EXCLUSIVE: Outstanding – making it achievable for all

Striving for outstanding may feel like searching for a pot of gold at the end of a rainbow but Ed Watkinson, Director of Care Quality at Quality Compliance Systems, offers some helpful tips on how it can be done.  

Thinking about receiving the CQC Outstanding rating can be compared to looking at a rainbow insofar as it is enticing, magical, alluring, hard not to focus on and to most a complete mystery!  And getting an overall Outstanding rating must seem to 99% of providers as realistic as that mythical ‘pot of gold’ at the end of the rainbow!

Only approximately 1% of social care providers have achieved the Outstanding rating and this figure seems to have been fixed and immovable throughout the first round of inspections that have recently been completed by CQC, even though during the three year programme the percentage of services rated Inadequate and Requires Improvement has reduced and the number of Good services has increased.

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Why is this the case? Surely there must be more care services out there that people using services, their relatives and other people involved on a day to day basis think are Outstanding? The conclusions you can reach are that services are not fully prepared for the areas that CQC will be focussing on during an inspection, or that CQC are not asking the right questions to fully understand the quality of care and support provided by care services.

For the purposes of this article I am going to briefly focus on how services could approach any impending inspection, what can be done to prepare for a CQC inspection and how to manage the actual onsite inspection visit. I have spoken many times over the last year about this subject and provided advice on how to improve your chances of being rated Outstanding, and was really pleased that a provider contacted me six months after listening to a presentation I gave, to say that they had followed the advice given and had just been rated Outstanding! This was such a proud moment for them, and just went to show that it can be done, and there are pots at the end of the rainbow waiting to be found!

The relationship with the regulator has changed over the past three years. Prior to the ‘new’ inspection methodology of giving ratings for services, there was a pure compliance approach – you were either compliant or non-complaint, with no graduation or recognition for being ‘better than compliant’, and as such there were limited incentives to improve as being compliant was in effect being  Good. With the recent ratings model of inspection, it is a real opportunity for care providers to take the initiative and to ‘sell yourselves’ and show what you do to ensure that CQC have the information and evidence they need to come to a favourable judgement, above being compliant.

To do this, service providers shouldn’t be afraid of the regulator and should be on the ‘front foot’ and proactive with the inspector. A powerful way of thinking is to treat the inspector as you would treat a prospective client of your services – you would show the best you had to offer, engage with them, smile, encourage them to ask questions, welcome them back and give them materials to take away to look at later on. This approach may seem a bit alien to some, but in my time as an inspector if I was met by someone pleased to see me and who engaged with me I knew I was in for a more productive inspection than when being met by a frowning person with arms folded, and staff running away from me!

However, to be proactive you need to ‘talk the language’ of the regulator, and not rely on them to interpret what you are showing or saying. Fortunately for you the CQC ‘language’ is very clearly explained and shown on their website, and in the ‘provider handbooks’. You need to be fully up to speed with the five Key Questions, Key Lines of Enquiry (KLOEs), the Prompts and the Characteristics of Ratings. Most people will have a good grasp of the Key Questions and the KLOEs, but the Characteristics of Ratings define how CQC will judge the evidence presented, which is convenient for you as they provide a very useful ratings benchmark for you when looking at the evidence to answer the questions that CQC will ask.

You also need to ensure that you have the evidence to show the inspector during their visit. If you sit back and wait for the inspector to find evidence, and they don’t see the really good evidence then you have no one to blame but yourself – it isn’t the inspector’s job to find everything that you do, and it can only be in the report and help with your rating if they have seen it or have it to take away with them. I suggest developing two files of evidence divided by the five questions and the KLOEs and within the file place the evidence to support what you do, or clearly indicate where the evidence can be found. You were right, I did say two files –  both the same, but one for you and one for the inspector to take away with them.

This will be a great help for the inspector when writing your report, if they have a structured file that will act as an aide memoire for them, and it will ensure that your evidence will be included in the report and the subsequent judgement CQC make when rating your service.

Looking at CQC information and reports written, the language used to describe an Outstanding service invariably includes the following terms – ‘innovative’, ‘extraordinary’ or ‘exceptional’, so you need to develop your service and the evidence to support these descriptors. Look at other Outstanding reports on the CQC website and steal ideas from other providers, and to be honest I would be surprised if you thought that the practice described in many of these reports was very different from what you do now. It comes down to how the evidence was presented and the outcomes for people that use services are reported. In addition, look at the CQC Characteristics of Ratings for examples of Outstanding practice, and ensure you are consistently looking for evolving best practice by using information from organisations such as SCIE, NICE, Skills for Care and other local networks.

It is also advisable to undertake ‘mock inspections’ of your own service based upon the questions CQC will ask to prepare staff for the experience, and to highlight where you need to improve. Being part of an inspection is just like anything else – the more you do it the less scary it is, and what you want is for all staff to be confident during an inspection and to avoid the situation when you look at a rota for a certain day and say to yourself ‘I hope CQC don’t turn up then!’

In summary to increase chances of being Outstanding you need to:

Be creative (and if you can’t do that steal other people’s creative ideas and make them your own!)

Make sure the evidence is clear, demonstrates innovative practice and is available for the inspector to take away

Be prepared for an inspection –  make sure everyone in the service knows what they will be looking for and what constitutes Outstanding care

Be open and engage with the inspector and treat them as potential users of your service

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