“Measure what is important, don’t make important what you can measure”                  Robert McNamara

“Outcomes should be used as a principal measure for quality assurance of services” Care Act 2014 – Statutory Guidance

Most people intuitively understand these statements – but agreeing on the outcomes can prove to be a challenge.  And we all know that the experience of the journey to achieve them is just as important.

Taking the time to plan your approach to quality is critical.  How many times have you read a service description which starts with a statement about quality?  Providers are inevitably “passionate” about quality; it’s “central” to what they do; they have extensive “quality assurance systems”.  But then they immediately go on to describe the services they provide, rather than the way in which they listen to and communicate with their customers to know what each of them individually wants.  Some might reference training, staff supervision and DBS checks as examples of their commitment to quality.  Surely these are just the necessities of being in the health and social care business – they don’t really tell you much about quality.

When you talk to service users about quality, they almost always list two things:

• communication (listening first and foremost) and,
• attention to detail

But when you talk to service providers, there are lots of things which seem to get in the way:

• language – the process becomes a semantic exercise
• cost of measurement – and the risk of it becoming an industry in itself
• complexity of the product often means that proxy measures are needed – getting these right can be time consuming and a negotiation in itself
• when the outcome is essentially a subjective feeling, people start to get nervous in measuring it, especially where payment is linked to it
• people without enough understanding of the product means quantitive and transactional input type metrics dominate
• external criteria (often regulatory) end up taking precedence
• enabling people to actually say what they think, rather than be afraid of the consequence of saying it
• the need for instant and single purpose feedback leaving people feeling “surveyed” out.

10 ways to achieve quality

These are 10 things which have helped providers achieve better quality in their services:

1.  Good, solid person centred planning is a must – it will take time to do well, but the planning is a part of the journey, building the relationship, and pays dividends for everyone in the longer run.  Without the service user saying what change they want, you’re very likely going to be measuring the wrong thing.

2.  Superlative communication skills and strategies which are tailored to each individual person.  These need to go far, far beyond publishing menus or residents meetings.

3.  Having the confidence to allow different ways of measuring and capturing information – it really doesn’t always have to be a piece of paper.  It can be videos, pictures, stories, case studies, and it can certainly be longitudinal.

4.  Aligning all the system involved in supporting someone is a must – finance systems and the systems to support staff (training; ratios; line management structures; supervision; etc) are equally important.  And most organisations have their own processes for monitoring and evaluation – these all need to sync.

5.  Being clear and where possible including all of those elements of the systems which are involved in the care and support experience is a must.  The world of care and support is now so fragmented it is rare than one single provider has control over every element.   Consider what opportunities there are to create person centred quality plans which stay with the person and they move around the system and stay focused on their experience of care, rather than always looking at the providers in separation.

6.  Being clear on what you mean by “quality” is an important early part of the journey – many organisations actually mean “performance management” which can be or at least feel very different from the customer’s perspective.  And others confuse or conflate good practice principles of customer service which then become the end in itself.

7.  The best organisations know that quality is systemic – i.e. it is a part of the warp and weft of every action and every aspect of the service – not a separate activity in itself.

8.  You need to consider the  behaviours of the leadership in the service and the organisation – what do they see as important?  What information do they ask for and look at to know that?  How do they feedback to the service?  How do they really make it safe for quality to be everyone’s business?  These are all key questions in getting quality right.

9.  Ensuring there is a validation to any external regulation process.  Working as a specialist advisor to CQC I know that there are lots of ways a provider can evidence compliance – but it’s always important to check things through to make sure.  And where services are part of bigger groups, there is often a tension with minimum compliance levels and the best practice identified locally.

10.  Good service user involvement, beyond individual person centred planning, are key elements in a quality service.  More on this can be found here.

Experience suggests that most of these are easier said than done.  If I can be of any help in supporting you to think them through, then please do just contact me.