and possibly improve based on their experiences. This can be illustrated by the quotation below:

“The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service.” (Borill et al 1999 p.6).

Stevens has for example reported from a number of surveys from UK nursing homes to suggest that there is a reduction in carer burden and significant reduction in stress when staff work in teams resulting in better coping and satisfaction. Both these studies (Stevens, 2004; Borill et al 1999) found that service users surveyed showed more satisfaction when carers and health workers worked in teams

Healthy and safety at work

The responsibilities of care home proprietors are subject to a range of health and safety legislation among them the Health and Safety at Work etc. Act 1974, the Management of Health and Safety at Work Regulations 1999 which require employers to assess the risks to employees and other who may be affected by their undertaking, (residents) and the control of Substances Hazardous to Health Regulations ( Care Quality Commission, 2010).

These regulations have led to dramatic improvements in the safety of residents and people working in care homes according to the care quality commission. For instance, guidelines requiring minimalist manual handling has significantly reduced the numbers of health workers staying off work due to illness which has a positive effect on the level of personal care of residents ( CQC, 2010a). However, a report for the Joseph Rawtree Foundation (JRF, 2008) showed that the percentage of medication errors and adverse events in nursing homes

have increased despite regular inspections by the CQC. Stevens (2004) has also reported survey results from 27 residential homes with dementia patients where 19% cases of medication errors were reported.

In my care setting, clear improvements can be seen from less harm to residents when using the hoist but not many service users like to use the hoist. Some risk assessments in care homes have made it very difficult to take residents outdoors or even for activities outside the home for fear of not meeting the Health and safety requirements and this ends up reducing the quality of care.

3.3 The following recommendation can improve the quality of care in Nursing homes

Training /education

This means acquiring knowledge and skills or new information on how to do things according to the recommended regulations and standards ( Stevens 2004). This is a very important aspect in nursing homes all trainings as it provides ongoing trainings to update service providers and equip them with relevant and current information that enables them to provide the best quality of care that will be satisfactory to service users. In our nursing home trainings are offered and need to be implemented then supervision is done and in cases where need for retraining arises, arrangements are done and they are offered for the benefits of service users, service providers and the community at large as it reduces or minimises preventable accidents and this promotes the quality of service

Review

This means going through the set of targets or planned activities to see the progress whether it is improving or getting worse. This alerts and actions or precautions are put in place to make the situation improve for better quality of service ( Stevens, 2004). For example in our nursing home there are always monthly reviews of care plans of service users this includes individual or family interviews to determine whether residents are improving or need some improved care plans like in moving and handling procedures (use of hoist or belts) and then action is taken accordingly. Also for staff there is quarterly staff meetings or when need arises and previous discussed or current issues are raised and a way forward on how to carry on is agreed. There are always individual supervisions done by allocated persons and each employee identifies areas that need improvement and good performing areas by doing this there is improvement of quality of service

Conclusion

It has been shown that in order to improve services to users in the social care sector, it is important to follow principles, guidelines and procedures set by government, industry bodies or even individual homes. There is also need for planning, doing and checking and then reviewing to assess shortcomings in order to design improvement regimes. Similarly, it has been shown that although there is legislation and care industry standards, it will require long term commitments in developing methods, instruments and communication procedures involving all stakeholders at care or residential home level.

Managing Collaboration & Multi-Agency Working for older people’s services

Executive summary and introduction

Collaboration in the field of both welfare and healthcare, on one level, can be expedient, efficient and economical. On another, more practical level, it can be a minefield of legislative, practical and interpersonal difficulties. (Arblaster. L. et al 1998)

This report will consider these aspects in direct consideration of collaboration of the various aspects of care related to the elderly.

It has to be viewed as being within the spirit and the legislative restriction of the NHS Plan (DOH 2000) and therefore considers the methods of collaboration with the PCTs in some detail, and also in the spirit and legislative requirements of the National Service Framework for the elderly. (Rouse et al 2001)

What is collaboration between organisations?

The transition from the concept “Empire” culture to the “Seamless interface“ culture is effectively based on the concept of practical and effective collaboration. (Powell, J. & Lovelock, R. 1996)

The changes that were proposed in a number of recent pieces of welfare based legislation (after the 1993 changes in the community care organisation and the National Service Frameworks to quote just two), have all espoused collaboration as their raison d’etre. Clearly, in consideration of the elderly, there are numerous organisations that can potentially collaborate (Appendix Two), and all have their strengths, weaknesses and pitfalls. Let us examine one important area as an illustration.

If we consider the welfare/health service interface. Primary healthcare teams control access to secondary and community health services through patient referrals. Social Services equally manage funding for home care and residential services including nursing home facilities and control access through assessment and care management. (Glendenning C et al 1998).

When it is the case that, in terms of professional organisations, one depends upon another for access to services, their ability to obtain their own organisational or professional objectives can be severely compromised. (Haralambos M et al 2000).

In practical terms, the GP is dependent on the social services to fund the appropriate facility whether it is a nursing home, domicillary enhancement services to keep a patient out of an acute medical hospital bed, or other forms of social support to facilitate the timely discharge of a patient from hospital. The arguments for collaboration are so overwhelmingly obvious that they hardly need repeating here.

In real terms, the consideration of collaboration between organisations more analytically hinges on the question, “which organisations?”. The example that we have given is a fairly common collaboration and is therefore enshrined in both common working practice and also with legislative and regulatory boundaries. The advent of the National Service Frameworks have helped promote commonly recognised goals and objectives across the health/welfare spectrum of care, although a number of financial issues and problems with the organisational culture interface can commonly difficulty in everyday practice (Wierzbicki & Reynolds 2001).

