In the last issue of Care Management Matters, we looked at the Driving Up Quality Code. We explored the reasons why providers should sign up to the Code and make a public commitment to improve the quality of service provision for people with disabilities, following the shocking abuse that took place at Winterbourne View.
Signing up to the Code is not a tick-box exercise. It is a commitment to embrace scrutiny. Providers embrace the feedback from people who use services, families, staff and professionals, on the quality of their service provision. By creating this culture of openness and transparency, the intention is for good organisations to flourish and poor provision to be exposed and addressed.
What makes a good provider?
Scrutiny of the service can be undertaken through an inclusive, reflective, honest and open self-assessment process. There is no set way to undertake a self-assessment. It is not about trying to be a ‘perfect organisation’ or to compete with others.
There is no such thing as a perfect organisation, however being able to spot that people are living an unfulfilled life in an unsafe environment is the mark of a good provider. Being open and honest about this is the mark of an even better provider. Being able to celebrate success is important, but as important is to know where we are failing or where we have made mistakes. The self-assessment process needs to ensure that both the positive and negative aspects are reflected upon and addressed.
Self-assessment in practice
Care provider, CMG Ltd, is an organisation that has undertaken two company-wide self-assessments since signing up to the Code. It has also encouraged individual services to undertake a self-assessment process.
CMG was keen to ensure that the process of gaining feedback was not only inclusive but creative and engaging. The company invited over 100 people it supports – staff, relatives and external professionals – to a ‘self-assessment day’. Rather than simply asking people to fill out forms, it held a series of creative workshops. In 2015, the theme of the self-assessment day was ‘The road to quality’. Each workshop was facilitated by one of the company’s regional directors and attendees were split geographically into each workshop so that they could address both organisational and local issues. Discussions then took place around each of the five areas of the Code.
The people supported by CMG created artworks to display different modes of transport, eg. tractors, trains and boats and also took part in the workshops. On the day, feedback on what the organisation does well and what could be improved upon was pinned to the displays. The day culminated with a ‘road to quality’ being laid out through the centre of the room, with everyone posting a ‘brick’ containing an idea.
All the feedback from the day was then evaluated and written up into a report which included a comprehensive, but achievable, action plan of activities that the company would undertake to address the ‘things it could do better’. This document was then circulated company-wide and to all participants. CMG also made sure that, in its 2015 event, it reflected upon the action plan from the 2014 event and outlined how it had addressed each point. Therefore implementing and building upon the previous year’s feedback to continuously improve.
Choice Support took a slightly different approach to its organisational self-assessment. It organised an event that was a cross between a café conversation and speed dating. The company invited people it supports, families, staff, commissioners, care managers and housing providers and had 14 sessions across the organisation in one year. Each session was chaired by a trustee. Conversations were fast and furious and people were encouraged to be open and honest. Its subsequent action plan then took the form of a traffic light system to highlight progress.
It is, of course, up to each organisation to decide how it wants to carry out its self-assessment process. However, it is recommended that organisations should stick to the following principles:
Include a range of people: The self-assessment should not be carried out by managers in isolation. It should involve the active participation of the people they support, families and frontline staff. Wherever possible, external colleagues, such as commissioners and members of the local learning disability team should be encouraged to participate.
Include a range of evidence: Use as wide a range of evidence as possible, and preferably from more than one source. For example, evidence can be gathered from sources such as: meeting minutes; survey questionnaires from staff, people you support and families; focus group discussions; reviewing complaints and Care Quality Commission reports.
Breadth and depth: Particularly for larger organisations, the self-assessment needs to ensure that all areas of the organisation are looked at and it is representative of all employees, not just managers or Board members. Each provider will need to think of ways to ensure that all staff are involved in the process to understand their unique contribution to the organisation.
Constructive challenge: The organisation should rigorously challenge itself and encourage active and open discussion. Make it okay to be open about what obviously isn’t working and also to question practice that is more commonly accepted but shouldn’t be.
Creativity: Try to explore creative ways of ensuring meaningful involvement by participants to make it a positive, enjoyable and motivational exercise. This could include, for example, the use of video, social stories or drama.
Ongoing improvement and action planning: The self-assessment is not a ‘pass or fail’ test, but a recognition that there will always be room for improvement and change. The feedback provided from your self-assessment process should be documented in a report alongside an action plan, to ensure the suggested improvements are actually made.
The openness and transparency of self-assessment is beneficial to the organisation, those it supports, their families, carers, commissioners and inspector. An organisation that is willing to look at how well it does, constantly improve and build upon its assessments will reap the rewards for everyone.
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