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2016/2017 Project Activity

What are the characteristics of an inspection process that leads to improvement?

Iriss is currently collaborating in partnership with the Care Inspectorate to undertake a short inquiry project focusing on improvement. Our inquiry will focus on understanding the key characteristics of inspection processes that lead to improvement. This project has been designed to be short term and agile to help us respond to the experience and ideas of inspectors and providers.

Over the next three months, we will gather data and generate ideas in three ways:

1. Analysing existing inspection and improvement intelligence.
2. Internal scoping exercises including a staff survey.
3. Qualitative in-depth workshops with inspectors and providers.

In February and March, we will host two workshops with providers and inspectors to begin to understand and unpick the complexity of improvement. We will share the learning from these workshops in this blog and in a final written output.

By blending our own expertise in improvement with this engagement, we will learn about the mechanics and the magic of improvement and how to implement it across the sector.

A note from The Care Inspectorate:

“As part of the Care Inspectorates review of methodology, we have sought to develop approaches to scrutiny which support improvement.We have a specific duty under section 44 of the Public Service Reform (Scotland) Act 2010 to further improvement in the quality of social care services, and we do this in a variety of ways through our inspections.We need to be able to identify what aspects of care need to improve, and show how this can help evidence improved outcomes for people who use care services and their carers.

Partnership working is an imperative priority for the Care Inspectorate, and we are committed to collaboration and joint working. We embrace the opportunity to work in the most efficient and effective way possible, utilising knowledge, skill and expertise within and outwith the Care Inspectorate to bring about delivery of high quality services.

We are delighted to have the opportunity to undertake this piece of work jointly with Iriss and care service staff.

Our vision is that the people across Scotland receive high quality care that meets their need, rights and choices.”

– Linda Kemp, Project Lead: Methodologies

Article by Rhiann Mcleann January 20, 2017

 

Workshop 1 Overview,  February

My name is Rebecca Dodd and I work with Iriss as an associate researcher. I have worked on a number of public and third sector projects involving education, libraries, health and wellbeing, youth issues and the arts.   My role in the Care Inspectorate Project involves analysing a survey of Care Inspectorate employees and observing workshops held between Iriss and the Care Inspectorate and sharing my observations and conclusions.

The Workshop

On 1^st February 2017 I observed a workshop held at the Scottish Youth Theatre, between IRISS and a group of care professionals, 4 of whom worked for the Care Inspectorate (1 Project lead, 3 Inspectors) and 11 Managers and Team Leaders who worked across 6 different Scottish Care Homes, the majority of which focused on residential elderly care. The purpose of this workshop was to encourage dialogue between managerial staff and inspectors with the aim of establishing effective relationships between care homes and inspectors and continually improving services.

The first part of the workshop involved asking the participants to establish ground rules. Participants agreed that all discussions were to remain confidential. Everyone agreed that it was best to frame feedback from a positive perspective while remaining honest, and acknowledged the need to agree to disagree. Speaking one at a time and reflection was also an essential ground rule. All participants agreed that all members of the group needed to acknowledge each other’s mutual investment in care. I was pleased to see inspectors and frontline care professionals so eager to establish effective modes of communication.

Participants were split into four groups and asked to respond to the following questions:

Question 1: What worked when it came to improvement? (include actions from both inspectors and services)

Common themes included trust between inspectors and management teams, and involving all staff in care homes in the self-evaluation and inspection processes. Signposting good practice was universally regarded as a positive step toward improvement, as well as having clear direction; it was agreed that communicating specific requirements for improvement often resulted in quick wins, a sense of achievement and improved morale. All participants agreed that improvement plans needed to be realistic in terms of time and finances.

Question 2: What didn’t work? Why?

Challenges included poor attitude and power balance between managers and inspectors, as well as a lack of consistency with inspectors. Failing to recognise degrees of improvement, together with excessive focus on grades also were considered ineffective ways of creating improvement. Service providers agreed that inspectors need to improve their appreciation for changes to everyday services such as new, challenging residents or high staff turnover. I was pleased to see that inspectors seemed receptive to this suggestion. Further discussion led to both sides agreeing that external pressures from the Care Commission, Care Home Owners and Local Authorities were not helpful in sustaining improvement.