Other organisations have to liaise and collaborate with the Social Services Dept. such as local and national voluntary support groups and specialist interest support groups, (often disease process based,) and these generally have much looser procedural issues and practices which may need different considerations. We shall discuss these in greater depth elsewhere in this essay.

What are the problems?

Taking a broad overview of the scope and possible nature of collaborative enterprises. Problems can arise from a number of organisational areas. Financial considerations, especially financial accountability, cause problems when this eventuality has not specifically been legislated for. Appendix Three sets out many of the potential pitfalls in this area. We observe that the health based services are essentially free to the patient whereas Welfare is largely means tested and thereby rendered vulnerable to changes of political direction and pressure. (Audit commission 2004)

Another major area of potential difficulty stems from the historical development of professional language, terminology and working practices that each collaboration can interface. Client, patient , in need, deserving, dependent – all are terms frequently used by various healthcare professionals, but with different interpretations and nuances of meaning. Collaboration will inevitably require a more exact and specific vocabulary to be evolved and agreed. (Garlick C 1996).

Collaboration inevitably means information sharing. The “Empire” concepts and constructs take a long time to die and be eradicated, but the seamless interface can only realistically be expected to work if all available information is shared. This raises serious problems of confidentiality if information is expected to be shared between healthcare professionals and collaborating agencies from the voluntary sector for example. (Cameron,A et al 2000).

What are the solutions?

Management solutions can be both complex and difficult to introduce or impose. By virtue of the potentially disparate nature of the collaborative partnerships that we are considering, there is clearly no “one size fits all” solution. It is for this reason that general principles are more useful than specific suggestions.

The management of change (and therefore the solutions) is perhaps the most fundamental element in the discussion. Visions, ideas and directions are of little value if they cannot be translated into reality. (Bennis et al 1999).

We can turn to the writings of Marinker (1997) who points to the fact that systems change, and indeed change management itself, are responsive to the acceptance of a division between concordance and compliance. People generally respond better to suggestion, reason and coercion rather than imposition of regulations and arbitrary change. The models that rely on publication and dissemination of information are generally more likely to be well received and more fully implemented, particularly if it is peer driven. (Shortell SM et al 1998)

This is perfectly illustrated by the Davidmann Report (Davidmann 1988) on the debacle of the introduction of the Griffiths Reforms in the 80s.

(Griffiths Report 1983). His major findings were that the Reforms failed because changes were imposed rather than managed

Collaborative solutions should only realistically be made after a careful consideration of the evidence base underpinning that proposed change. (Berwick D 2005).

Modern management theory calls for appropriate evaluation of the need for collaborative proposals by considering the evidence base on which the situation could be improved, its implementation by making managers aware of the need for change and proactively encouraging them in the means of implementation, and then instituting a review process to evaluate the effectiveness of the measures when they have been in place. (Berwick D. 1996) (Appendix five)

Models of Collaboration

There are a great many models of professional collaboration cited in the literature. In order to make an illustrated analysis, we will return to the specific example of the Health/welfare interface to consider some of the models in that area. In general terms, all of the models follow the functional structure – Plan, Implement and Review (expanded in Appendix Five).

The Outreach (or Outposting) model appears to be a commonly adopted model (McNally D et al. 1996), whereby a social worker is attached to a primary healthcare team. In terms of our analytical assessment here we should note that such arrangements, if subjected to process evaluation, generally promote progression towards a seamless interface in areas such as:

The sharing of information and in mutual understanding of the different professional roles, responsibilities, and organisational frameworks within which social and primary health services are delivered.

It is also noted that such benefits are generally greater if the implementation of such models is preceded by exercises including team building or joint training exercises. (Pithouse A et al 1996)

Other models include the Joint Needs Assessments model in which service commissioning between primary health and social services teams have a common assessment base (Wistow G et al. 1998). This does not appear to have been as successful as the outreach model, and has had a rather variable history (Booth T 1999).

Collaboration here has involved a variable number of agencies but not always the primary healthcare teams. The new primary care groups will have a strategic role in the commissioning of a broad range of health and welfare services. All NHS organisations have a clear imposed duty of collaboration and partnership with the local authorities (NHSE 1997)

Collaboration in the form of joint commissioning models have also been tried. They tend to fall into one of three patterns including

Area or locality as basis for joint commissioning
Joint commissioning at practice level
Joint commissioning at patient level

None have been in place for long enough for a realistic assessment of their relative strengths and weaknesses to be evaluated yet. (Glendenning C et al 1998)

Models- Interprofessional/teams

One of the more successful models of collaboration is that of the multidisciplinary pre-discharge assessment team which, when it works well, can be considered a model of good collaborative working (Richards et al 1998). This requires all of the elements referred to above to be successfully implemented and to be in place if the optimum result for the client is to be obtained. Such a model calls for professional integration and collaboration of the highest order if National Service Framework Standard Two is to be fully realised. The framework calls for all concerned professionals to:

Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries.

It is, in our estimation, the crossing of these boundaries that, perhaps, is the key to collaboration.

Review

Collaboration as a concept is comparatively easy to define. Any dictionary will give a reasonable definition. As a workable model of practice, it is far more nebulous and hard to achieve. In this review we have tried to consider the barriers and management problems that make it harder to achieve together with the mechanisms which will militate towards successful implementation.

We have identified financial and cultural barriers, as well as structural and organisational ones equally we have pointed towards models of collaboration which appear to be working well. It would appear to be the case that the prime factor in the success or ultimate failure of a collaborative exercise, is the success and management skills with which it is initially introduced.

References

Arblaster. L. et al (1998)

Achieving the impossible : interagency collaboration to address the housing, health and social care needs of people able to live in ordinary housing:

Bristol Policy press and Joseph Rowntree. 1998

Audit commission (2004)

Older People – Independence and well-being: The challenge for public services

London: The Audit Commission 2004

Bennis, Benne & Chin (Eds.) 1999

The Planning of Change (2nd Edition)..

