Is ‘good’ good enough?

Is ‘good’ good enough? This may sound a rather strange question, especially for providers who have worked hard to ensure they get a ‘good’ CQC rating in all or most of the five domains that the CQC now looks at in every inspection. However, I would argue that there are (at least) two things to consider before patting oneself on the back regarding a ‘good’ rating.

Firstly, what does ‘good’ actually mean? For the CQC ‘good’ is essentially the benchmark; in other words, the other three possible ratings (‘inadequate’, ‘requires improvement’ and ‘outstanding’) are derived from ‘good’. What’s less clear is where ‘good’ came from in the first place. From what I can glean, having attended CQC training on the ‘new’ inspection process, and having looked at a number of ‘good’ reports and compared them with those with poorer ratings, a ‘good’ rating is simply what most people (residents, relatives, commissioners, staff, management, etc) would expect from this type of service. In other words, ‘good’ equals good practice – and why would anyone accept anything less?

Unfortunately, of course, people do accept less, hence the relatively high number of services with a ‘requires improvement’ or ‘inadequate’ rating. What’s surprising, therefore, is the ‘jump’ from ‘requires improvement’ to ‘good’, whereas it might make more sense to have an extra rating along the lines of ‘satisfactory’. The problem with the ‘good’ rating as it stands is that it may lull providers into a false sense of complacency: ‘We are good, so why worry about doing any better?’

This leads us to the second consideration: putting to one side for a moment the question of what ‘good’ means in the first place, is it good enough? In other words, does ‘good’ mean there is no room for improvement? Presumably not, otherwise the CQC would not have introduced the ‘outstanding’ rating. However, this then begs the question as to whether ‘requires improvement’, as a rating, has any real value; after all, couldn’t this apply to any service, however ‘good’ or ‘outstanding’ it might be?

Of course, the short answer is that there is always room for improvement. After all, what is ‘outstanding’ if not ‘good plus’? So why not have ‘good plus plus’ and so on? In other words, there should never be room for complacency. Apart from anything else, what happens when the CQC changes its ratings and/or its inspection methodology (and don’t tell me this won’t happen!)? Or even, what happens if a completely new regulatory body with a completely new methodology replaces the CQC (and don’t tell me that won’t happen either)? Suddenly, ‘good’ may not be good enough at all.

In my view, the only answer to this, the only way to ‘future proof’ the quality of a particular service, is to be continually striving to improve, to be continually aiming to do better. This may be stating the obvious, but in my experience, and judging by the ratings reports which the CQC publishes on a regular basis, not every provider is thinking this way. Part of the reason for this may be the legacy of previous CQC inspection process, which was essentially a ‘pass-fail’ system – and in which it was actually very difficult to ‘fail’, i.e. to be non-compliant. Many providers I’ve spoken to, and especially the rather surprisingly high number who have yet to be inspected under the new regime, seem to still be thinking in this ‘pass-fail’/’compliant/non-compliant’ way. I would suggest that some of them are in for a shock when the CQC does finally get round to visiting them……

But why wait for the knock on the door? Surely, it makes more sense to build continuous improvement into the working practices of the whole service? In other words, to make striving to do better part of the ethos, part of the culture, of the whole organisation.