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Improving quality for service users

Continually improving the service user and workforce experience, to bring the best outcomes achievable is a constant focus for CGL. We acknowledge these are changing times, which require changing practice and methods. By doing things better, we can achieve more with fewer resources. This gives rise to exciting, creative new opportunities for the quality agenda involving service users and the workforce alike.

CGL’s Quality Improvement Tool

The Quality Improvement Tool (QIT) supports staff to continuously make improvements to the quality of care and service user experience. It provides a framework for understanding each part of the service user journey, identifying evidence-based quality problems and developing plans for improvement leading to positive change. 

Research, evidence and learning from the health and social care sector and beyond have been utilised to inform the QITs design and the approach to using it:

  • We’re growing a learning culture where mistakes and development areas are openly acknowledged and seen as a springboard for improvement. The aviation industry has utilised this approach to achieve a highly reliable safety record (Matthew Syed, 2015, Black-Box Thinking: The surprising truth about success).
  • The QIT employs the concept of ‘marginal gains’, which has proved revolutionary to British competitive cycling; make just a 1% improvement in everything you do and over time, these gains add up to a substantial overall improvement. Everyone has a responsibility in making small changes and working collectively, great things can be achieved.   
  • The Francis Inquiry (2013) recommended that standards are developed to define the fundamental ‘basics’ needed to deliver safe and effective services. Quality standards have been defined for each stage of the service user journey which reflect the latest evidence, policy and practice.
  • In the modern world, the majority of errors are not caused by ‘ignorance’, rather they relate to not effectively making use of what we know. We focus on translating knowledge, guidance and evidence into practice through creating user-friendly tools, such as checklists, which have been shown to lead to significant improvements in safety (Atul Gwande, 2009, “The checklist manifesto. How to get things right”, 2009).

How it works

Staff and service user engagement at every stage is vital to making meaningful improvements.

There are 3 main elements of QIT:

1. Quality Standards for a safe, effective, caring, responsive and well-led service.

These break down each stage of the service user and staff journey into small bite-sized parts which are reflected in a list of explicit, strengths based and measurable statements. ‘Essential’ standards are highlighted so that they can be prioritised.

The Quality Standards are multi-functional, for example they can be used:

  • In recruitment to assess candidates competency using evidence based standards;
  • As part of induction and ongoing training to support staff learn the essential standards for delivering a safe and effective service and their role in this;  
  • As a self-assessment tool considering how practice compares to the latest policy and good practice guidance. This could be used with an individual in supervision or could be done by a whole team to assess service quality performance;
  • In audit; either ad hoc or as part of CGL’s Quality Audit Cycle (more below);
  • By staff, whilst actively undertaking tasks as a check list for all the composite parts, that need to be in place to deliver the best possible service user experience.

2. Quality Audit Cycle for services to objectively identify gaps or areas for improvement and measure progress made since the last audit.

Every 3 months, all services undertake a set of quality audits to objectively evaluate practice in the key areas of service delivery.  This is an opportunity for staff and service users, working together, to openly and honestly identify gaps or weaknesses in the service user experience.

CGL’s quality audit cycle covers the following areas:

  • Assessment
  • Risk and recovery planning
  • Case Records
  • Supervision
  • Safeguarding
  • Service User Involvement
  • Equality, Diversity and Inclusion
  • Health & Safety
  • Incident Reporting & Investigation
  • Information Security
  • Learning cultures
  • Governance structures

The results are captured on CGL’s service user safety software (Datix). This provides dashboards giving percentage compliance rates for each audit area so that managers can assess whether quality is improving. This information is used by teams to identify specific standards where they need to focus their improvement efforts.  

Each audit is repeated every 6 months. This gives a meaningful timeframe for planning how to make improvements, implementing planned changes and evaluating the impact.  

3. Quality Plans and Toolkits to support quality improvement.

The ‘intelligence’ gained from the audits is used to develop a Service Quality Improvement Plan. This is designed to be an overarching plan, owned by staff and service users, which is values based and service user focused. Its impact is maximised through concentrating on a small number of high impact outcomes.

A number of supporting tools have been produced in conjunction with service users and staff to help with quality improvement, including:

  • Top tips
  • One page information bulletins on key papers and organisational learning
  • Checklists
  • Training materials, for example bite-sized learning products

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