O-22 Cqc requires improvement to outstanding in one year: a hospice journey

Background Inspected in February 2016 the hospice achieved an outstanding rating for Caring and requires improvement for four other key lines of enquiry, Safe, Effective, Responsive and Well-Led, including three breaches of legislation. A new leadership team had been in place for a short while and had already identified an action plan and programme for improvements. Aims There was a lack of audit, quality assurance and governance within the organisation. Reporting of incidents was underpinned by a blame culture which acted as a barrier to incidents being reported, leading to a lack of learning and accountability. Longevity of service amongst some clinical staff created an environment that was resistant to change and a lack of recognising the need to improve and monitor practice. Method A priority was to recruit to key posts including a new Registered Manager and Head of Information and Quality, a team who had the knowledge, skills and ability to engage clinical teams in the change process. Education sessions were carried out to explore how to use incidents as learning experiences to implement changes to practice and improve accountability. A new competency framework was introduced. An audit and research group was set up to facilitate audit becoming routine practice. Quality and data spot checks were carried out monthly. A clinical management team regularly reviewed policies and guidelines in line with legislation and national standards. Improvements were underpinned by improving the patient/carer experience and outcomes: Advance Care Plans, Patient Centred Goals, and Preferred Place of Death. There was investment in workforce wellbeing: clinical supervision, Schwartz Rounds and a representative group. Outcome Inspection in February 2017 achieved ‘Outstanding’ in Caring and Responsive, ‘good’ in Safe, Effective and Well-Led. Overall achieved outstanding, and a delighted workforce. The inspectors noted ‘impressive improvements and a learning culture throughout the hospice’.