Holt, Rinehart and Winston, New York: 1999.

Berwick D. 1996

A primer on the improvement of systems.

BMJ 1996; 312: 619-622

Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 – 316.

Booth T. 1999

Collaboration between health and social services; a case study of joint care planning.

Policy Polit 1999; 19: 23-49.

Cameron,A. Brown H and Eby,M.A. (2000)

Factors Promoting and Obstacles Hindering Joint Working;

School for Policy Studies, Bristol. 2000

Davidmann 1988

Reorganising the National Health Service: An Evaluation of the Griffiths Report

HMSO : London 1988

DOH 2000

Department of Health (2000)

The NHS Plan. A Plan for Investment. A Plan for Reform. Cm 4818.

London: The Stationery Office

Garlick C. 1996

Social solution.

Nurs Times 1996; 92: 28.

Glendenning C. Rummery K, Clarke R 1998

From collaboration to commissioning: developing relationships between primary health and social services

BMJ 1998;317:122-125

Griffiths Report 1983

NHS Management Inquiry Report DHSS, 1983 Oct 25

Haralambos M, M Holborn 2000

Sociology: themes and perspectives,

Harper Collins 2000.

Marinker M.1997

From compliance to concordance: achieving shared goals

BMJ 1997;314:747–8.

McNally D Mercer N. 1996

Social workers attached to practices. Project report. Knowsley:

Knowsley Metropolitan Borough and St Helens and Knowsley Health , 1996.

NHSE 1997

National Health Service Executive. Health action zones

invitation to bid.

Leeds: NHS Executive , 1997(EL(97)65.)

Pithouse A, Butler I. 1994

Social work attachment in a group practice; a case study in success?

Res Policy Plann 1994; 12: 16-20.

Powell, J. and Lovelock, R. (1996),

Reason and commitment: is communication possible in contested areas of social work theory and practice?’, in Ford, P. and Hayes, P. (eds), Educating for Social Work: Arguments for Optimism,

Aldershot, Avebury, pp. 76–94.

Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow 1998 Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ, Jun 1998; 316: 1796 – 1801

Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001; 323: 1429.

Shortell SM, Bennett CL, Byck GR. 1998

Assessing the impact of continuous quality improvement on clinical practice: what will it take to accelerate progress?

Milbank Quarterly 1998; 76: 593-624

Wierzbicki and Reynolds 2001 National service framework’s financial implications are huge BMJ, Sep 2001; 321: 705.

Wistow G, Brookes T, eds.1998

Joint planning and joint management. ,

London: Royal Institute for Public Affairs, 1998.

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Work-life balance is a broad concept which is closely related and derived from the research of job satisfaction. There are both intrinsic and extrinsic factors which affected perceptions of job satisfaction within individuals. Intrinsic factors referred to job characteristics specifically. However, the extrinsic factors referred to the social and cultural norms the individual holding the job operated by. Hence, Work-life balance was considered one of the inputs of this extrinsic factor.

Hackman and Oldham’s Job Characteristics Model

Work/life balance is the ability to do great work and get all of your other priorities accomplished, too. That means giving people the freedom to choose when and where to do their work so they can best balance every aspect of their life.

The point is, people are working. Work/life balance isn’t about doing less work. It’s about having the freedom to choose when and whereaˆ¦aˆ¦.

Introduction:-
Why is it important to develop a work-life balance?

The answer lies in how we deal with that old adversary stress. Maintaining a work-life balance is essential in handling stress. Balance is the key to dealing with stress and a chaotic life.

Balance provides us with necessary time to ourselves, enhances our relationships with our families, friends and gives us opportunities to relax. Balance brings our lives into focus, sharpens our perceptions and gives us time to discover ourselves.

Balancing time spent at work and time spent at home doing other activities should be equally balanced. We all need a breather from work and from time to time we require a break from home life. Balance gives us the means to bring our lives into harmony.

Relationships with family, friends and partners suffer when there is an imbalance between work and life. Not only do relationships suffer when there is an imbalance but our work performance suffers as well. If we give our all to one we neglect the other. This creates chaos and stress in our lives. Stress is the byproduct of imbalance and steps should be taken to reduce or avoid stress by balancing work and life.

How can we develop a work-life balance?

In order to develop balance between work and life we must start with giving equal time and attention to both. Never take your work home with you and leave your home life and all of its problems at home. When you are at work be wholly and completely at work and when at home be completely committed to caring about family matters only. This will reduce unnecessary stress on yourself, family and coworkers.

Work Life Balance

Work Life Balance Day was initiated by the National Framework Committee for Work Life Balance Policies in 2001. The Committee seeks to encourage and support employers to put in place a range of flexible working arrangements which help employees to combine employment with the other commitments in their lives. The Committee established a Panel of Consultants who will advise employers on putting in place a Work Life Balance Policy and associated arrangements.

Work Life Balance initiatives can be advantageous to both employers and employees:

For employers, Work Life Balance options can make an organization more attractive to recruitment candidates, as well as supporting the retention of current employees. When recruiting, employers can attract individuals from a wider pool of candidates, providing the organization with the best prospect for selecting high quality employees;

For employees, Work Life Balance options can allow them to remain in, or re-enter, employment while meeting commitments in other parts of their lives (family, education etc).

16 Ways to Encourage Work/Life Balance in Employees
By David Hakala on April 16, 2008

As a recession looms and companies slash their payrolls, it is more important than ever to keep remaining employees productive and happy. One issue that employers constantly wrestle with is work/life balance, the allocation of employees’ time and energy between work and family, health activities, hobbies and all of life’s nonwork requirements.

