=Paper=
{{Paper
|id=Vol-280/paper-10
|storemode=property
|title=Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework
|pdfUrl=https://ceur-ws.org/Vol-280/p03.pdf
|volume=Vol-280
|dblpUrl=https://dblp.org/rec/conf/ectel/PanneseACNPRS07
}}
==Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework==
https://ceur-ws.org/Vol-280/p03.pdf
Star Rating for Social Care Services:
Simulation Scenario in the PROLIX Framework
Marcello Allegri1, Maria Carlesi2, Gavin Nettleton1, Lucia Pannese2, Kevin
Pudney1, Malcolm Rose1, Mauro Santalmasi2
1
SCIE
Ist Floor, Goldings House, 2 Hays Lane,
London SE1 2HB, United Kingdom
2
imaginary srl
c/o Acceleratore d’Impresa del Politecnico di Milano
via Garofalo 39 – I-20133 Milano, Italy
info@i-maginary.it
Abstract. According to the Commission for Social Care Inspection,
performance in Care Homes can be evaluated through a range of indicators in
each of the different outcome areas specified by the UK Department of Health.
Each indicator partially contributes to the result in its respective outcome area,
in proportion to its weighting within the same area. The competencies of the
employed staff affect the overall quality rating (“Star Rating”) of services.
Since the result of each area is linked to the competencies of the human
resources involved, the Authors are designing a simulator which works as an
assessment tool. The simulation of a possible or desired star rating is turned into
prioritized potential competencies gap that should be filled in order to achieve
the desired result. Thus the simulator acts as a Training Planner.
Key words. Simulation, Social Care, Quality Rating, Performance.
1 Quality and Performance in Social Care. Background
Information
The actual performance of the Care Homes in the United Kingdom is assessed by
the Commission for Social Care Inspection (CSCI).
The CSCI website shows some ongoing developments in the assessment
methodologies: basically the main proposed development will be the introduction of a
‘star-rating’ for quality for all adult care homes.
Moreover, the performance of individual workers is related to the National
Occupational Standards which are a set of competences that underpin the National
Vocational Qualifications.
2 Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework
1.1 Describing the Quality of a Service: CSCI’s New Ratings
CSCI has 100,000 downloads of its home inspection reports every month so it
knows how important good information is to people who are trying to judge the
quality of the care they are considering, and is aware that the way it describes the
quality of a service needs to be clear and simple. People who use this information can
then understand how well a particular service meets the needs of the user or patient.
An overall quality rating has a twofold objective: first, it allows a simple
comparison between different social care services, in spite of their complexity;
secondly, the quality rating is expected to be perceived as an incentive to improve by
providers of services and involved workers.
Services rated as being among the best will want to maintain their rating and not let
their standards slip. Services with the potential to make improvements will want to
improve. They can be confident that when improvements take place CSCI reports will
tell everyone about their success.
CSCI wants to achieve a ratings system that:
• is easily understood by everyone;
• providers of social care and their staff can relate to and which encourages them to
improve their service. CSCI does not want providers to chase ratings but wants
them to seek to provide high quality services;
• councils and health agencies can use in deciding how to give incentives to
providers to improve services;
• shows an open and transparent way of reaching the rating.
1.2 CSCI Proposals for a Quality Rating
CSCI will be introducing a published quality rating for all care services from mid
2007. There are two parts to how they will do this:
Part One: a simple graph that shows how well the service performs under eight
main headings called ‘Outcome areas’;
Part Two: an overall rating based on the evaluation obtained in the Outcome areas.
CSCI will use an outcomes graph to say how the service performs in eight main
areas. It will be using the outcome areas published in the Department of Health’s
recent publication ‘Our Health, Our Care, Our Say’. Mapping these to the existing
CSCI areas of regulatory assessment will continue for the rest of 2007. The
Department of Health outcomes have been identified as being important to people.
It will also add a further judgment area related to ‘Leadership and Management’.
Some people using services will be able to make choices, retain degrees of
independence and participate actively in decisions relating to their care.
