Seeing the big picture

In my previous post I suggested that although a great deal of a manager’s time in the social care field is, by its very nature, taken up with ‘fire-fighting’ and crisis management, it is still possible to keep this under control and to prevent things from spiralling totally out of control. In other words, it is quite possible, and, indeed, essential, to manage crisis management. And one way to achieve this is for managers to ensure they have access to good ‘intelligence’, i.e. knowledge, regarding their service.

I pointed out that if the ‘fire-fighting’ analogy is going to be used properly, then it is important to remember that actual fire-fighters rely heavily on having good intelligence when confronting a fire or other disaster; in fact, both their lives and the lives of those they are rescuing depend upon it. Furthermore, an important role of the fire and rescue services is to share their accumulated knowledge and wisdom with others in order to help prevent fires and other disasters occurring in the first place.

So it seems to make perfect sense for managers to have as much relevant and high quality intelligence regarding their services as possible. Not only can this help them deal more effectively with the everyday crises that are an inevitable part of their job, but such knowledge can help them prevent such crises arising in the first place. However, managers and service providers will only be able to benefit from such intelligence if they have robust quality assurance (QA) and governance systems and processes in place in order to collect, collate and analyse the multiple streams of information that are constantly flowing into the service.

In fact, all services in the health and social care sector have some form of QA and governance system and process in place, even if they may not refer to them as such. In very small services, a great deal of quality assurance is conducted by the service manager ‘in their head’; in other words, the manager, because they are very ‘hands on’, knows exactly what is going on in all parts of the service at all times. In practical terms this can be very effective on a day-to-day basis; the problem is, of course, that it relies on one, or sometimes two or three, individuals being constantly present in the service. But what happens when the manager is on leave, goes off sick or suddenly leaves the organisation? How are other staff then able to access all this accumulated knowledge and wisdom?

Larger organisations, and especially the big ‘corporate’ providers, often have very elaborate QA and governance systems in place, and carry out regular reviews of all their services. This does not mean they are any better managed, but it does mean there is a constant ‘audit trail’ of information which others can access. And, of course, one of these ‘others’ is the CQC itself, who, rightly or wrongly, still seem to have a built-in bias towards such audit trails. In other words, the CQC likes to see every part of a service as fully documented as possible as evidence of quality.

And in any service, large or small, it clearly makes sense for as much information as possible to be accessible to other people, so that in the event of a crisis (including the sudden absence of the manager), these individuals can take up the reins and have a clear idea of what they are confronted with and how to deal with it.

I mentioned earlier that there are constant streams of information flowing into any service. These include the daily, and often informal, interactions with service users, relatives, staff, visiting professionals, and so on. It also includes reports, audits, staff supervisions and appraisals, assessments, reviews, staff and management meetings, training courses, etc. Some of this information may be very useful, or indeed, critical, for the service manager, whereas some of it may be just ‘noise’. A crucial part of a manager’s role, I would argue, is to be able to separate out the useful from the ‘noise’. It is also essential that they can make proper sense of the information that is useful; in other words, they need to be able to ‘translate’ information into knowledge or intelligence.

Leaving aside the question of such a ‘translation’ for the moment, there is also the issue of collation. By this I mean how best to gather all this disparate information together in a manageable form in the first place. This may be for a number of different purposes; for example, to put together a management or company report, a business plan, a staff performance review, a resident’s care plan review, and so on. Or it could be in order to construct a ‘big’ or overall ‘picture’ of the whole service.

It is this idea of constructing a ‘big picture’ of the whole service that I would like to focus on here, because this is precisely what the CQC does when it carries out its routine service inspections. Essentially, it wants to take a ‘snap-shot’ of the whole service with regards to its overall quality. And the way it goes about this is to gather and collate as much information (evidence) as possible within the time available. As readers will be fully aware, to facilitate this process of information gathering and collation, the CQC ‘breaks down’ each service into five ‘domains’ (safe, effective, caring, responsive and well-led), and twenty five key lines of enquiry (KLOEs). This is simply to help guide the evidence gathering process and to enable to inspection team to come up with a rating for each service.

But as I always tell my clients and prospective clients, and as I’ve written numerous times on this blog and in social media discussions, there is nothing to stop service managers constructing their own ‘big pictures’. In other words, they can take a leaf out of the CQC’s own book by gathering and collating their own evidence for each the domains and KLOEs. What’s more, they can make this a dynamic process, rather than simply waiting for the next CQC inspection. By ‘dynamic’ I simply mean managers can gather information on a continuous basis, and update existing information as and when necessary. This means they will, in theory, always have an up to date, overall ‘picture’ of their service.

The reason such a ‘big’ or overall picture matters is that without it, managers are essentially ‘flying blind’. In other words, they will have no real idea of how safe, effective, caring, responsive and well-led their services actually are; until, of course, the CQC arrives and constructs its own ‘big picture’ of the service. I often get the impression, though, that many managers and providers, whilst acknowledging the importance of having such a ‘big picture’ of their services, still do not see it as a priority.

And this brings me back to the whole question of crisis management and whole ‘fire-fighting’ analogy. Many crises are quite preventable and only occur because of a lack of effective intelligence. If the manager had had a better understanding of the overall service and had been aware of potential ‘flash-points’, then it is quite possible that things would never had got out of hand in the first place. And even in situations where crises do occur, having that wider perspective can only ever help rather than hinder.