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Mike Richards: Ratings in the hospital inspection programme


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  • 1. Ratings – A key part of the new CQC hospital inspection programme Professor Sir Mike Richards Chief Inspector of Hospitals November 2013 1
  • 2. Our purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care 2
  • 3. Asking the right questions about quality and safety Safe Effective Caring Responsive to people’s needs Well-led 3
  • 4. Ratings in the new hospital inspection programme • Rationale for ratings • The task • Proposed approach • Making judgements • Some examples to ask for your views 4
  • 5. Rationale for ratings • The public want information about the quality of services presented in a way which is easy to understand • The approach taken by Ofsted is seen as a model, though we recognise that hospitals are more complex than schools. Patients/public may, for example, be interested in a particular service (e.g. maternity or frail elderly care) rather than a single global rating • Ratings of services and of Trusts should hopefully be a driver for improvement 5
  • 6. Ratings: Proposed approach (1) • A four point scale will be used for all ratings • • Good • Requires Improvement • • Outstanding Inadequate Ratings will always take account of all sources of information • Intelligent monitoring tool • Information provided by Trust • Other data sources • Findings from site visits • Direct observations • Staff focus groups • Patient and public listening events • Interviews with key people 6
  • 7. Ratings: Proposed approach (2) • Bottom up approach: Rate each of the 8 core services on each of the five key questions (safe, effective, caring, responsive, well led). • Then rate the Trust as a whole on the five key questions, including an overall assessment of well led at Trust level. • Derive a final overall rating. • Note: Where Trusts provide separate services (e.g. A+E or maternity) on different sites we will attempt to rate these separately 7
  • 9. Safety Data/Surveillance Direct observation • Never events • Safe environment • Serious incidents • Safe equipment • Infections • Safe medicines • Safety thermometer • Safe staffing* • Staff survey (selected items) • Safe processes • Safe handovers • Safe information/records 9
  • 10. Effectiveness Data/Surveillance Direct observation • HSMR • Management of the deteriorating patient • SHMI • Care bundles • Mortality alerts • Pathways of care • National clinical audits 10
  • 11. Caring Data/Surveillance Direct observation • Inpatient survey • Staff/patient interactions • Cancer patient survey • Comfort rounds • Friends and Family Test • Patient stories • Response to buzzers 11
  • 12. Responsive Data/Surveillance Direct observation • Waiting time standards • Patient reports • Cancelled operations • Translation facilities • Ambulance stays • ‘Comfort factors’ • Analyses of complaints (e.g. TVs, seating areas, rooms for parents) 12
  • 13. Well-led Data/Surveillance Direct observation • Staff survey (7 items) • Interviews (CEO, MD, DoN etc.) • Staffing levels • Focus groups • Sickness rates • Board/ward interactions • Flu vaccination rates • Staff reports (e.g. of bullying) • Board minutes • Quality governance minutes • Mortality reviews • Handling/learning from complaints • Risk register 13
  • 14. Service: Maternity Positive findings Negative Findings Safe • • • • • • Effective • • • • • • Caring • • • • • • Responsive • • • • • • Well led • • • Rating • • • 14
  • 16. Trust X: Ratings Safe G G G RI RI RI RI RI RI G G G G G G O G I RI G G G G G RI G RI RI RI G G RI RI RI RI Overall RI G Outpatients RI G End of Life G RI Peadatrics G RI Maternity G RI Critical Care RI G Surgery Caring G Medicine Effective RI Accident & Emergency Responsive Well Led Overall RI G RI RI RI Key O Outstanding G Good RI Requires Improvement I Inadequate UA Unassessable 16
  • 17. Judgement 1: Medical Care, Trust A • Medical care was found to be good on almost all wards, with audit data showing good clinical outcomes • However, one ward for frail elderly was understaffed and had a high incidence of pressure ulcers and falls How would you rate this service? 17
  • 18. Judgement 2: Surgical care, Trust B • Trust B had 5 ‘never events’ over the past year (somewhat above average for a Trust of this size). All related to retained swabs. • The inspection team reported that the Trust has taken this very seriously. The WHO surgical checklist has now been fully implemented and an open, learning culture in theatres is now evident. • Surgical outcomes are otherwise good and patients report that staff are very caring. How would you rate this service? 18
  • 19. Judgement 3: Caring, Trust C • The inspection team observed multiple staff/patient interactions indicating high levels of caring. Several patients at the listening event also reported positively on the caring behaviour of staff. • However, results from the inpatient survey indicate that this trust is in the lower quartile in terms of patients’ experience of care. Howe would you rate this service? 19
  • 20. Judgement 4: Paediatric A+E services, Trust D • Adult A+E services at Trust D were judged to be good on all domains (safe, effective, caring, responsive, well led). • Trust D has no consultants in A+E trained in paediatrics and very few nursing staff are trained in paediatric resuscitation. • Care for children once admitted was judged to be good/outstanding. How would you rate (1) The A+E service (2) The paediatric service? 20
  • 21. Judgement 5: Non clinical services, Trust E • Trust E has good or outstanding ratings for all 8 core services. • The Trust was recently found to have poor hygiene in its kitchens by environmental health inspectors. • The Trust management was horrified that they had not spotted this for themselves and had immediately rectified the situation. They were very open about this at the time of the CQC inspection and appear to have learnt from this experience. Q: Should this incident affect the Trust’s rating? 21
  • 22. Trust X: Ratings Safe G G G RI RI RI RI RI RI G G G G G G O G I RI G G G G G RI G RI RI RI G G RI RI RI RI Overall RI G Outpatients RI G End of Life G RI Peadatrics G RI Maternity G RI Critical Care RI G Surgery Caring G Medicine Effective RI Accident & Emergency Responsive Well Led Overall RI G RI RI RI Key O Outstanding G Good RI Requires Improvement I Inadequate UA Unassessable 22