Other people, for example those with complex needs, may have difficulty
exercising choice. Independence and involvement may be represented by small signs
of progress. In these circumstances, services will need to show that they engage with
advocates and specialists to help people to communicate their needs and to involve
them as much as they are able.
The outcome headings are shown below, and some examples of the way CSCI
thinks they relate to regulated social care services are presented.
Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework 3
• Quality of Life – e.g. People who use the service have their independence actively
promoted. People are supported to live a fulfilled life making the most of their
capacity and potential.
• Exercising Choice and Control – e.g. People who use services, and their carers,
have access to a service they think will be responsive to their individual needs and
preferences. People have choices within the service they receive and feel able to
express preferences that might be different from others receiving the service.
• Making a Positive Contribution – e.g. People are seen as full members of their
community. They are helped to be as involved in their community as they wish and
their contribution is valued equally with other people.
• Personal Dignity and Respect – e.g. Respect for individuals is a priority in every
part of the service. The environment is good. The processes and procedures support
respect. The way people are treated shows respect.
• Freedom from Discrimination and Harassment – e.g. People who use services have
fair access regardless of their faith, beliefs, colour, sexuality, ethnicity or disability.
The service has clear, open and transparent ways for people to express concerns
and anxieties and these are acted upon and addressed.
• Improved Health and Emotional Wellbeing – e.g. Emotional and mental health
needs are responded to even where the person has other primary needs. People
have a right to exercise choice and control and where necessary this involves their
advocates being involved on their behalf.
• Economic Wellbeing – e.g. People should feel in control of their resources so that
they can make choices on a daily basis. People receiving social care services are
facilitated to contribute to their community by carrying out paid and/or unpaid
employment appropriate to their preferences and skills.
• Leadership and Management (the additional outcome) – e.g. People experience
well led services. Providers and staff understand what makes a high quality social
care service and how to make it happen. They know how to make the service better
and are able to do so.
CSCI will group the current National Minimum Standards (NMSs) under the most
appropriate outcome heading. And over the next few years as NMSs change CSCI
will put the new ones into the Outcome areas. CSCI will no longer report against each
national minimum standard in their report. Instead, inspectors will use the NMSs as
part of the evidence to reach a judgment on each Outcome area. For each of these
headings CSCI says whether the service is excellent, good, adequate or poor.
A graph will be used to show what the service does well and where it needs to
improve. The chart will be published in the summary of each inspection report
following a key inspection.
2 The Simulation in the PROLIX Framework
PROLIX is a 4-year research and development IP project co-funded by the
European Commission under the 6th FP, Priority 2 "Information Society
4 Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework
Technologies". The objective of PROLIX is to align learning with business processes
in order to enable organisations to improve the competencies of their employees more
quickly as business requirements change.
The Social Care Institute for Excellence (SCIE) is facilitating the social care test
bed in the PROLIX project. SCIE's aim is to improve the experience of people who
use social care by promoting knowledge and awareness about good practice in the
sector in order to increase the quality of the service.
2.1 The simulation Tool: Role and Objectives
The simulator would provide the care home owner/manager with a pre-inspection
diagnostic tool that gives the care home manager a detailed insight as to what star
rating he/she might expect and where services could be improved to increase the
probability of obtaining a better star rating. Thus, once competencies have been
weighted and linked to the different items contained in the model, and which
contribute to determining the star rating, the simulator will simultaneously act as both
a decision support system and a training planner: simulating a desired rating will be
translated by the simulator into a list of prioritized competency gaps that should be
filled (in order to increase the probability of obtaining a better star rating). Planning to
fill these gaps according to the resulting prioritization means simply planning some
training for the involved staff (Fig.1).
Fig.1. The whole process and the role of the simulator.
