Quality of Care Approach: overview and

implementation progress update

Healthcare Improvement Scotland

• One organisation, many parts, one

purpose: better quality health and

social care for everyone in

Scotland

• Five strategic priorities:

− Priority 4: Provide and embed

quality assurance that gives

people confidence in the quality

and sustainability of services and

supports providers to improve

Context

• National direction: Sustainable, high

quality services for the people of

Scotland

• Changing health and social care

landscape

The ask

Cabinet Secretary for Health and Wellbeing August 2014

“These new reviews will first and foremost focus on the quality

of care. But they will add to our scrutiny regime by considering

the whole system, including staff levels, and patient

experience. The reviews will play an important part in ensuring

that our NHS continues to be open and honest to those it

serves – Scottish patients. As well as being truly open and

transparent our NHS also needs to reflect on best practice and

support staff to emulate success and spread good practice

so that it becomes common practice everywhere.”

Our response

Quality of care approach work programme

Design phase

• Independent design panel

• A new approach

• National consultation

• Positive engagement …..but “How do we

make it work?”

• Final Report: March 2016

The quality of care approach

• Brings a consistency to all of our external quality assurance work.

• Strong emphasis on supporting quality improvement to drive better

outcomes for all who use healthcare services.

• The Quality Framework underpins the approach.

Quality Framework update

• Further review post publication of the

Health and Social care standards (June

2017) to ensure continued alignment.

• Updated framework is currently going

through an external quality assurance

process.

• Will be published as part of a package of

tools and guidance.

The QoCA self evaluation process

• A key part of the quality of care approach.

• Service providers will be supported to use the Quality Framework as a basis

for self-evaluation and reflection.

• The self-evaluation alongside other shared intelligence about service

providers will form the basis for supportive conversations.

• The aim of these conversations is to hear about what is working well, but also

to identify where there may be difficulties or barriers to improvement.

• Identification of opportunities for mutually agreed proportionate and risk based

intervention which may be additional assurance activity, improvement support

or a combination.

Testing updates: organisational self-evaluation

tool

• Two completed organisational self-evaluations and evidence.

• Internal analysis and then with the input of service-based specialists to

identify any gaps and formulate an initial assessment of what the

information is telling us (in conjunction with the most recent shared

intelligence report).

• Feedback and listening and learning sessions have been held.

• Final package of tools and guidance for the programme of organisational

reviews will be refined based on test outputs.

Testing updates: thematic review test

• Site visit to NHS Lothian CAMHS at the end of May.

• Output from the test shared with NHS Lothian for internal improvement

purposes.

• Feedback and listening and learning session held.

• Final package of tools and guidance for thematic reviews will be refined

based on test outputs.

Other testing and alignment work

• The HEI self-assessment has been aligned under the domains of the

quality framework and NHS Borders has tested this.

• The independent healthcare team has mapped the IHC ‘quality

statements’ to the quality framework domains. A test exercise has been

completed with a hospice in the east of Scotland.

• The OPAH self-assessment has been aligned to the quality framework

domains and we are scoping whether the high level organisational self-

evaluation could be sufficient to also inform OPAH inspections (and the

planned work to move into non-acute hospitals and SDUs).

• The joint inspections of adult services and prisons inspections are

also scoping or taking forward work to align with relevant parts of the

quality framework.

Looking forward

Horizon 1 (2016-end

2017)

• QoCA methodology

development and testing

• Joint strategic inspection

methodology review

• OPAH/OPAC redesign

• Alignment with HSCS and other

relevant work

• Engagement with key

stakeholders

• Awareness raising with the wider

service

• Outcomes planning and

evaluation framework

Horizon 2 (end 2017-2019)

• QoCA methodology phased roll-

out

• Integration of the quality

framework to existing scrutiny and

QA work

• Building HIS and service capability

• Thematic reviews of major

priorities (intelligence driven)

• Supportive Conversations

• Services signposted to appropriate

improvement support

• Learning points shared nationally

• Outcomes, planning and

evaluation framework review –

short term outcomes – are we on

the right track?

• Ongoing reflection, feedback and

refinement of the methodology

Horizon 3 (2019-2020)

• Quality framework embedded in

all external quality assurance

and scrutiny activity

• NHS boards using the quality

framework routinely for self

assessment, reflection and

internal assurance on the

quality of care they provide

• Innovation and improvement in

the quality of care as a result of

quality of care approach

• Outcomes and evaluation

framework review – medium

term outcomes – is QoCA

delivering the predicted

outcomes

Value