- Identify what aspects of your service need to improve. Providers rated 'requires improvement' or 'inadequate' should look at why they failed to meet the required Care Quality Commission (CQC) standards.
- Consider what improvements need to be made and when they need to be made by.
- Allocate adequate resources to make the improvements.
- Draw up an action and improvement plan that specifies what action you will take and when you will take it – CQC will normally require you to do this.
- Implement the improvement plan and check that the improvements have resulted in lasting change.
- Always look at your services to identify possible improvements.
- It is better to identify and deal with areas of non-compliance before a CQC inspection to avoid costly improvements in a short space of time.
All care services will need to improve following a CQC inspection. Some will need to improve as a matter of urgency following the awarding of a rating of 'requires improvement' or 'inadequate' in one or more of the key lines of enquiry (KLOEs). Other providers will want to keep improving to consolidate the rating of 'good' or 'outstanding' awarded for the KLOEs and overall. Services that fail to implement continuous improvement will stagnate and will soon fall below the acceptable standard required by CQC.
This article focuses on those services where improvement is required following a rating of 'requires improvement' or 'inade-quate'. However, the methodology will apply equally to those services wishing to continuously improve the quality of their ser-vice.
Identify what needs to be improved
To improve a service means to raise the quality of service provision. In social care services, improvements may be required in one or more of the KLOEs. The first step is to identify exactly where the service did not meet, or evidence that it met, the required standards. There is a difference between these two circumstances: sometimes a service does meet the standards but did not provide evidence of this at the time of the inspection. In such cases, this is easy to rectify by making sure that everyone knows what went wrong and what to do to prevent it happening again.
If your service has not met the required standards, you should examine the details of the non-compliance. Records kept dur-ing the inspection and from the feedback session, as well as the inspection report, will be vital documents in this process. You should also hold discussions with those present during the inspection. It may be necessary to clarify with the CQC inspector where the service was non-compliant and you should make records of any such discussions. At this stage the inspection report is final and to argue the point with the CQC inspector will prove fruitless.
Identify what needs to be done and when
Once you have identified the detail of what needs to be improved, consider what action needs to be taken. Of course it will not be possible to do everything at once, and some areas will be more pressing than others. However, waiting until the inspection report is published will be a waste of valuable time. You should use the records made during the inspection to develop an action and improvement plan straight away. Prioritising the actions using a simple matrix (Table 1) may prove useful in this exercise. Any actions that were mentioned in the CQC feedback session during the inspection would be in quadrant 1 of the matrix and must be done immediately.
Check you have the resources you need
The next stage is to determine how to make the improvements. In many cases simple changes to systems or how you apply them will be enough, and you can deal with these in-house. In other cases, you may need extra resources. These may be staff, investment in fixtures and fittings or equipment, new software or external support. Before investing in the service, carry out a cost-benefit analysis to make sure that: (1) you identify the benefits; and (2) that the benefits outweigh the cost. Table 2 shows an example of a cost-benefit analysis for investing in an expert consultant to support a care home with making improvements required in service provision. It shows a return on the investment of 8.58 times, which should reassure the care service that the investment will be worthwhile.
Make a plan
In most cases, the CQC will require an action plan that specifies what action needs to be taken and when it must be taken by. An action plan should go a little further than this. It should specify:
- what action will be taken
- who will take the action
- when they will do it by
- what resources they will need to undertake it
- how the service will know it has
- been completed
- when it will be reviewed.
Put the plan into action
Making the plan is the easy bit. The challenge is to implement the improvement plan and then to check that the improvements have resulted in lasting change and an overall improvement in service provision. This is the area where services struggle as they run out of momentum once the urgency of getting the action plan submitted to CQC is over. Also, the day-to-day running of the service detracts from the implementation of the improvement plan; this can have potentially catastrophic consequences if CQC visits before significant progress has been made. It is a good idea to allocate a senior member of staff to be responsible for co-ordinating the improvement plan and to give them the resources and time to implement the plan. They may require external support and Table 2 shows typical costs for an expert consultant to provide this.
Keep on improving
Once the required improvements have been made it is tempting to relax and wait for the next CQC inspection. This is a dangerous strategy as the standards required are higher every day. You need to continue the momentum of change and always seek to look at the service to identify possible improvements.
Prevention is better than cure
Any improvements forced on a service will be costly. This is because they will require a large amount of resources at one time. It is better to plan changes. One way to achieve this is to undertake either self-audits of the service or commission an external auditor. This way any areas of non-compliance will be identified and dealt with before a CQC inspection.
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