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Hans F. Hansen

Requires Improvement to Outstanding…

Thanks again for the feedback about last week’s blog; as always, if you have implemented any of the suggestions or ideas we have shared, we would love to hear from you!

As I said last week, I wanted to spend a little bit of time this week looking at Pam’s specific example of how she supported an organisation to go from Requires Improvement to Outstanding; ultimately to show that is possible and achievable, it just takes a whole team approach. For completeness, I have included Pam’s example below:

“For the service I supported to Outstanding, I began by having a very honest and difficult conversation with the manager which led to other challenging conversations with staff. It’s crucial that the staff are on board and understand their part in it all, rather than inspection being seen as something which goes on behind the closed door of the manager’s office.

Within a month everyone could see their part and actions to address these coming to fruition. This resulted in staff looking forward to me returning so that they could give their updates to be recorded on the action plan.”

Let’s take a closer look at what Pam did and what we can glean from her example…

“I began by having a very honest and difficult conversation with the manager”
In the blog two weeks ago, I shared some figures from the recently released Skills for Care program “Well Led” which we have just started delivering:

99% of “good” or “outstanding” services had either “good” or “outstanding” in the fifth key question – “Is the service well led?”

This demonstrates that the manager’s role is vital, because those services that do not achieve good or outstanding in “Well Led” find it very difficult to achieve good or outstanding overall. So, Pam’s starting point is of course, spot on. But what did she talk about? The key component of the conversation was firstly that the manager understood there were challenges (see “awareness is the first step” later on), but (and in some respects the most important) was willing to embrace the changes, despite people’s usual reaction to change i.e. resistance and this is something we will talk about in a future post. Think back to last week’s post, “continuous improvement is a mindset”, and a key characteristic of good and outstanding services. (see below)

“which led to other challenging conversations with staff”
According to the psychologist Nathaniel Branden, “Awareness is the first step” and is the precursor to impactful change. As soon as the conversation with the manager has happened, the natural next step is to talk to the staff in order to build a culture of openness and fairness that CQC are looking for evidence of.

“It’s crucial that the staff are on board and understand their part”
It starts with communication…. if the experience of staff in previous inspections has been something that they should be worried about because the manager is worried, then this is the opportunity to shift the mindset of staff. Set the expectation that inspection is an opportunity to shine, it’s an opportunity to show the inspectors what a fantastic job they do.

Staff should be clear about what they are responsible for, namely the duty of care that they have for their safety to practise and inspection is a reflection on the whole team, hence the need for them to be on board etc

“inspection being seen as something which goes on behind the closed door of the manager’s office”
Perhaps in the past, inspection did take place behind closed doors in the manager’s office before CQC took over; those of you who have experienced a CSCI inspection will know what I mean. However, think back to the blog post “CQC Inspection Methodology” that we posted a few weeks’ back and you will know that inspection is very focused on what’s actually happening in practice. CQC will spend time talking to both staff and the people you support plus, wherever possible, external stakeholders.

One of the things that we talked about in that CQC inspection methodology post was how to prepare your staff for what’s going to happen when CQC are carrying out their inspection and one of the key pieces of that jigsaw is observation. https://www.linkedin.com/pulse/cqc-inspection-methodology-sarah-knapp/

Clearly observation is not something that can happen in the manager’s office; it is something that happens with the people you support and it is vital that CQC actually see what’s happening in practice….

“Within a month everyone could see their part and action to address these coming to fruition”
Thinking back to what the psychologist Nathaniel Branden said, awareness is the first step, but the second step is acceptance. One of my favourite modules in Lead to Succeed is module 2 which is Developing Positive Culture. When we, as leaders, set the expectations and the culture appropriately i.e. “we are all in this together”, change can actually take place very quickly.

As Pam described, within a month people could see their part and see it coming to fruition. This has a huge impact on motivation, morale and the confidence of our staff which in turn impacts on the quality of service delivered to the people we support.

“This resulted in staff looking forward to me returning so that they could give their updates to be recorded on the action plan.”
Look what happens when “we are all in this together”; we share a common goal, staff are actually looking forward to inspectors returning so they can share their successes and achievements. This is exactly the kind of culture CQC are looking for…

Next week we are going to discuss, resistance to change and some of the practical strategies outlined in module 4 of Lead to Succeed.

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