Studies have shown that too much work can lead to a variety of stress-related illnesses that sap workers’ vitality, making them more prone to errors on the job, absenteeism, burnout and turnover. The tendency for work to dominate employees’ lives is increased when layoffs and hiring freezes leave fewer workers with more to do. The remaining workers are often the hardest to replace because they are the best. It behooves companies to encourage employees to sustain healthy work/life balances. Here are some tips that companies can use to keep their work forces healthy and productive.

On-the-Job Training:-
Management

ManagementHYPERLINK “http://www.hrworld.com/management/” support for work/life balance is critical, and it must come from the top. Too often, the perception that hard work is the only way to rise in a company keeps employees at the grindstone, working themselves into illness.

Survey of employee

Surveys of employee’s work/life issues can help a company understand workers’ needs and design appropriate policies to meet them. Studies have shown that respect for work/life balance needs is high on employees’ lists.

Set priorities for all work

When priorities are unclear, employees tend to overwork because they think that everything must get done at once. Setting priorities allows workers to schedule tasks over a reasonable period of time.

Train line managers to recognize signs of overwork.

Supervisors can spot increasing error rates, absenteeism and signs of stress-related burnout more easily than anyone else in the organization. Workers who show these signs of a poor work/life balance can be referred to employee-assistance programs.

Seminars on work/life balance

It can help employees understand its importance and find ways to achieve it. Such seminars teach employees how to better manage their workloads, eliminate unproductive work habits, get sufficient exercise and negotiate more flexible work conditions that meet their needs.

Make Work More Flexible
Flextime

It is one of the most useful tools in helping workers achieve a good work/life balance. Companies should identify which jobs lend themselves to flexible work scheduling and implement formal policies for coordinating flexible schedules with an employee’s supervisors and coworkers.

Telecommuting

It is a way for employees to work from home while taking care of a sick or dependent family member. It also cuts down on stress and unproductive time due to a commute. Studies have shown that telecommuters can be 30 percent more productive than their office-bound counterparts. Many companies are implementing formal telecommuting programs on an as-needed or permanent basis. Telecommuting can be a terrific recruitment tools as well.

Job sharing

It can keep two valuable employees busy while reducing work-related stress. In a job-sharing arrangement, two workers work part-time and share the workload of one job. Careful coordination between the two workers, their supervisor and their co-workers is necessary to make job sharing work.

Allow for Time off from Work

Encourage the use of vacation and sick-leave time. Supervisors should advise employees to use their vacation and sick-leave benefits when signs of burnout or illness arise. Companies can implement use-it-or-lose- it policies to encourage employees to take time off when it is necessary.

Leave policy:

A formal leave policy for employees with dependents recognizes and encourages the need to care for sick children or elderly parents.

Paid childbirth or adoption leave gives women and men the flexibility to keep their jobs while attending to a new addition to the family. This option is almost always cheaper than the alternatives of burnt-out employees or those who leave the company.

Limit how often employees take work home. The line between work and home lives tends to blur when employees regularly take work home. This practice should be monitored by management personnel, who should also develop plans for making sure that work gets done at the office instead of at home.Some companies allow employees to take leave for community service. These firms recognize that employees obtain life satisfaction from projects or work outside of their regular jobs.

Bringing Life to Work
Bring-your-kids-to-work day

It is a way to get employees’ families involved in their work lives. The opportunity to share a day of work with children is a benefit that many employees appreciate.

Sponsoring employees

It family-oriented activities is another way to combine work and life. Sporting events, excursions to amusement parks, fishing trips and other family-oriented jaunts are good opportunities to help employees strike a work/life balance.

Companies need to promote their work/life-balance policies year-round – not just in employee orientations and handbooks. Frequent, positive communication of these benefits reinforces management’s commitment to help workers achieve work/life balances and gives employees the feeling that it is OK to live a little.

Balancing Life and Personal Commitments

Work-Life Balance does not mean an equal balance. Trying to schedule an equal number of hours for each of your various work and personal activities is usually unrewarding and unrealistic. Life is and should be more fluid than that.

We want to make sure you have the resources, services and tools you need to get the balance that is right for you and to help you in your personal and professional endeavors.

WORK LIFE BALANCE: Benefits to the organization

Measured increases in individual productivity, accountability and commitment

Better teamwork and communication

Improved morale

Less negative organizational stress

WORK LIFE BALANCE: Benefits to the individual

More value and balance in your daily life

Better understanding of what your best individual work life balance.

Increased productivity

Improved relationships both on and off the job

Reduced stress

Balancing Work and Life

Your department and colleagues can contribute to your work-life balance

Managers play an important role in helping faculty and staff achieves the right work-life balance. When you create and promote a work atmosphere that makes it easier for your team to achieve a better work-life balance, you have happier, healthier employees who are more productive and satisfied in their work and a less stressful work environment overall for your team. Being flexible and understanding the needs of each of your employees will help you to build a more positive and successful work environment.

Tips for helping your team achieve a better work-life balance

Consider flexible schedules, alternate work arrangements or job sharing where appropriate and be supportive of these arrangements (they shouldn’t have a negative impact on career growth and success)

Be flexible, considerate, and respectful of personal or family responsibilities

Allow for time to pursue professional development and community service opportunities

Promote a positive work environment through your leadership and support of employees

Promote a “disconnect from work” atmosphere when employees have scheduled time off (no cell phones or lap tops) where possible

You can contribute to your own work-life balance

It is important that you, as an individual, find ways to create the right work-life balance for yourself. The best work-life balance for you may be different than that of your coworkers or your manager. For some, working long hours creates value and balance in their lives. For others, it is not a routine they can productively or enjoyable maintain. The best work-life balance also changes for each individual over time and is usually different for someone just starting in their career than someone who is retiring. A good work-life balance for someone who has no children may be different than that of someone with children, and many people are caregivers to older family members as well. Your best work-life balance will change, and while we strive to help create an environment that allows you to integrate your personal and professional lives, you must find ways to create the right balance for your self.

