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Well-Led: Leading by example
What would their answer be to well-led?
The CQC Well-Led domain could be read out on question time to the array of politicians that fill the platform. With a few word changes, it would make for a good question base on how each party conduct business;
- How does the service promote a positive culture that is person-centred, open, inclusive and empowering?
- How does the service demonstrate good management and leadership?
- How does the service deliver high quality care?
- How does the service work in partnership with other agencies?
But why is it paramount for Health and social care to get this right?
The state of health care and Adult social Care in England 2014/2015 reads that the Well-led rating gained by providers was the most closely aligned to the rating given overall. The correlation would certainly suggest a strong well led organisation was important in receiving an outstanding CQC rating overall.
It also states ‘In the challenging environment for health and adult social care, financial resources are not the only answer. For health and social care services to be able to ensure the quality and safety of the care they provide, they will need strong leadership and resilience.’
Let’s look at some aspects associated with Key lines of enquiry more closely
How does the service promote a positive culture that is person-centred, open, inclusive and empowering?
In May 2016 The CQC published a report called Better Care in my hands. The review looks at how people are involved in their own care and what enables that to take place. The report identifies four main areas drawn from findings in the review they suggest service providers implement to further person-centred involvement;
- Personalised care plans – this is explained as a collaboration with service users clearly identifying and continuing to monitor their wishes and preferences.
- The sustained and supported involvement of families and carers in the care of their loved ones.
- The coordination of people’s involvement in their care as they move between services –examples such as health and care passports and community and peer support programmes are used.
An open culture does not just rely on the care and support shown to service users, but heavily relies on the investment in staff in sharing a positive open culture. This provides a platform to share both ideas and concerns and a safe space to do so for both service users and staff. Skills for Care help identify the key ingredients to this in their Culture for Care tool kit.
Within the ‘a business case for culture’ segment, the benefits are listed to adopting a positive culture, amongst them are a reduced staff turnover, and the ability to attract more skills and talent due to a stable workforce.
How does the service demonstrate good management and leadership?
I believe that an initial measure is for the leadership of an organisation to understand roles and responsibilities – even if they are the only person being both provider and manager, a clear line between hats is necessary.
My experience has shown that the difference between the provider’s and the manager’s responsibilities are not always in focus. This can lead to gaps in duties and opportunities and risks being missed. Questions often come up in a CQC interview, where there is also a failure often to articulate the separate responsibilities as ‘Registered’ manager and or provider.
To create an open positive culture, it is vital that senior management know
- where the service is going
- how to get there and
- how to communicate this.
The CQC requires a number of assurances at the point of registration. One of those is an understanding of the composition of the service. The statement of purpose is not a catch all for the above, but a mandatory document containing the services aims and objectives. It can be useful beyond the regulators use of it, being updated as changes are made to the service. CQC do also provide a template and guidance which can be found here .
How does the service deliver high quality care?
This is often answered by the other Key Lines of enquiries as the sum of their parts.
On the 24th June, Mark Carney the Bank of England’s Governor gave a speech to clarify the Bank’s contingencies in light of Brexit. The point being made was although the situation for the country is not one they hoped they would be in, that not only had it been thought of as a possibility, but that the bank had done all it could to ‘stress test’ the banks resources and plan contingencies.
Good leadership collects information it needs, measures the risks and benefits and acts on the findings.
The story goes that a family cut a joint of meat in half for every roast before cooking and served it in two pieces. When asked, they could not say why they did this, and asked the grandmother why it was done. The grandmother said ‘It was because we never had a dish big enough for the joint’. If you are collecting data as a leadership, know why you are doing it and what it can inform. Knowledge is indeed power if you collect what you need.
How does the service work in partnership with other agencies?
Within the political arena we have seen the best and worst of this over the last few months. From the positive aspects, parties have come from different degrees of the political Landscape and shared a stage for ‘remain’ or ‘Brexit’. I don’t think for a minute that it always meant harmony, but there was a shared goal and a common good to work together.
If you scour the internet, working with others has been a mandate for years, but unsurprisingly one that is not easily accomplished. The Social Care Institute for Excellence have resources such as Factors that promote and hinder joint and integrated working between health and social care services. Good leadership ensures the relationship, policies and procedures to enable working together and to steel a slogan no longer needed elsewhere…
‘together we are better’.
The work of the Health and Social Care sector is one that cannot afford the high drama we have seen unfold over the last couple of weeks across the political landscape, but ones we can certainly take lessons learned.
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