When I think back on my experience of being inspected by the CQC, my first reaction is rarely positive. Whether it is the general anxiety about not being able to control the process or outcome, or if people the inspectors talk to will say the right things, or any of the other things that might go wrong – or specific memories of having to spend inordinate amounts of time and hard effort to rescue catastrophic consequences (the 30 years old ward that needs rebuilding to meet current space requirements; a potential Deprivation of Liberty scandal as a result of a misunderstood reference to a locked door by a new junior staff member).
What could we have done to improve the experience, and even make the inspections a positive experience (as the CQC would dearly like them to be, I'm sure)?
To me, the answer is straightforward, but it can be difficult to find the time and the focus to do it properly, and it needs people with the right skills to set the systems up. These are the things I wish I had in place in preparation for inspections.
1. Post-Francis, all organisations will have a much stronger focus on clinical safety, quality and outcome. To be demonstrably effective, this needs to be integrated into a culture of clinical/professional leadership and responsibility, backed up by policies at corporate and operational level, that clinical staff are familiar with, embrace, and can confidently articulate.
2. CQC Inspections tend to focus on things that are important; these should be important all year round, and be part of everyday management and performance focus, built into systems and reporting.
3. Mandatory training is crucial in ensuring that all staff know about important policies and procedures, the purpose of the organisation, and the role they play in it. Content of training should be constantly updated; all new staff should be able to demonstrate at tendance; annual refresh for all staff should be prioritised and enabled by accessible formats, and closely managed.
4. Cascading of information through Team Briefs etc should be timely, consistently scripted and delivered, and serve the purpose of being relevant to staff, and spreading best practice through the organisation.
5. Patient and carer information should be consistent across the organisation, as well as being regularly audited for being up-to-date in every sense from contact names and emails/phone numbers to changes in legislation and policy.
6. Part of the preparation for inspections should be to acknowledge where there will be issues (room sizes that no longer comply with best practice, poor staff survey, high staff turnover etc.) and be prepared to address them directly.
These steps are based on my own experience and views. They will not guarantee a faultless inspection, but the confidence they give an organisation can make a real difference.