Suggestions for getting a better work-life balance that is right for you:

Define and create your own work-life balance

Be accountable for balancing your personal and professional commitments

Help your manager understand the right balance for your life and help to work out an arrangement that supports your needs

Strive for meaningful achievements and enjoyments in work, family, friends, and self each day

Work life balance

what are the benefits and barriers associated with the achievement of a work – life balance for employees and employers?

The importance of the achievement of a work-life balance and the issues which can be faced when initiatives to achieve such a balance are implemented One issue surrounding the concept is that ‘work life balance’ is often loosely defined as simply referring to the balance between an individuals time spent at work and on home life. In fact employees are usually monitored on various factors including their attention whilst at work. ‘Central to definitions of work-life balance then is the notion that the modern employment relationship is a negotiation to establish the boundaries around the attention and presence required,’ creating the need for employees to consciously incorporate practices into their lives to integrate the work and non-work aspects. Work-life balance can be defined as ‘a reconciliation of paid employment and life.’

It has suggested by McKee and colleagues that a series of historical shifts has shaped, to some degree, the debate about work-life balance. Broadly speaking they suggested these were the absence of fathers from home through war, imprisonment or long working shifts, the entry of large numbers of women into the workforce; the changing composition and structure of the family; expanding male unemployment; the increase in singe working parents; the intensification of working hours; an ageing population and the growing number of cared for groups; and the growth of equal opportunities. (McKee and colleagues) It is accepted that the feminization of the work force increases the need for family friendly policies, however studies are said largely to have narrowly focused on the experiences of women with the double burden of employment and domestic and child care tasks, at the expense of a broader concept (Ransom, 2007). It also must be noted that the…

Work-Life Balance b/w personal and professional life

When an individual maintains a balance between his personal and professional life, the phenomenon is called Work-Life Balance. This expression holds worth a lot because it is very important to have a balance between personal and professional life. Work life balance is at the forefront of the world of work. Kaizen, the Japanese philosophy for continuous improvement, along with the role of information technology (IT) helps and guides the management people, to get the maximum output with the help of available resources.

The balance between personal and professional life vary from person to person and the organization where he or she is working. When an individual does not maintain a balance and works too much in the organizational setting, this may cause him some medical, psychological and behavioral consequences, as a result his or her productivity will also be low. Studies have shown that work life stress is harmful to the employees. Late sitting and working too much can cause imbalance in an individual’s personal and professional life; however there are some techniques to manage the work life stress e.g. time management, task management, relaxation, flexible working hours, working from home and exercise etc. Work life balance improves individual’s health, job satisfaction, commitment, involvement and reduces absenteeism and presenteeism (state of physical presence but not productive). Despite of the progress in the betterment of maintaining work life balance, there is still more to be done.

One important factor is the degree to which work life balance are generally applicable across the whole hierarchy of the organization. Those lower down the organizational hierarchy are sometimes not entitled for some benefits or uninformed about relevant company policies. Work life balance can assist employers and employee to be healthy and productive in their personal and professional life.

“Balance is not better time management, but better boundary management. Balance means making choices and enjoying those choices.” – Betsy Jacobson.

For some people spending more time in the organization is more important than the time they spend at home. However, there are people who give priority to the personal and family life. In this technological era, some organizations also offer flexible working hours. One can carry laptop, PDA, black berry and is connected with suppliers, venders through internet 24 hours a day. The moment he gets any query, he responds to it. There are some work-alcoholics who take their laptops and PDAs to the vacation and face the annoyance of their wives while checking the emails.

People are more interested in looking for a job that gives them flexibility at work. Necessary arrangements for work life balance are required by all workers at different times in their lives because balance is instrumental in quality initiatives by preparing an individual to deal with the change. An individual can give his best only in a conducive environment e.g. students want to study and work at the same time; parents want to have time with their children and the older worker approaching retirement to have the opportunity to stay in the workforce on reduced hours. Mostly the employers and the employees agree that organizational objectives are more important, so it is the obligation of the employer to help people in work life balance.

CONCLUSION

Work life balance does not just happen; it is your own personal strategy of the manner in which you make a conscious choice to put balance in your life. Work life balance means different things to different people. It is a personal decision on how you want to balance your time between work and your personal life. It is a decision on balancing and maintaining a focus on what is most important to you. No two people share the exact work life balance preferences. Examine what is important in your life and what is your highest priority. Examine what your personal life goals are related to your job and your personal life. Personal life goals should reflect the value and principles that you focus your life on. None of the priorities are set in cement and there should always be room to make changes because your priorities and goals can change. Whenever you are experiencing competing priorities, stop and take a close look at your situation. Look at what is being expected for you to accomplish and make an accurate estimate of what you can accomplish and what you cannot accomplish. This should be a honest accounting of yourself and your priorities. Avoid setting yourself up to fail because you are trying to accomplish more than you can effectively balance in your life. If you over extend yourself your work life balance will be out of control.

“Work/life balance is not a ‘nice to have’ when we’re in a boom time. It can have a fundamental impact on the corporate performance at all times. Companies who focus on and measure staff wellbeing are in fact being very prudent. They’re making as big a contribution to their bottom line as those who are looking at ways to increase sales or cut costs

Literature Review

It is a truth that work and family life cannot be separated, they both act together and the lines of demarcation of family life and work life cannot be drawn. With changing times, social structure, nature of business and globalization at fast pace; boundaries of work is changing rapidly. Working patterns and timings are in constant change but the pace of change is more rapid. The need for the change is being derived from individuals and organizations. Organizations are expected to perform at its optimum and provide better services 24/7 which requires employees to devote extended working hours to deliver service and this in turn effects personal lives of employees and creates an issue of work-life imbalance which is of paramount concern for everyone to have work-life balance (Jacobs & Gerson, 2001) (Taylor, 2001).