2.2 Empirical Approach to Set Up the Model
A set of rules has to be defined to model the business process in order to obtain the
outcomes that describe how a service performs. Each outcome area (called “Factor” in
the model) relates to regulated social care services via a set of items (called “Sub-
factors” in the model). A rule takes the following entities into account:
• domain logic: what are the dynamics of the process, how do the outcomes have to
be computed;
Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework 5
• a set of scenario parameters could be defined as fixed (i.e. scenario constraints) or
changeable (by the user during the simulation start up phase);
• for each Factor a grid of Sub-factor weights could be defined to describe Sub-
factor relationships;
• for each Factor a grid of Competency weights vs Sub-factors could be defined to
describe how a competency weights in the related outcome area.
A rule is defined considering the possible relationships between domain logics,
scenario parameters, Sub-factor weights and Competency weights. Once a set of rules
is defined, the model will “compute” how well the service performs under the eight
headings called Outcome areas.
On the basis of the case study the empirical model will be determined and used as
basis for the development of the simulator: the output of the simulation will be
expressed paying attention to both the quality level of the outcome (areas and items)
of the simulated process and the levels of the competencies of the staff involved.
The CSCI rules used to assign a rating to care services can be used as guidelines to
create rules and weights for the model. In fact they are expressed in linguistic terms:
excellent, good, adequate, poor. The proposed evaluation is based on the relative
importance of the proposed Outcome area in the global framework, therefore to
determine an empirical model it is necessary to formalize the rules and develop an
appropriate scale of weights. The formalization of rules in fuzzy terms will allow the
model to respect the criteria used by CSCI. The flexibility of the rules will be
maintained in the model; this ensures that it will be possible to monitor the levels of
the Outcome areas which are of greater importance if the global desired performance
level in the specific scenario is to be achieved. Each item contributes to generate the
result of its Outcome area in proportion to its specific weight within the area.
Moreover the item related to a fundamental Outcome area (i.e. for example Personal
dignity) should have a stronger influence than items related to other areas deemed to
be less important. The same ratio is valid for those human resources competencies
which are more or less important for determining the final outcome of the entire
process. Nevertheless the same competencies could sometimes influence different
areas at the same time (which does not happen with items).
SCIE’s knowledge base was mapped as the model for the simulation. Empirical
evidence has now to be gathered from inspectors: It is necessary to gain familiarity
with the ‘rules’ (expressed as “guidance” by CSCI) and to understand the judgments
the Inspectors apply when arriving at scores. This will represent an important step in
developing the model regulating the simulation.
3 Technical Description of the Simulation
The simulator is a web application based on a multi-tier architecture. To ensure
scalability and flexibility, the Process Simulator has been designed as a “modular”
application that will allow each module and the whole environment to be quickly and
easily configured without needing to be re-implemented. The next step will be to
interface the simulator with the so-called “Matching Engine” of the “Competency
6 Star Rating for Social Care Services: Simulation Scenario in the PROLIX Framework
Analyzer” module of the PROLIX project, to ensure that the prioritized list of
competencies can be exploited by any other module in the project.
In order to reinforce these features and to facilitate the integration with the other
PROLIX modules, the architectural approach of the process simulator “is migrating”
to a pure MVC architectural pattern that decouples data access, business logic, and
data presentation and user interaction. Framework Spring has been chosen as the
MVC framework; it is an open source web application framework for the Java
platform and offers the features that are required for the effective creation of complex
business applications outside of the programming models that have historically been
dominant in the industry.
The interface between the application (business logic tier) and the data tier is
managed by Hibernate; Hibernate is an object-relational mapping (ORM) solution for
the Java language: it provides an easy to use framework for mapping an object-
oriented domain model to a traditional relational database.
Fig.2. A screenshot of the simulation tool (prototype).
References:
1. PROLIX website - http://www.prolixproject.org/
2. Skills for Care website - http://www.skillsforcare.org.uk
3. Star-rating for quality for adult care homes; CSCI website -
http://www.csci.org.uk/pdf/quality_ratings_tagged_v2.pdf
4. The National Minimum Standards -
http://www.dh.gov.uk/assetRoot/04/13/54/03/04135403.pdf