The CQC's 'outstanding' formula

The CQC's 'outstanding' formula

Every year, the Care Quality Commission (CQC) release their annual State of Care report. Data taken from the inspection of more than 16,000 adult social care providers from April 2015 to July 2016 revealed the following of social care providers:

  • The majority, 71%, received a rating of 'good'
  • 1% were rated as 'outstanding'
  • Of the inadequate services re-inspected, more than three-quarters (77%) were able to show that they had improved the quality of their care

In the report, the CQC goes to great depth in analysing the care facilities rated as outstanding. They comment on the common trends they have noticed that run throughout outstanding care homes, and include case studies of providers that are rated as outstanding. The report presents a kind of formula, a combination of factors that when bought together result in outstanding levels of care.

What exactly is outstanding care

In this blog post, I look at the key takeaways from what the State of Care report reveals about outstanding care. I'll break up the formula and we'll look at each factor in turn, but before we do that, let us be clear on what exactly outstanding care is. The word 'outstanding' is more than just 'very good' or 'impressive', it means something is so good it stands out from those around it. The word defined is...

Marked by superiority or distinction; excellent; distinguished:

The CQC defines their outstanding rating as a rating for services that are performing exceptionally well. It is clear that to achieve this highest of accolades, a care provider has to go above and beyond in their delivery of care.

CQC Outstanding Formula

The 'outstanding' formula

Although not blatantly written out as a step-by-step guide, the CQC does give clear indications of what it takes to be rated outstanding in its State of Care 2015/16 report. Taking the key points of advice and what the CQC tells us about the services rated outstanding gives us a kind of formula...

Strong and transparent leadership

In any business or organisation, the culture and motivation is determined by the leadership. If a care service is led by passionate, motivated and positive persons, the whole service's team will inevitably learn from this and it will reflect in their delivery of care. Likewise, the team will feel safe and inspired by a leader who is transparent and clearly conveys their vision and motives. The CQC's ratings back this up, showing that the overwhelming majority of services rated as good or outstanding overall have good or outstanding leadership.

A positive organisational culture

A team who care and work for each other will ensure individuals feel safe and wanted. Carers who are positive about the service, their leaders, and their fellow carers, contribute to a culture which breeds good care. Again, strong leadership is vital, and the leadership team is required to be visibly and actively promoting an open and positive culture at all levels.

Good oversight of care

A leadership team that is engaged in the service and is willing to get stuck in to find out the real issues will almost certainly be an effective one. A good oversight of care results in leaders who know the pulse of their service, staff that feel valued and secure, residents/patients who receive good quality care, and family and friends who have confidence in the care provided. The CQC cite the management team at Northumbria Healthcare NHS Foundation Trust (rated outstanding) as an example. The leadership was focused, aware of the trust’s strengths and areas for improvement, and had strong clinical and public engagement.

Driving change through effective systems and processes

Good leaders create strong systems and processes that drive improvement to support themselves and the service they run. The CQC highlights the need for systems that:

  • help plan staffing and train staff effectively
  • manage essential functions such as safeguarding, safety alerts and care plans
  • strengthen governance and help to ensure transparency so that services can learn and improve when things go wrong

Open to challenge and change

The care system is changing faster now than ever before, and a culture that fails to represent the four points above can be a major block to change and improvement. A positive, open and passionate culture is able to tackle fresh challenges and will readily change to improve patient care.

CQC Ratings
Just 1% of adult social care services are rated outstanding

A good measure of whether your service is open to change is how well you recieve the news of a CQC inspection. The CQC say that services who welcome re-inspections have staff who are clearly engaged in the ethos of learning and improvement and are all to glad to show the Commission the change and improvemnt they have made.

Effective collaboration with partners

I'll make no bones about it, being a care provider is becoming tougher. Demand and financial constraints are making it ever harder to go it alone, pointing up the huge importance of collaborating with other care services. This takes the form of working more closely with local authorities or the region's NHS trust through simple initiatives such as Sutton CCG's Red Bag. Another example discovered by CQC inspectors is a hospital where staff developed a newsletter that went out to GP practices monthly to inform them of any changes to their unit.

Engaging with those who use the service

The CQC also found in their report that services rated as good and outstanding engaged well with the people who use their service, including their families and the community they come from. Services that engaged effectively designed care plans, facilities and activities that meet people’s diverse needs and preferences.

The formula ensures improvement

Even if you feel your service is some way off outstanding, taking time to consider the points above and seeking to implement them will bring about improvement in your service. An outstanding rating doesn't just happen overnight and it has taken the services who currently have this rating years to develop and nurture a culture and environment which delivers outstanding levels of care.

By first identifying where change needs to happen and showing a willingness to make it happen, your service will inevitably improve, and one day you could quite probably be looking at a big green star when you peep in that envelope containing your CQC inspection report!

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