Act now to avoid regulatory action for failing to improve quality

In our last blog, we discussed the expected change in focus from the Care Quality Commission (CQC) as they attempt to tackle services which are failing to improve between inspections.  This could have significant implications for operators, should the CQC decide to apply an overall inspection rating.  

Would you want your organisation to be labelled as “Requires Improvement” or “Inadequate”?  Much of this will depend on how operators demonstrate their capability and track record for moving services to ‘good’ or ‘outstanding’.  A renewed focus on leadership and safety is expected as part of the revised inspection approach.  

Now is the time to act for care home operators who have services ‘stuck’ at a ‘requires improvement’. In this blog, we set out what we consider to be some of the fundamental building blocks of achieving and sustaining high quality care.

Each service or home will have its own specific strengths and areas for improvement - however, where a significant proportion of homes within a single provider are rated at less than ‘good’, it’s usually indicative of a requirement to make changes at a corporate level, aimed at supporting staff in homes to deliver high quality care.  Corporate enablers of quality are expected to be increasingly scrutinised by the CQC during 2017.

Below, we set out five areas for consideration by those care home providers who have recently, or are about to, embark upon a quality improvement programme:

  1. A commitment to quality - and quality improvement should come from the top of the organisation - whether that’s the CEO or another board member, the strategic intention to shift homes to ‘good’ or ‘outstanding’ – for the benefit of residents – should be heard loud, clear and frequently.  A quality improvement programme or quality strategy document is one way to frame this communication, and to generate commitment amongst staff.  It should also enable the board to track progress against the programme’s stated objectives for quality improvement.  

  2. Home ‘Manager’ or ‘Leader’? – most definitely ‘Leader’.  The commonly used title of Home Manager, derived from the regulatory description of the role, underestimates the role and contribution of these individuals.  Yes, strong managerial skills form a key part of the job, but the functioning of a home which delivers high quality care is hugely dependent on the commitment, contentment and confidence of its staff – and that is enabled through effective leadership, as is shaping a culture which is supportive of staff, open and focused on the needs of residents. Culture is a factor of home level leadership values and behaviour (listening to staff, residents, families, their own visibility and accessibility) influenced by the wider organisational culture.   Leadership development support for home leaders is becoming more commonplace and should form a key part of any quality improvement effort.

  3. Nursing workforce – it is essential that the planning and delivery of nursing care services have robust clinical leadership.  A professional nurse workforce will benefit from professional leadership and support, in terms of their own development and from the comfort of knowing that nursing standards are the business of the board.  We see huge variation in how care home providers leverage the benefits of employing registered nurses.  Compared to, for example, NHS providers, the care home sector has often lagged behind in this area – and as a result, hasn’t always obtained the benefits of a workforce who are professionally trained (and regulated) in the core values required for delivering high quality care.  Good nurses won’t hang around in an environment which isn’t open, supportive, resident focused and safe. Nursing care providers should consider the prominence of nursing leadership from board level and the extent to which specific professional support and guidance is provided.  

  4. Standardisation of operational processes and quality assurance at home level – empowering Home Leaders to get on and run their homes should be balanced with the need to provide a degree of central guidance in relation to core operating standards and procedures, including those related to quality assurance of services.  It is important that Home Leaders and staff understand core systems for planning and delivering care – and it is easier to assure that these systems are effective when there is standardisation across all homes within a portfolio.  We’ve seen some great, practical examples of standard procedures being developed on the basis of what makes a good or outstanding home. Not only does this provide an opportunity to standardise in a way which meets regulatory requirements, but also to identify processes which could be streamlined.  A degree of staff training to support the roll out of a standardised operational framework should also be provided.  

  5. Laser like focus on quality – quality related KPIs should be integrated as part of routine performance reporting together with operational and financial performance management information.  All three are interrelated and should be viewed as a ‘whole’ by management.  A business which has developed its capability for extracting, analysing and acting upon quality KPIs is able to foresee risks to quality and manage them accordingly.   Our experience shows that providers with less developed processes for monitoring quality are more likely to encounter problems – including regulatory compliance issues. Providers should start with the current IT systems but aim to make better use of the available data. Delivering quality improvement and sustaining quality requires a laser like focus on a range of predictive and backward-looking indicators of care quality.

PwC supports a number of private care home and healthcare operators to improve care quality – including the development of corporate and service level systems for monitoring quality, operational processes and service leadership.  If you would like to discuss how your organisation might approach its own quality improvement drive then please get in touch.

John Morris |  Director
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