Work life balance is an adjustment in working patterns to mingle work with other responsibilities (Smithson & Stokoe, Discourses of Work-Life Balance: Negotiating ‘Genderblind’ Terms in Organizations, 2005) regardless of gender. Work-life balance reflects; “The extent to which an individual is equally engaged in – and equally satisfied with – his or her work role and family role” (Aziz & Cunningham, 2008), similarly according to Clark (2000) as cited by Othman, Yusof, & Osman (2009) work life balance is defined as, “Satisfaction and good functioning at work and at home with a minimum of role conflict” (Othman, Yusof, & Osman, 2009). It is also eloquent that every individual is to require maintaining and achieving a balance between their paid work and family responsibilities be it child care, elder care, leisure time, self development (Hogarth & Bosworth, 2009). It is debatable that the word “balance” means settled equilibrium but can work and life outside work can be in equilibrium?

Initially, work was considered as the only responsibility of male members of the society while women were only responsible for the domestic chores (Bailyn, Drago, & Kochan, 2001), (Eikhof, Warhurst, & Haunschild, 2007). This framework has been followed for ages and it was widely believed and accepted that the bread-winners of the family were only men. However as time evolved and in order to earn and have better lifestyles for their family, female workforce in the labor market started to increase, the conventional image of male as bread winner started to transform and now female also played an equally important role as an earning member of the family (Easton, 2007), (Flechl, 2009), (Malik & Khan, 2008) (Hakim, 2006), (Strober, 2010), (Lourel, Ford, Gamassou, Gue?guen, & Hartmann, 2009).

Evolution of females at work life

The Second World War brought the contribution of women to the forefront. The discrepancy between men and women started to emerge, as it came in to notice when the female gender entered the work force around the globe (Goldin, 1991), which added another responsibility to their account that now they were multitasking between work and family life, taking care of their family as well as their work both came under their life domain (Tijdens, 1997), (A.Milkie & Peltola, 1999).

It was seen that at the time of Second World War keeping aside the traditional division of labor on the basis of gender, women entered the work force and start performing the men’s job in the industries to prove themselves as capable enough to perform tasks in a more organized and better way (Milkman, 1987). It is a sad fact that in spite of their dual dedication, even during this time period, they were not considered as a factory worker instead their identity was recognized as women only (Trey, 1972), (Hyman & Summers, 2004).

At the end of the war; the female workers were forced and left stranded out of the labor market in order to take care of their more traditional responsibilities. Fortunately, for women this was just a temporary setback, as the number of women workers has increased after the Second World War which shows that the pattern set during the war time is still being pursued by females persistently till present (Milkman, 1987), (Bird, 2006). This is evident from a research conducted by Goldin (1991) on the percentage of working females in USA as according to this study; the participation rate in 1890 was 5 percent, 1940’s was around 10.1 percent, while in 1950’s it increased to 22.2 percent and then kept on increasing and finally reached 60 percent in 1990’s (Goldin, 1991).

Female workforce is not only increasing in European countries, but also in Pakistan; women are entering in the labor force with an increasing trend (Hussain, Malik, & Hayat, 2009). According to Federal Bureau of Statistics of Pakistan, the women entering into the work force have increased to 11.81 million (53.72%) in 2009 from 10.96 million (51.78%) in 2008. This labor force comprises of 74% females in agriculture sector, 11.9% in manufacturing, 11.6% in service sector, while the rest of 0.9% are working in other sectors (Federal Bureau of Statistics, 2010). These statistics shows that with an increasing number of female workforces, it has become mandatory for women to maintain a balanced work and family life.

Change in the Role of Women with Added Responsibility

The role of women modified after the Second world war, as females started entering in the labor force as bread earners to support their families due to economic pressures (Hakim, 2006) and to improve the life style of their living (Emslie & Hunt, 2009), and changed the traditional image of male being the sole responsible for earning the livelihood for all family members. With the enhancement of this new role as bread earners, the responsibility also increases for the women as now they have to look after their work life also along with the family which makes it difficult for them to manage both responsibilities simultaneously (Lourel, Ford, Gamassou, Gue?guen, & Hartmann, 2009),(Flechl, 2009), (Work-Life Balance, 2010).

Although the conventional model of male bread winner starts to modify but still the distribution of duties between men and women remains unchanged. As now women are sharing the responsibilities of men by entering in the work force but on the other side the duties performed by females are not being shared (Emslie & Hunt, 2009), which is creating a conflict between their family and career life (Zulu, 2007), (Thompson & Walker, 1989).

Originally, women had to take care of family matters only while men were responsible for work related issues. But with the change in the role of female, now they have to manage their family and professional life effectively which is creating a burden on them (Malik & Khan, 2008), (Callan, 2008), (Dulk & Peper, 2007). As they have to perform tasks like;cooking, shopping, cleaning (A.Milkie & Peltola, 1999), listening and comforting children, providing emotional support to partners and parents (Emslie & Hunt, 2009) and other domestic chores; which were previously considered as the only responsibility of females. But with the passage of time, now they have to perform their official tasks along with all these household chores but men are still only responsible for work related issues.

