Managing Quality in Social Care

Paul Johnston Impact Change Solutions Ltd 3 rd February 2012

Discussion points

• • • • Different concepts of ‘Quality’ The role of the LA Strategies for improving Quality Quality Management Systems – Desirable features – Examples

Different concepts

• • • • Stakeholder perspectives Quality Standards Experience of using services Outcomes achieved – SPRU Outcomes Measures – PSSRU: OPUS, OSCA, SCRQL, ASCOT – ASCOF

Different Perspectives or Common Ground?

Providers of Care Services Quality Domains People who use services Commissioners Source: Measuring for quality in Health & Social Care – RCN Position Statement, 2009

Common Definition of Quality

• • International Association of Homes & Services for the Ageing (IAHSA) Global quality improvement initiative Characteristics of the ‘ideal quality ageing services’ provider – – Person-directed care Continuous quality improvement – Workforce excellence – – Leadership & integration Innovation – Community Involvement

The role of the LA

• • • • • • Create a vision for quality across the local care market Provide a focus on local priorities Define the improvement challenge Manage quality within its own operation Influence provider quality (via contracts, market position statements, relationships) Report on standards across the market

The Role of the Provider

• • Care Standards legislation requires Regulated Providers to: – – Establish and maintain a quality system Review and improve quality of care – Make quality system reports available to the Regulators – Consult with Service Users and Representatives No such requirement for Unregulated Providers – Micro Providers, Personal Assistants etc.

– Need to encourage & incentivise suitable approaches

Strategies for Improving Quality

• • • • • • • Vision & Leadership for Quality Recognised standards (CQC Essential Standards, ISO 9000 etc) Bias towards local priorities Quality Management System – Audit - compliance, performance, processes & systems – – – Evaluation - aims, objectives, activities, outputs, outcomes, costs Research – benchmarks, models, learning Feedback – service users, staff Improvement Plans Organisational learning Support mechanisms & incentives

Model Systems

• • • • • Nationally / Internationally recognised Sector-specific / Service-specific In-house Off-the-shelf Support Mechanisms & Incentives

Quality Management Systems - Desirable Features • • • • • • • • Must be owned & led by the organisation (can’t be imposed) Evidence based, relevant Person-centred, outcome focused Informed by service user feedback Stimulates action & change Holds the organisation to account Is transparent whilst remaining confidential Council on Quality Leadership (CQL) – 8 key factors / 34 success indicators

(Inter)nationally Recognised Systems

• • • • For example TQM, EFQM, ISO 9000, IIP, EQM, SERVQUAL etc Industry-wide, but can be applied to H&SC subject to some adaptation of language & context Can be resource-hungry More suited to larger organisations Risk of adding to ‘management control’ at the expense of service improvement

Sector-specific and Service-specific Systems • • • • • E-QALIN (European Quality Improving Learning in Residential Care Homes) CQL Guide to Person Centred Excellence (Disability, Mental Illness, Older Adults) Care Fit for VIPS (Dementia Care) Outcomes STAR (various) PEARL quality accreditation programme (Four Seasons Health Care)

Off-the-Shelf Systems

• • • Support CQC registration CQC Compliant Various points of focus – Care & client management – Health & safety – Quality assurance – HR & Admin e.g. EQMS, Vistapoint, Qual A Sess etc.

E-QALIN

Residents Staff Leadership Surroundings Learning Organisation Residents Staff Leadership Societal Impact Future Orientation Structures & Processes Results

• • CQL 8 Factors 34 Indicators

CQL

• • • • • • • Positively Enriching And enhancing Residents Lives (PEARL) Accreditation scheme for FSHC’s dementia care facilities Follows the VIPS model Assessment against PEARL criteria Action Plan to address gaps Support for Home Manager Reassessment & Accreditation

• • • • • • • Off-the-shelf Compliance Management System Document Storage & Retrieval (Document Manager) User Interface to records (Navigator) Change and Version Control (Change Manager) Tailored to business requirements (System Manager) Audit and action planning function (Audit Manager) Integrates with Microsoft Office applications and SharePoint

• • • • • • • • •

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Qual A Sess

Support & Incentives

• • • Provider Capability?

System Effectiveness?

Outcome Performance?

• • • Relationship approach (e.g. Warwickshire) Audit approach (e.g. Coventry) Financial approach (e.g. Torbay)

Financial Incentives

• C-QUIN Torbay – Care Homes Market – – – – – – – General improvement (5 of 6 themes) Specific improvement (NOF Fractures) Payments linked to performance - £1000 per home Relatively low take-up (36% of the market) High pass rate (93%) Application process described as ‘extremely detailed’ Success described in terms of output and actions, rather than outcomes

Questions

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