At the end of September the CQC published the latest version of its draft strategy for further discussion. With COVID-19 accelerating change in the way that many services are delivered within the healthcare system, the CQC is looking to update the way it works to deliver its purpose; to ensure that health and care services in England provide people with safe, effective, compassionate, high-quality care and to encourage those services to improve.
The CQC is taking an in-depth look at how health and care services work together and how they can evolve in order to meet people’s needs and improve outcomes for all concerned. In doing so, patient safety is being pushed firmly to the top of the agenda.
The strategy document, which is currently up for consultation until March 2021, focuses on four key areas, namely:
People, Smart, Safe and Improve.
People is all about involving patients more in their own care, listening to their views and encompassing their feedback to improve their experiences of the healthcare system. It is now not enough to look at just one service in isolation, the CQC will be looking at every touch point a patient goes through with a particular focus on the evolution to Integrated Care Systems.
Smart is taking a more dynamic approach to regulating. Rather than relying on periodic inspections, the CQC aims to harness information from many more sources, digital channels being key. There will be a higher focus on risk, so that resources can be targeted where they will make the biggest impact.
Safe is bringing patient safety into the limelight, promoting strong, safe cultures, which includes transparency and openness, and a culture where risks are not overlooked, ignored or hidden. It means learning from experience, both good and bad, with the overall vision of achieving zero avoidable harm.
Improve aims to make it easier for people to access the care they need, enabling the system to provide the most appropriate services, as and when they are needed, resulting in better outcomes. This will be achieved by sharing learning, information, advice and support, and will require joined up systems to provide the data required for this type of intelligence based approach.
This new oversight from the CQC will move safety significantly up the healthcare agenda and looks to take a much more holistic approach, gathering data from a broader range of sources, and rating Trusts on how well they collaborate with other organisations within their ICS or STP.
Patient Safety and Zero Avoidable Harm
This increased focus on patient safety will be music to the ears of Risk Managers and Quality Managers everywhere. There have been numerous reports over the years that have called for better patient safety, such as the recently published Cumberlege Review: Independent Medicines and Medical Devices Safety Review.
The CQC consultation document notes that safety is a key concern, and that it is still often the poorest area of performance in CQC assessments. Safety starts with an environment where staff are able to report concerns openly and honestly without fear of being blamed. While changing culture doesn’t happen overnight, as we’ve discussed before, moving to a Just Culture, where processes are at fault rather than the people working within them, is a positive step in the right direction.
Investing in more robust patient safety reaps many benefits, including reduced incidents of avoidable harm - indeed one of the key points in the CQC document is that stronger safety cultures should result in a vision where there is zero avoidable harm. There are other similarly compelling benefits including:
Reducing staff burnout – Having a process that enables people to report incidents truthfully without blame or fear of recrimination not only reduces stress on staff, already heightened by COVID-19 and a key factor in staff burnout, it enables the organisation to learn from mistakes. Reducing staff burnout also means fewer staff leaving the profession and taking with them many years of valuable experience, which need to be replaced through lengthy and expensive recruitment programmes.
Cost and resource savings - The cost of additional treatments and care for patients that have suffered avoidable harm goes into many £millions per year, and so too does the cost of legal action from victims. These are conservative estimates and reducing these amounts puts money back in the NHS pocket for more proactive rather than reactive solutions.
Lives are saved – Just a small improvement in patient safety for procedures that are performed thousands of times per year means the risk is reduced and lives will undoubtedly be saved.
Systemisation of the Process
Adopting a Just Culture empowers employees to report incidents, both good and bad. Creating a culture of visibility is where everyone is encouraged to take ownership and where, when things go wrong, the system is a fault rather than the people. Encouraging this open attitude to reporting incidents means that correct and comprehensive information is centralised, enabling the organisation as a whole to learn and improve.
While as a Risk Manager or Quality Manager you are not necessarily able to influence a change in culture across your organisation, there is quite a bit you can do to provide the mechanisms that support and encourage open and transparent sharing of knowledge. The CQC document notes that it is crucial for all health and care services to have access to the right support and insight to help them to build strong safety cultures, learning from safety incidents and improving working practices as a result.
Four Key points to improve Patient Safety
The CQC document states; ‘We’ll expect to see proper processes and frameworks to show how people are being involved, and evidence to prove this is happening.’ It also states that the CQC will intervene much sooner to assure itself that that services are focusing on protecting people before they experience poor care and avoidable harm. Care organisations need to have the systems in place to support staff in safe processes. Here are four key points to consider.
Adopt a system that is designed for the purpose of collecting data on risks, incidents, investigations, claims and feedback. Relying on spreadsheets provides no audit trail of information, and no central repository for reliable data. Such a solution provides an audit trail, showing compliance as well as providing the means for staff to report safety concerns in a blame-free setting, so that the organisation can learn and continually improve.
Choose a best in class solution that that has the breadth and depth to manage all information, and ensure that it is stored centrally, making it easily accessible for analysis of trends and causal effects.
Learn from experience – experiences both good and bad are an opportunity to learn how things can be improved. For example, the National Quality Board provides National Guidance on Learning from Deaths.
Join a community for sharing best practice in patient safety, risk and quality management. Build connections across the health sector that will enable you to share experience and to learn from other organisations.
With COVID-19 adding to the burden of an already stretched healthcare sector and reports such as the recently published Cumberlege Review, the CQC’s increased scrutiny of patient safety is well timed. If healthcare organisations can step back, review patient safety and in so doing, ask their frontline staff what they think, they may find that providing them with a voice is a meaningful move towards better patient safety and all the benefits that that entails – for everyone.
For further reading and your chance to contribute to the CQC’s new strategy click here.