Due to this unending list of duties women had to perform at home which are less flexible, demanding and experience interruptions (Aziz & Cunningham, 2008); effects professional life or relaxing time of females which leaves negative impression on work life balance as compared to men (A.Milkie & Peltola, 1999). Hence, in order to run work and family life smoothly women are expected to make larger sacrifices because they possess less power and authority due to the tradition and cultural norms of the society. Women can equally enjoy roles as mothers and workers but still feel more pressure than men because home responsibilities are greater and require more sacrifice (Stephen, 1977), (Thompson & Walker, 1989).

According to Coltrane (2000), Greenhaus and Parasuraman(1999), Rothbard and Edwards (2003) as cited by (Malik & Khalid, 2008) it is a known fact that women typically do a bigger share of the household labor than men and that extra work at home partially constrains the time women can spend in paid work. Straub (2007) identifies that women tend to spend more time to family activities as of men and the same amount of work hours as of men.

Challenges Faced by Women while Handling Work and Family Life

With the amount of responsibilities added to the role of women, it has given rise to multiple challenges that they are facing in their daily life. Performing various tasks and playing different roles which includes; mother, wife, caregiver (for parents and elderly) and employee simultaneously becomes very difficult for women to fulfill (Straub, 2007), (Beauregard & Henry, 2008). It is a challenge for women to give proper time and attention to; children especially who are very demanding under age of 13 (Thompson & Walker, 1989), husband to maintain healthy relationship (Jacobs & Gerson, 2001), other members of the family (parents, elderly) (Lourel, Ford, Gamassou, Gue?guen, & Hartmann, 2009) and to their work life for career progression (Aziz & Cunningham, 2008). A balance between all these responsibilities is directly linked with the career performance as well as physical and mental wellbeing of women (Whitehead & Kotze, 2003), (Creating Work Life Balance, 2009).

Female workers also have to face lots of social pressures which do not allow women to have late sittings at the work place for official matters or to visit places related to work (Hakim, 2006), (Jacobs & Gerson, 2001). These restrictions are mostly raised by the members of the family which includes; husband, in-laws, brother and parents which creates hurdles in their career progression (Schwartz, 1989). Women also encountered issues like stereotyping, sexual harassment and discrimination which make them feel insecure and confused about whether they should raise voice against inequality or remain quiet and face it (Ibrahim & Marri, 2008), (Lee & Brotheridge, 2005).

According to Easton (2007) and Zulu (2007), Glass ceiling is also one of the obstacles which hinders women while climbing ladders of hierarchy in organizations because business environment for women is more stressful and not at all easy as compared to men. As women are in minority and mostly perceived by men as blend of doubt, attraction, respect, confusion, competitiveness, pride and animosity; therefore this mixed perception creates glass ceiling at the time of promotions (Flechl, 2009), (Lourel, Ford, Gamassou, Gue?guen, & Hartmann, 2009).

As managerial positions require strong decision making skills while women are considered as emotional and required ample amount of time to make decision for important matters (Aziz & Cunningham, 2008), therefore women are not easily designated for senior managerial positions because of perception that they are best regarded as housewives’ and mothers (Dulk & Peper, 2007), (Kafetsios, 2007).

The other challenge for women is the career development and promotion in their professional lives. Senior positions require long hour’s commitment, work related seminars, conferences, workshop and tours which makes it difficult for women to reach due to family responsibilities (Beauregard & Henry, 2008), (Hochschild, 1997). Also the fact that creates hurdles in women’s progression is pregnancy and childbirth; because they have to take maternity leaves which results in missing out opportunities for promotion (Straub, 2007), (Doherty, 2004), (Schwartz, 1989).

Although there are many women who want to achieve career advancement with fulfilling other house hold tasks (Kafetsios, 2007), but organizations fail to realize that talented and motivated women can be committed to family as well as career and can do best for the middle management (Saltzstein, Ting, & Saltzstein, 2001) but as organizations are reluctant to reduce pressure and provide flexibility this leads to recruit other employees rather than providing training to women employees (Clutterbuck, 2003), (Doherty, 2004).

Consequences of Imbalance Work and Life

Due to the challenges faced by women in their work life, it becomes difficult for them to maintain a balance between their work life and family life. Therefore it leads to number of negative consequences, not only at part of individuals but organizations also have to face certain setbacks (McPherson, 2007), (Hyman & Summers, 2007).

Individuals

As women have to execute variety of roles in their family and work life, it becomes tough for them to handle diverse tasks effectively at the same time providing equal amount of attention to every role. When women were unable to manage all these roles, it results in physical as well as psychological problems (Kirrane & Buckley, 2004); which includes increased level of stress, anxiety, lack of concentration and decrease in levels of alertness, energy and general health (Beauregard & Henry, 2008), (Franche, Williams, & al, 2006)

Work life imbalance also has implications on the relationship among family members as due to the demanding nature of work, it becomes difficult to spend time together which results in lack of bonding among family members (Lee & Brotheridge, 2005). Hence due to this situation, women may experience guilt and regret because they are unable to meet expectations of their families (Abercromby, 2007), (Creating Work Life Balance, 2009).

Organizations

Unbalanced work and family life also have negative impacts on the part of organizations, as when women workforce are not satisfied with the roles they are playing it reflects in their performance at work place (Tausig & Fenwick, 2001), (Nolan, 2005). According to Straub (2007), Kafetsios’s (2007) and Lambert et al., (2006); collision in work and family life results in reduced levels of job satisfaction, loyalty, organizational commitment, work effort, performance; while increased the level of absenteeism and turnover.

Policies and Steps taken by Organization to Support Work Life Balance

With the changing trends of economic development, equal employment opportunities and others, the issues regarding work-life balance has gained much attention from media and researchers globally (Kirrane & Buckley, 2004). The work-life balance debate mostly discussed the fact that individuals have too much work to do that very little time left for themselves or family (Eikhof, Warhurst, & Haunschild, 2007). As the time spend on work does not only include the contractual hours of employment but it also include the unpaid activities such as unpredictable long journey times, hence the line between work and family is becoming more blurred than before (Hyman & Summers, 2004).

