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Why external inspection isn’t the only answer

For the last five years, hardly a day has gone by without something in the news about health care safety or quality. From Winterbourne View to the Francis Inquiry, Berwick Report and the Keogh Reviews, health services and the quality of their care have been placed under extreme scrutiny. There is a relentless pressure on organisations to provide additional responses to nervous commissioners and regulators, and to continually re-assess themselves against the next set of recommendations to ensure we haven’t got the next Mid Staffs. And one of the key lessons we should have learnt is satisfying external regulators is only part of the process. Unless services themselves (and we mean at ward and team level) truly own quality and safety, no amount of external inspection, whether from the Trusts own Nursing & Quality Directorate, or the CQC, Monitor and TDA,  will secure the sustainable delivery of safe and high quality care. The issue for Boards is to ensure that this message runs through the organisation, from bottom to top, like Blackpool in a stick of rock, and to set up systems and structures to support the internal assessment of safety and quality, so that ‘Stop the Line’ procedures are owned and understood by all. Common issues arising seem to be:

Insecure Management – a lack of robust internal assurance and compliance controls has meant many Trust Boards are continually faced with having to react to external pressures, and lack the confidence and robust systems to challenge external regulators

Commissioner skills and capacity – with the new CCG’s responsible for quality, including Serious Incident Management, it is becoming clear that in some areas the staff involved at CCG’s often don’t have either the skills, knowledge or capacity to do this effectively

Nervous systems – fear of being the next Mid-Staffs or Winterbourne View has meant the overall system is continually demanding more and more assurance of quality, which paradoxically sucks up management capacity and reduces the availability of internal resources to address the fundamentals of quality

This creates dilemmas for organisations and systems, making them unsure which priority to focus on next.  As experts in safety and quality, at Niche Patient Safety we have had the pleasure of working with forward thinking and innovative organisations who have embraced the challenges they face and engaged us to assist them to further develop their approaches to quality and safety. And for these organisations, some common themes resonate:

Integrated Governance – risk management functions are vital to underpin any integrated governance system and to ensure a truly continuous cycle of learning and improvement. Organisations that have fully integrated governance systems including claims, incidents and complaints alongside health & safety are more able to proactively manage quality and safety

Commissioning for Quality – robust commissioner assurance systems, including regular provider/ commissioner meetings with triangulated and agreed information requirements and fixed agendas, and frequent and close contact Serious Incident management processes bring clarity to the commissioning for quality process. Commissioner fears based on a lack of information are overcome with open book approaches to sharing quality performance, and sound and principled approaches to managing incidents as they arise

Clinical Risk Management – fully developed processes to triangulate claims, complaints and incident data gives organisations a framework to address the contributory factors that cause these issues, and serves as early warning triggers for services at risk of quality breaches. This enables stronger systems to focus on true assurance, and brings leadership and ownership to the management of system safety and quality, not continually asking for reassurance that gets in the way of patient care.

Nick Moor, Partner, Investigations & Reviews

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