Managing Quality in Social Care

Paul JohnstonImpact Change Solutions Ltd

3rd 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

CommissionersPeople who use services

Quality Domains

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

ResidentsStaff

LeadershipSurroundings

Learning Organisation

Structures & Processes

ResidentsStaff

LeadershipSocietal Impact

Future Orientation

Results

CQL

CQL• 8 Factors• 34 Indicators

• 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

How VistaPointTM can help your business:• Meets CQC and Ofsted requirements. • Meets Certification requirements for the ISO 9001:2008 Quality

Standard.• Provides all the information you will need to comply with the

"Essential Standards of Quality and Safety" and to complete your Provider Compliance Assessment.

• Systems available for a wide range of sectors. Simply select and click on the coloured boxes on the left for more information, sample documents and pricing.

• Start-up businesses have all the information and help needed to get up and running.

• Comprehensive, easy to use, well established and consistently successful.

• Competitively priced, with discounts available for multiple packages. • All documents supported on a CD-ROM (MS Word format) to

download to your computer so that you can quickly and easily edit them to suit your needs.

• Regularly up-dated

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

http://www.flickr.com/photos/horiavarlan/4273168957/

Questions