Safety through learning is nothing without a strong culture - (Part III - Understanding CQC's new vision) | QCS

Safety through learning is nothing without a strong culture – (Part III – Understanding CQC’s new vision)

Dementia Care
July 27, 2021

In a bold new vision, the Care Quality Commission (CQC) has set out a strategy, which it says combines “learning and experience” with “valuable contributions from the public, service providers” and its partners.

As a result, the CQC says its strategy, which covers four key themes (‘People and communities’, ‘Smarter regulation’, ‘Safety through learning’ and ‘Accelerating improvement’), will be more “relevant”, more “flexible” and more “responsive” to cope with the ever-increasing challenges that the social care sector faces.

The CQC also says that the new directive will ensure that it achieves its core aims – to not only ensure that social care providers deliver “safe, effective, compassionate high-quality care” but that the CQC gives them the tools to change.

In the third of four articles, Quality Compliance Systems, the leading provider of content, guidance and standards for the social care sector, has asked Ed Watkinson, a former inspector, to explore, examine and demystify the ‘Safety through Learning’ theme.

Safety through learning is nothing without a strong culture

When we talk about safety, the word ‘culture’ should always closely follow. In this theme, the CQC has shown that it is deeply committed and passionate about ensuring that every service has a strong culture of safety embedded within it, which includes a focus on “learning and improvement”.

I think when we consider a culture of safety, it’s important to see it through the context of recent events. The CQC has learned a lot from the pandemic and while ensuring care services are safe has always been a pre-requisite, it has perhaps been pushed even higher up in its list of priorities.

For the CQC, safety is inextricably linked to learning and improvement. Its argument is that if a culture in a service is not right, then that particular service is not going to learn from its mistakes. If the provider is not learning from errors made, the CQC’s view is how can it improve?

Closed cultures

In the CQC’s eyes, therefore, a culture within a service must be open, honest and transparent. If it is not, then the likelihood is that the provider cannot be operating a safe service.  This brings me on to ‘closed cultures’ or ‘closed environments’ in a service.

It is an important distinction to make. When people think of closed cultures in the social care sector, they tend to think of the Winterbourne View or the Whorlton Hall scandals, where abuse was found to be systemic throughout the assessment centres. However, closed cultures, when they are present, do not always impact on an entire service. Instead, they are often found in small teams, who may work together, and share a different set of cultural safety values, which are not in keeping with the CQC’s values, or the social care service they work for.

The CQC is committed to rooting out these closed cultures. But it’s one thing to promise to banish them from the social care sector, and another to actually come up with regulation that works. In my experience, closed cultures are exceptionally difficult to eliminate for the simple reason that those engaging in them are expert in concealing them.

Richer data taken from multiple sources will help the CQC to identify closed cultures

That said, I believe the CQC’s strategy to expose and eliminate them is a good first step. While it will focus on mental health services, on learning disability services and on residential care homes, its plan to gather information from a multitude of sources will help the CQC better identify when a service is closed culture.

Critics of the CQC strategy might well disagree. Some might say that as services with closed cultures don’t co-produce and collaborate, how will continuous monitoring, which relies heavily on intelligence and data, make a difference? I would argue that if the CQC comes across a service which is not actively sharing information, or one where data sources are in short supply, it will signal a red flag. This will in turn prompt the CQC to investigate further.

I also think that content providers like QCS can help Registered Managers to instil a culture of openness within their services. How? Well, closed cultures thrive in information silos, which is typical of service where a closed environment is present. The QCS system, on the other hand, enables managers to cascade policies, procedures and best practice content down to staff as and when it is required, which promotes top-to-bottom transparency in a service.

Finally, and one of the most important aspects of the new strategy, is the CQC’s desire to “involve everybody”. This means involving service users, those who they judge to be important to them and external organisations, to affect real and profound change. However, the CQC is keen to use the insight which it has gathered “to promote a national conversation on safety”. The hope is that it will lead to a greater understanding and knowledge around instilling a culture of safety in services throughout the country.

In the fourth and final article, Ed Watkinson will be looking the fourth key theme, ‘Accelerating Improvement’.


You can read part II of ‘understanding the CQC new strategy’ here

Read Part II – ‘Smarter Regulation’ here 



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