Question 3: Rank what worked in order of effectiveness

Positive engagement and cooperation both within care facilities at all levels and with inspectors was consistently ranked as the most effective means of ensuring improvement. Clarity of expectations and clear directions for improvement were also top priorities. Recognition of resources and limitations, together with realistic planning for improvement rated the third highest. Focus on success was also a focal point.

Conclusion

Participants were invited to give feedback on the workshop, and one participant suggested the use of My Home Life cards. These cards contain a picture, and participants selected which card best represented their impression of the workshop. For example, one person selected a picture of a tree and said that they considered the workshop to represent growth; another selected a compass and said that it represented her service going in the right direction. I had never heard of Home Life Cards prior to the workshop, and would recommend their use in any group as a fun and effective icebreaker to get everyone talking. Overall, this workshop was highly successful and sure to open more positive dialogue at our next workshop in March.

– Rebecca Dodd, February 20th, 2017

Workshop 2 Overview, March

On the 1^st of March, 2017, Iriss reconvened with the same group of care professionals from our last meeting in February. Everyone agreed that the last meeting had been productive and that all of the ground rules that had been set at the first meeting should be kept in place.

Defining Improvement

The first part of the workshop comprised of the challenging task of defining improvement.

At the end of the last meeting, participants were given the following activity:

We would like you to go back to your services and work with a group of people (which might comprise of people who use your service, staff, families, other management) to develop your own definition of improvement.

1. What would improvement look like to you?
2. What process would you follow to achieve it?
3. How would you know it was a success?

Approaches to the exercise varied. One person or group formed the questions into survey which they distributed. There were 11 responses, all from users of care services. The responses were limited; most were only a few words, with many omitting some questions.   The first question tended to get responses to the effect of “making things better”. The responses to the second question were broadly themed around getting effective people or organisations to make the improvement happen. The answers to the final question mainly consisted of improvements being seen.

Another group reflected on an initiative in their own service. They agreed that improvement meant having a sense of purpose, and a system of monitoring progress, while creating a happy and safe home environment for their residents. With regard to processes, the group agreed that connecting with residents, internal staff and looking at other services would achieve improvement. Success would be measured by contented residents.

After a short discussion of this activity, participants were then asked to work in groups to come to a consensus of how to define improvement, followed by a group discussion to see if a single definition of improvement could be agreed. Everyone agreed that improvement was not just about making things better, but that improvement needed to be defined by all stakeholders working together for a common purpose that results in positive outcomes and interactions that meet everyone’s expectations. Everyone agreed that improvement needed to be documented in a balanced and honest fashion for future reference.

Our final agreed definition is that:

Making improvements is about working together to achieve a shared vision that results in positive interactions and outcomes for people.

Survey Analysis

After these activities I gave a short talk on a survey I analysed of 67 people who worked in various roles in the Care Inspectorate. The findings were consistent with the findings of the last meeting. Survey respondents universally agreed that clear feedback with specific directions was the best way to encourage improvement, as well as maintaining positive, constructive and honest relationships between care homes, inspectors and external and internal stakeholders.

Group Activity

Delegates then divided into four groups and were asked to complete an improvement plan along the following four themes:

1. Trust between inspectors and services
2. Involving staff in inspection and improvement
3. Signposting to good practice
4. Understanding limitations (financial, bureaucracy, partners, etc)

This activity was guided by a worksheet that gave the following questions based on the Plan, Do Study, Act (PDSA) method of improvement science:

• What is the outcome you are seeking?
• What needs to happen?
• How should it be done?
• Who needs to be involved (roles)?
• Timings/duration
• How will you know it has worked?

Groups engaged very effectively on this activity, with a variety of themes emerging, including the need for all staff to be involved, and the need for time-limited milestones to be achieved. The findings from this activity will be further explored and used to create a guide for improvement for the Care Inspectorate.

Conclusion and Evaluation

At the end of the event, we invited participants to write their evaluation on post-its. Delegates enjoyed the opportunity to collaborate with people from outside their own services and the group discussions. In terms of what could have been better, delegates said that they would have liked more time to discuss themes and recap what they had learned. Several wanted future workshops, with many expressing an interest in a continued relationship with Iriss. Overall, this series of events was a positive way for care professionals and care inspectors to interact and share experiences and practice.

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2015/2016 Project Activity

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2014/2015 Project Activity

Iriss is working with the Care Inspectorate to explore the future of social services in relation to risk and innovation  using our Imagining the Future resource.

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