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08th April 2020

How to achieve Outstanding in the Well-Led category?

In my last piece, I suggested ways in which you could score highly in the Safe key question, which as we all know is exceptionally challenging to get right. In this blog, I want to focus exclusively on the Well-led question and the key lines of enquiries (KLOEs) that underpin it.

Again, with only two percent of providers recording an Outstanding rating in this category [i], it’s a domain that practitioners often struggle to excel in. So why’s it a key question that so many providers struggle with?

As a former inspector, the first point I’d like to make - particularly for those just starting out - is that it’s easy to get bogged down in the complex language that the Care Quality Commission (CQC) uses.

To summarise, and simplify, the content of the well-led key question, the CQC is focussing on evidence   that a culture of leadership has been deeply embedded within the service, which empowers carers to provide an innovative package of person-centred care.

At first glance it’s also easy to be intimidated by the five Key Lines Of Enquiry (KLOEs) - that underpin the Well-led question. However, if you pare them down, you’ll see that each KLOE can be neatly summarised into one word. The first KLOE, for example, relates to culture. The second one is focused on governance, while the third KLOE highlights the need for involvement. The fourth tests for improvement, and the final KLOE is centred on partnerships. Now let’s look at each one in greater detail.

Culture

Embedding a person-centred culture within a care home cannot be achieved over night. It often takes years to develop and should be seen by Registered Managers as a long-term project.

That said, there are extremely effective compliance management tools, which if used correctly, can help ensure that the policies and procedures are fully integrated into all aspects of the care service which will promote and support best practice in this area.

Take Quality Compliance Systems (QCS), the UK’s leading provider of compliance management tools, for instance. It not only allows its members to access the latest HR policies but also provides a template for Registered Managers to write their own staff handbook. While these tools can only equip members with a skeleton framework to build upon, QCS also publishes policies, which are constantly being updated, that add to a Manager’s ability to establish Outstanding culture within the service. There are policies, for instance, that provide guidance to Managers around involving staff in understanding the need for regulation and reviewing processes.

QCS also provides subscribers with survey and meeting tools that capture the staff’s view of a service, enabling the Manager to make tweaks on a regular basis which lead to improvement culture through listening to what is important to stakeholders

For example, in instilling the right culture within a home, a survey can highlight the need for a service to take one step backwards before it takes two steps forward. In the short term, this could mean that the culture within a service suffers. This may seem too radical a step for some but believe me it’s not as it is vital to get the culture right, and this may mean that some elements of the service have to be dismantled and then rebuilt

However, that said, there are also effective steps that you can put in place immediately when embedding culture. Most importantly, a Registered Care Manager has to lead by example. In setting the culture and vision, the secret to outstanding leadership is to motivate and inspire staff. It’s also about listening to staff’s concerns and ideas and acting upon them. Managers who empower carers are much more likely to create an environment where staff demand stretching targets to work towards. That requires a ‘flat’ organisational structure, and not a hierarchical one, where everyone from cleaners to carers feels that they can contribute.

It’s vital too that staff are recognised when they achieve higher standards of care. It may not seem much, but, in a sector where retention and recognition is a huge challenge, a small token of appreciation goes a long way, as it lets that carer know that their work is valued and contributing to the success of the whole service.

Equally, excellent leaders are sensitive to the individual circumstances of their staff. Nowhere is this better demonstrated than the policies that Well-led homes are implementing in the current COVID-19 outbreak. With the schools currently closed, the best managers understand that carers are often juggling caring for service users with home schooling their children. It may be that they or a member of their family contracts COVID-19 and the whole family are forced into self-isolation. Whatever the scenario, providers who excel in the Well-led KLOEs, have created robust and flexible working plans that provides contingency at every level. Such strategies are much easier to introduce if a home already has a shared culture in place, and support each other to achieve improved outcomes for everyone involved in the delivery or receipt of the service

Governance

A service that practices outstanding governance is one where people’s roles are clearly defined with the organisation. That essentially means three things: people know what they’re doing, when they’re doing it, and who they are doing it with.

