During a recent webinar, CQC talked about the characteristics they see in the organisations that are improving. They are that the organisation is outward looking, it responds well to feedback and where the leaders have an ‘open door’ culture. It is striking that these features of improving organisations are the same as those of good leaders – outward looking, responsive and open. Leadership that is open to new ideas, to learning and to doing things better is strong leadership. And leadership of this kind is critical in ensuring that health and social care organisations provide good outcomes for patients and service users.
At Verita we have been working with a number of organisations in recent months who are facing CQC inspection, particularly relating to their leadership and governance – whether they are “well led”. Although the words ‘CQC inspection’ run a chill through most managers, CQC are really only looking for evidence that organisations have strong, high quality leadership in place. Leadership of this kind is something that all organisations need – whether the CQC ask them for it or not.
We have developed a comprehensive approach to responding to “well led” reviews which helps organisations assess the effectiveness of their leadership and any areas for improvement in response to the questions that organisations are being asked. The framework also helps organisations prepare for CQC inspections, particularly looking at the key lines of enquiry that relate to “well led”. Our experience is that the approach we have developed works equally well in both health and social care provider organisations.
There are two publicly available frameworks which define the key elements of a well led organisation: the NHS Improvement well led framework and the CQC key lines of enquiry. There is a lot of overlap between the two; the NHS Improvement framework is more comprehensive with eight main components, whilst the CQC framework has four. Four of the components are virtually identical in both frameworks, with the CQC one having an additional component, “working in partnership with other agencies”, which is not included in the NHS Improvement document. We have combined the two to produce nine components of well led:
- Leadership capacity and capability
- Clear vision and credible strategy
- Culture of high quality and sustainable care
- Clear responsibilities, roles and systems of accountability
- Clear and effective processes for managing risks, issues and performance
- Appropriate and accurate information which is effectively processed, challenged and acted on
- People who use services, staff and families are actively engaged and their voices are heard
- There are robust systems for learning, continuous improvement and innovation
- Working in partnership with other agencies for the benefit of patients or service users
Verita’s approach involves triangulating data from a range of sources to produce the most comprehensive picture possible of an organisation and how it works. This includes interviews with staff throughout the organisation from Board level to the front-line, with patients or service users, their families and external stakeholders, including commissioners. We also review a range of documentation, including, for example, the terms of reference of governance committees and the minutes of Board meetings.
In our experience, there are a number of aspects of the way that an organisation works that are particularly important:
- Are the right people with the right skills leading the organisation?
- Does it have a culture that is focused on both effective management and the patient or service user experience? For example, is more attention paid to financial performance, the patient or service user experience or a balance of the two?
- Are governance processes adequate – is there an appropriate committee structure and audit process involving the right people that scrutinises the right information to assess how well the organisation is performing? Is it straightforward or too complicated?
- Are senior managers visible, known to staff and in touch with what is really going on in the organisation?
- Is there a culture of evidence? In a heavily regulated sector we know that, is something isn’t recorded, it hasn’t happened. Is there a clear flow of information that is evidenced, for example in meeting minutes, that tracks through to the Board?
- Is there a clear “golden thread” from the ward to the Board? This involves both the scrutiny and transmission of data and the presence of senior managers on the front-line checking that the data they are receiving mirrors the experience of front-line staff and patients or service users and that key messages are being effectively communicated.
- Is there a strong voice for patients or service users and their families and is their evidence that it is acted on?
Changing leadership and culture can seem like daunting challenges. But changing to being an open, learning organisation is really about taking a series of small steps. Why not start today?
Verita, a leading consultancy specialising in investigations and quality improvement in health and social care. If you would like to find out more about Verita’s well led review process, please contact Peter Kinsey at [email protected]