In my previous post I explored some of the issues surrounding the idea of an ‘Outstanding’ rating, and particularly in the context of such a rating being both desirable and extremely difficult to obtain. And just to emphasise how difficult it is, I looked at the CQC overall ratings figures for adult social care (residential and home care) services since December 2018. Of the 11,960 reports produced during that period, only 4% were rated ‘Outstanding’ whilst 68% were rated as ‘Good’.
As I suggested in that post, ‘Outstanding’ is essentially about adopting innovative and creative thinking and practice in a service, linked to continuous organisational learning and improvement. But in order for this type of thinking and practice to work effectively it has to be built on solid foundations, i.e. ‘Good’ ones. Perhaps another way to look at this is to say that an ‘Outstanding’ service is one which is able to be creative and innovative with its ‘Good’ thinking and practice.
So clearly, the first thing any manager or provider needs to do is to ensure their service is ‘Good’. Furthermore, they need to be able to evidence this, both for the CQC and for their own management purposes. And as I argued many times on this site and in social media discussions, the best was to provide such evidence is to use the CQC’s own ‘quality metrics’, i.e. their five domains and 24 key lines of enquiry (KLOEs). More and more services appear to be adopting this approach, basing their own quality assurance (QA) systems and processes around collecting evidence for the KLOEs.
However, there are still a number of challenges to this approach, not least deciding what counts as ‘evidence’ in the first place. And then there is the question of how to interpret the evidence that you do have, and what to do with it in terms of presentation and reporting.
It was with all this in mind that I decided to pull together a number of existing resources that I had already developed along with a couple of new ones, and to offer them as a KLOE Audit Toolkit. The basic idea behind this online resource is to make the whole process of gathering, analysing, presenting and reporting KLOE ‘Good’ evidence a lot easier. As ‘Good’ is essentially the ‘baseline’ for any service, it seemed to make sense to focus on gathering and analysing the essential KLOE evidence that demonstrates that a service has reached this baseline. However, there are also a number of other useful resources, including my e-book on QA and access to Therapeia’s online audit tool.
Before you all rush off and invest in this resource, I would just like to say a bit more about the issue of ‘evidencing Outstanding’. Clearly, if a service is already ‘Good’ it is understandable that the manager wants to take it up a level. However, and as I pointed out in my previous post, when it comes to providing evidence for ‘Outstanding’ it is not quite as straightforward as providing evidence for ‘Good’. And this is because the KLOEs are built around the idea of ‘Good’ as the baseline. In other words, inspectors want to ensure that services reach acceptable quality standards, and this is what they are looking for when they carry out their inspections.
Although the CQC has produced a number of characteristics for ‘Outstanding’, in my view the KLOEs themselves are not designed to find such characteristics. If they were there would be a lot more emphasis on terms such as ‘innovation’, ‘creativity’ and ‘organisational learning’ in the actual KLOE documentation itself. Such terms are mentioned quite a bit in the ‘Outstanding’ characteristics document, but in the KLOE documentation the emphasis, for totally understandable reasons, is far more on ensuring that service comply with all their statutory requirements and reach acceptable quality standards. This means that in terms of ‘evidencing Outstanding’ the onus is essentially on the manager or provider themselves to make the case for innovation, creativity and organisational learning within their service.