These issues make employers realize the importance of work-life balance in woman’s daily lives in order to get optimal outcomes from the female employees (Leeds list the benefits of better work life balance, 2004), (Jacobs & Gerson, 2001). Hence during 1980’s, many organizations starts to change their internal workplace policies, procedures and benefits. The changes included maternity leave; Employee assistance programs (EAPs), flextime, telecommuting, paid maternity leaves, home-based work, vacation, professional counseling, and child and elder care referral (Bird, 2006), (Hudson inc), (Sunil Joshi, 2002). At present, the work-life balance issues are assumed as the most discussed topic in the field of Human Resource world due to the recognition of its value and need in the lives of females (Smithson & Stokoe, 2005).

Considering these consequences resulting from imbalance work and family life, European companies have shown interest in reducing this imbalance and have launched numerous work-life balance programs specifically for females (Sikora, Moore, Grunberg, & Greenberg). According to a research conducted by Caroline Straub; on average 95 percent of European companies offer flexible timings facility to their employees, 79 percent employers allow employees to work from home, 23 percent provides opportunity to take paid vacations and only 34 percent emphasis on child care facilities (Straub, 2007).

However still, a question asked by most individuals today is as to why do work-life balance matter to policy makers, and why it might be of importance to employers? Which has been answered by (Gatrell & Cooper, 2008) through citing Swan and Cooper (2005) that the concept of work-life balance developed initially as a result of European government policies designed to work on addressing the pressures with balancing work and family life together, where both parents were employed. As further addressed by Lewis and Cooper (2005) cited by (Gatrell & Cooper, 2008) it has been observed that, work-life balance policies are associated with presenting employees with the chance to work flexibly, whereas initially the notions of flexible working were considered in equal opportunities program, with a special focus on working mothers. Today it is open to all. This leads to encouraging the concept of work-life balance in clear terms.

In New Zealand, (Kean, 2002) undertook a survey of the employees of 25 organizations which reveals that there is a clear relationship between the work-life balance policies with the employee’s intentions to leave the organization and actual turnover rates. This study suggests that the work-life balance policies have net positive effect on staff turnover rates.

On the other side there are managers who are reluctant to apply policies which promote work life balance; according to the study of Workplace Employment Relations Survey 2004 (WERS), 69 percent managers in private sector believe that it is solely the responsibility of individuals to balance their work and domestic demands (Hyman & Summers, 2007). They have the doubt of the benefits work life balance will bring to their companies and perceive that it will be costly to implement (Hughes, 2007).

But this is not reality, although costs will incur at planning and implementation stage but the benefits that will be availed afterwards will be higher from this cost.

Benefits earned due to implementation of Work Life Balance Policies

Work-life balance has become the focus of companies worldwide, who do not take it lightly at any time. Nowadays, it is important for managers to take work-life balance seriously. The more overworked employees, the higher the demands or the expectations on the department (Clutterbuck, 2003), the more the managers have to depend on their employees to perform at the highest possible level of proficiency, value, and quality (Jacobs & Gerson, 2001), (Human Resource and Skills Development Canada, 2003).

There are companies who believe that if employees maintain a balance between work and family, it will benefit the organization as a whole. A survey conducted of DuPont employees lead to a discovery that those who used work-life opportunities provided by the company were more committed to their work and believed in sticking with the organization (Clutterbuck, 2003).

The U.K 2003 Best Companies to Work for survey states that the companies who allow their staff to work flexibly earn fine dividends. In UK, the government has been promoting the concept of work-life balance for some time now and many large corporations have started to implement this religiously (Clutterbuck, 2003). The benefits that BT, a U.K based company and one of the leading providers of communication solutions and services around the world has achieved from this change are colossal; it results in a more flexible and an approachable workforce, recruitment and training costs have been reduced as now 98% women return to work after maternity leave which saves around ?3 million, absenteeism rate has reduced to 3.1% as compared to other U.K. companies whose average comes about to be 8.5%, one of the best aspects of work-life balance has been that around 7000 BT employees now work from home which has increased its gains of 31%, and flexible working arrangements means that BT can now respond to customer’s demand 24/7 (Hughes, 2007).

According to another research, the employee-opinion survey conducted at UK building society Nationwide, where more than three-quarter agreed with the statement that: “I am satisfied that Nationwide provides me with the opportunities to balance working arrangements with my personal life.” Therefore it is apparent as to how Nationwide has gained the following rewards over the period of three years; the number of employees returning from maternity leave has increased to 93%, employee turnover rate has decreased to 9.7% as compared to the industry average of 17%, the number of female part-time employees has increased to 50% and female home workers has risen about 150% (Job flexibility and work-life balance pay dividends for Nationwide, 2003).

In a recent newspaper article (Razvi, 2010) the writer talks about how in a country like ours, most companies apparently operate on an ‘eight to-whenever you’re absolutely finished’ work hours policy. The idea of striking a work-life balance is not always something that young people are made aware about as they enter the professional territory. Even prior to people entering the job market, hardly any are actually able to keep that delicate balance between their studies and their family and social life. What the balance adds up to is in itself dynamic, and fluctuates with the changing status, as well with the altering demands of the multiple roles.

Therefore, it’s necessary to focus on work-life balance, because if people are out of balance or stressed or sick then they will be less committed to the results (Tremblay, 2002), they will be less devoted to the organization (Yasbek, 2004), they will be less committed to the client, the customer, the product or service that you’re producing (Human Resource and Skills Development Canada, 2003).