Earlier this year, The Dean Neurological Centre in Gloucester, who support individuals with a range of neurological and spinal conditions, participated in a Provider Compliance Assessment (PCA). The assessment is designed to evaluate ongoing compliance with quality regulations and standards and was part of a wider review of all Elysium sites providing specialist tracheostomy and ventilator care.
In this EveryExpert article we speak with Aidan Davis, Head of Clinical Services at The Dean, about how they ensured the learnings from the visit benefited the whole team and why personalisation is at the heart of quality care.
Ensuring ongoing clinical compliance
The PCA is a thorough and detailed review that deep dives into the workings and processes of complex care, through the key themes of clinical documentation, evidencing care provided, accountability and assurance. Aidan Davis,
Head of Clinical Services, shares how the PCA plays an important role in ensuring ongoing clinical compliance.
Aidan says: “The purpose of the PCA is to replicate what the CQC would do if they came to inspect the service, to mirror the CQC’s framework, and to see how the service has responded to its most recent feedback from the CQC. This ensures that the visit is as meaningful as possible and generates an action plan so that we always maintain a high-quality standard of care. We are not looking for the service to be perfect, these visits are more about checking that our quality standards are always being met and that agreed actions are being adhered to, while demonstrating a commitment to continued development and improvement.
“The PCA is about thoroughly checking what we are doing and how we are communicating that across the team. Best practice isn’t something that is just achieved once at the point of an official CQC inspection, it is something that is worked on continuously, by a whole team. At The Dean we have a team of 184 staff, and we deliver complex care, including tracheostomy and ventilator care. The individuals we support have a wide range of physical needs, and the care we provide uses multiple devices and external equipment to keep them well, so it is vital that we rigorously check the quality of our care on an ongoing basis.”
Benefits of in-person assessments
The PCA team spent two days on site at The Dean, interacting directly with the team and reviewing the quality systems currently in place. Here Aidan explains the benefit of regular in-person checks to avoid complacency and maintain stringent quality standards.
Aidan says: “We have always prided ourselves on our local governance processes, but the visit allows us to really scrutinise our audits and look objectively at what we are auditing and the value of this. Are we asking the right questions and what impact do those questions have on the care we provide? Sometimes objectivity is hard to achieve day-to-day so setting time aside to focus solely on the quality of the checks we have in place, plus get the opinions of the external assessors, is very beneficial.
“External assessors ensure we are keeping up with best practice and policy – they bring with them a wealth of experience from across different services, and it helps to benchmark The Dean against their expectations and share good practice from other sites. We have regular online meetings with clinicians from across different services in Elysium, but as beneficial as they are, nothing can replace one-to-one interaction and feedback or in-person assessments.
“The PCA visit is also very beneficial for new team members and those in the wider leadership team who have not yet had exposure to external compliance visits, such as the CQC or our Local Authority. It’s very helpful to have practice and get increased exposure to external reviews – we always tell the team that if you’re asked a question, then there’s no wrong answers just explain what you do and why.”
Sharing feedback
During the PCA, the quality of The Dean’s auditing, plus the quality of the care being provided, were reviewed side by side, and both aspects received detailed feedback.
Aidan explains why sharing the feedback in an unedited form to the whole team was important to fully embed the learning from the process.
Aidan says: “If feedback is edited by the leadership team, then it adds an extra layer of interpretation and subjectivity to our results, which is not want we wanted. Our wish was for the whole team to receive the feedback as a group, each in the same way, so that we could come together as a team, collectively consider our results and then move forwards together while also offering the opportunity to ask questions.
“We felt this was important to do because I believe that hearing a message first-hand is better than it being passed on to you diluted or slightly changed, with everyone’s interpretation of feedback always varying based on their experience or role. It also helps to see the feedback within the wider context – sometimes we are only used to receiving personal feedback but seeing ourselves as a whole team, and understanding how we function as a group, is essential in making improvements.”
Responding to feedback
In response to the PCA feedback, the leadership team at The Dean created a detailed action plan, and Aidan shares how this plan is being implemented by ensuring that all team members get access to in-person support.
Aidan says: “Since receiving the results of the PCA visit we’ve implemented a thorough action plan. Some of these action points were easy wins, such as using alternative paperwork or working differently with our current technology to improve efficiencies. Other actions are ongoing because we’re focusing on creating changes in our approach to practice, and this will take more time in order to see sustained change.
“For example, we are holding care review meetings, with all team members. To ensure all staff get an opportunity to attend in person we are meeting each week on different days, at different times, sometimes at night so we can meet with the night staff. The meetings are a forum where people can ask questions or discuss case studies, and this is so much more productive than online communications or one-sided information delivery. Each person has a chance to contribute if they wish and ask questions, so we are improving understanding of how and why we are doing things as well as seeking ideas of feedback about what is working well.
“We also use the meetings as an opportunity to check in on everyone’s knowledge of our electronic systems, ensuring people are comfortable in what they have to document and why. Our documentation training is now treated as mandatory and we’re making really good progress towards ensuring 90% of our staff as a minimum have had this training.”
A tech-first team
More efficient documentation through the use of technology is an ongoing focus for The Dean and Aidan explains how the results of the PCA have prompted them to change parts of the interview process for new recruits.
Aidan says: “We are increasingly using technology as part of the complex care that we provide, and it is imperative that our staff feel comfortable using a tablet or a laptop to document care. So, we now review IT skills as part of the recruitment process, with a short exercise to complete some basic instructions on a computer.
“Challenges with IT can be a barrier to training and completing e-learning for teams, but also day-to-day tasks and recording care effectively. Many potential candidates have good IT skills if it involves using their smart phone to complete tasks, but in a clinical setting we need them to be more proficient in their IT skills. Being aware of any accessibility or IT issues at the earliest opportunity allows us to ensure staff are supported.”
Putting the resident’s experience first
As beneficial as the PCA process has been for the team at The Dean, not every element of care can be captured objectively, and Aidan shares how the resident’s experience should always be prioritised, and how personalisation is at the heart of quality care.
Aidan says: “Although we’re making positive steps in our auditing and our efficiency, it’s essential that we continue to prioritise the resident’s lived experience of care. The softer side of care, so to speak. What does the care feel like to the resident? What is their experience? Quality of care is paramount, we must meet our standards and be compliant with our documentation, but we have to also ask ourselves, what is it like to live here? How personalised is the care that our residents receive? To our resident’s quality care is not often related to measurable outcomes, but how it felt for them.
“Some residents live here with us for longer periods, so it’s really important that they feel comfortable here and that their wishes are taken into account, including their thoughts and ideas on how to improve the service. It is imperative staff deliver resident care in line with residents wishes and care plans, which at times can be in conflict with what might be recommended.“Quality complex care is always about achieving the right balance – we must document what we do and ensure that all quality standards are met, but from the motivation that everything must be for the resident’s benefit. The PCA is a vital tool in achieving this balance across a large and diverse team and helps ensure that we continue to achieve positive outcomes for residents.”
Make An Enquiry
If you’d like to make a referral then please get in touch with us.
You can also visit each service’s profile page to find out more about what our EveryExpert approach to care looks like in practice:
Adderley Green, Staffordshire
Badby Park, Northamptonshire
Garden & Jacobs, Hertfordshire
St Neots, Cambridgeshire
Stanley House, Herefordshire
The Avalon Centre, Wiltshire
The Bridge, Middlesbrough, Wiltshire
The Dean, Gloucestershire