This means setting up a service with processes and systems that ensure that high quality services are always delivered. In this respect, the best services tend to find a way of embedding quality assurance and good governance within the existing framework, while also tapping into the newest resources and best information.

Again, this is where an outstanding compliance management partner comes in. Why? Because such systems ensure that policies and procedures are regularly updated and aid carers to implement best practice. Compliance management systems can also help providers to tap into local and national networks to share governance best practice, changes in legislation and advance new innovation and thinking. With a pandemic gripping the planet, compliance tools that constantly analyse, absorb and conflate the latest thinking into easy to read polices is the best way to ensure governance.

The best governance systems are not a ‘bolt on’ to the service but are embedded into the thinking of the service and are conducted as part of ‘business as usual’, but outstanding services are flexible enough to recognise changes. Furthermore, these services have developed governance processes to reflect on, and review the success of any revised process or tools.

Improvement

This particular KLOE checks that a service is capable of both identifying and capturing improvement. The secret to scoring highly in the Improvement KLOE is being able to honestly evaluate the current state of your service. Without this visibility, it's impossible to measure improvement. Benchmarking and mock inspection toolkits, such as the ones supplied by the best compliance management systems, can help identify areas of improvement and best practice initiatives - all of which are aligned to CQC standards - to deliver better outcomes. If used in the right way, this can be transformative because it ensures that the right policies are in the right place at the right time, and most importantly, in the hands of the right people.

Quality Assurance is key too. More often than not, outstanding providers have built bespoke quality assurance management systems which constantly measure continuous improvement against CQC expectations. That means designing an iterative system that is able to adapt to change.

Involvement and Partnership KLOEs

A well-led service is one that is actively involved and fully engaged in co-production. In short, this means eliminating hierarchy and silos that might exist within a service. Outstanding services can evidence that they work in partnership with staff, residents, and their families to deliver the best service possible. But any journey of improvement must also encompass the local community too. Therefore, is the practice soaking up the best services that the community has to offer? If not, who should it be reaching out to? How should it go about forming partnerships, which if utilised correctly, can make it easier to deliver better quality services to residents?

An outstanding service is also one that constantly reflects on the level of engagement it provides. Again, surveys aimed at staff, service users and their families deliver the insight that a service needs to make changes. The best providers see this, not as a criticism, but as an opportunity to affect positive and lasting change.

Take the Coronavirus pandemic for example. In a few short weeks, it has transformed all our lives. In doing so, it has demonstrated the strength of technology. It has shown us that ideas can be communicated by video link just as effectively as in person.

Secondly, with COVID-19 severely limiting freedom of movement, apps like the one pioneered by QCS prove that it's possible to receive and implement the latest policies and procedure remotely, while also accessing the latest blogs, fact sheets - as and when they’re needed. Most of all though, technology in the form of telecommunications applications like Skype made it possible for elderly residents, who are self-isolating, to keep in touch with loved ones and expand their horizons beyond the local community.

Indeed, when the Coronavirus Pandemic is finally contained, perhaps we’ll all look at technology in a whole new light. It will have a long-term impact on social care services. And the challenge for providers will be to use technology to create bright new pathways for service users which will positively enrich their lives. That feels a long way off now. But it offers a glimmer of hope in these difficult times.

Ed Watkinson is Residential Care and Inspection Specialist at Quality Compliance Systems: If you'd like to find out more about QCS or about its compliance management systems, then why not give us a call on 0333 405 33 33 or by email: sales@qcs.co.uk

[i] Taken from ‘The state of adult social care services’ report (2014-17).

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Ed Watkinson

QCS Director of Care Quality

Ed serves as part of the Senior Management team at QCS. He is lead on the development of new quality assurance, compliance and care management policies and procedures. Read more

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