This week has been dominated by the topic of hospital inspection
On Monday the Keogh report was announced. Behind the distracting political noise the NHS crossed a really important threshold. For the first time, we saw hospital assessment as it should be – credible, meaningful, open, involving, comprehensive, constructive and helpful. As a consequence, the findings will surely be accepted by hospital boards, staff, and the public alike
Today, the Chief Inspector of Hospitals commenced work by announcing details of his routine hospital inspection process which, while not triggered by high mortality rates, seems to build on the approach used in the Keogh reviews
A large inspection team, with a varied membership including members of the public, expert clinicians, junior doctors, and student nurses will spend sufficient time to really understand the organisational culture. They will meet staff and patients and they will visit in and out of normal working hours
We are pleased to be one of the first 18 Trusts to be visited, potentially very soon. Some time ago we volunteered to help trial the new ‘Ofsted style’ rating system, so we are equally pleased to be one of 3 Trusts (as I understand it) to be rated in this way after our inspection
How to prepare? Indeed, should we prepare? Certainly we should inform staff about it, as we do whenever we are mentioned in national media. I have done that today – you can read my message here
I think it is difficult if not impossible to prepare – why would we, and what would we do differently? The teams, experienced as they are, will form an accurate impression of our organisation whatever we do between now and the big day. It seems to me that this is a key strength of this new system of inspection?
Professor Richards was instrumental in implementing cancer peer review inspections just over a decade ago. I was involved as a clinician, and I recall the early angst. But quickly the power of peer review became apparent, and now the validity of the visiting team’s findings is rarely questioned, and the improvements that have resulted are many and varied. I can see strong parallels with the new inspection process
Am I worried? Of course – however hard one works, and however committed one is to doing the right things, it is always anxiety-provoking to be scrutinised by others. We are on a journey in our Trust. Currently we are a middling performer overall, but with aspirations to keep improving. We think we are doing the right things, choosing the right priorities, and operating in the right way, but we are open to learning how to be better
Managed correctly, the findings of the visit will help us support our Trust to become even better. The importance of the five domains (well led / responsive / caring / effective / safe) is unarguable, and a balanced assessment of our performance against these will be difficult for even the most hardened opponent of change to resist
In this baking hot week, we have moved into a new era of hospital performance assessment. I believe it will be balanced, and rooted in the views of clinicians and public, and thereby credible and powerful. Most important of all, we will have an approach to performance measurement that our staff will recognise as valid, and will support. That can only strengthen the alignment between front line staff and their managers, and that in itself will be a huge step forward
MartinM
Tesco or PC World may not be good comparators for the NHS but Marriott or InterContinental hotels are. Each has individual brands against which each customer has clear expectations of delivery from that brand against which satisfaction will be measured and feedback given. They tolerate hotel inspectors to confirm their market possession and only attach value to being told what they don’t already know. The CQC are of similar worth.
AMC
Dear Mark,
Given the spatio-temporal and professional complexity of the hospital, as a distinctive world, where everyone and no one makes decisions, how do these inspections help? How does a single rating encapsulate the quality of care when it can be varied within the single institution? How are we to make sense of these inspections when many hospitals have gaps in the rota, any attempt to reorganise such services on a sustainable basis are met with local and national opposition. How can services be structured locally when the center has such a predominant influence with targets? How does one avoid accusations of pot-code lotteries when one is reliant on locums because junior doctors don’t want to work in hospitals where the demand exceeds resources. It does not help to say that management should recruit more professional staff when that is a structural problem faced by the NHS. Inspection regimes may perhaps be good.
How seriously must I take someone who treats a hospital like PC World or Tesco? It is a place where there is grief, loss, anxiety, fear about the potential impact of sometimes life-changing conditions. The inspectors want efficiency, asset utilisation, customer-orientation. As a doctor I only want to help the patient live better than when they arrived for a treatment or diagnosis. That sometimes takes more time than an ever-bulging list provides. Medicine is about people who care about helping other people coping with the challenges of living graciously. For that we need resources and time. Both are in decreasing supply and many inspectors are unwilling to say that the emperor has no clothes. Leave us to deal with the patients and tell the patients what the system can and cannot provide. You cannot make a silk purse out of a sow’s ear. That is what we are being asked to do. The inspection regimes are often sophisticated attempts to do this silk purse trick.
The inspectors have to deal with the fact that resources are limited and that requires political decisions to be made. Neutral quangos do not have the political mandate to make the necessary trade-offs. The policy makers, and the medical profession, has to decide on the role we ought to play. Are we the problem as has been alleged for almost 30 years and we have to decide to assume clinical citizenship roles in our hospitals and be where our rota says we should be. The decision must be made that either we can design services locally given our resources and demands or we constantly try to meet national targets and fail.
Mary Hawking
I agree: the Koegh report – even though, as expected, distorted, misinterpreted and misquoted by Jeremy Hunt – gives and excellent template for assessing Trusts which would be practical and helpful to the Trusts.
I just hope the CQC approach to other health and care organisations with lower political profiles such as care homes and general practices will be equally drastically changed and improved. (DOI GP retired 31.3.13 because of the Health & Social Care Act 2012)