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Healthcare Improvement Scotland

Quality of care review process

Quality of care review guidance
Healthcare Improvement Scotland

Diagram showing the 7 stages of the Quality of Care review process: Stage 1: Scope, Stage 2: Data, Stage 3: visit, Stage 4: Triangulation, Stage 5: Draft Report, Stage 6: Feedback, and Stage 7: Governance

The seven stages of the QoC review process

The guidance has been written with the expectation that a multi-professional approach will be taken. Areas to consider include the following:

  • How in-depth the QoC review is will be influenced by the scale of the review - clinical area or whole service
  • Local sponsor should identify staff with appropriate knowledge and skills, as required by the scope and complexity of the QoC review, to lead the process
  • Consider where it takes place – remotely or within a clinical area
  • Consider the governance pathway and final reporting
  • At any stage of a QoC review if a significant safety issue is identified use local escalation processes to ensure a timely response
  • Consider the methods to gather information – written, verbal and observational – to better understand the extent to which documented guidance/processes are implemented in practice.

 

Stages of the QoC review process

Stage 1 – Scope/commission of a QoC review

See quality of care review scope template.

  • When to undertake a QoC review – triumvirate leadership agreement for the commission
  • Proactive planned QoC reviews and at what level/scope?
  • In response to QoC concerns - criteria/triggers (incident reporting system, complaints themes/numbers, adverse event reporting, clinical judgement, signals in data – quality and workforce measures, staff survey/wellbeing, whistleblowing)
  • In response to a high performing team, in relation to QoC – to understand what are the key enablers, what is contributing to success and how this learning can be shared?
  • Who to undertake QoC review – seniority, clinical expertise, peer, external?
  • What do you need to understand, what questions are you trying to answer?
  • Consider how well you know your system? Record the understanding of those involved in the review on a Likert scale pre and post review
  • Who needs to be made aware of a QoC review – staff side, trade unions, pastoral support?
  • Consider timeline to undertake a QoC review and complete stages
  • Consider escalation and feedback routes and timescales
  • Consider final report writing and level of support required
  • Draft an agreement between the commissioner of the QoC review, the team/individual undertaking the review with the service lead which outlines the scope of the QoC review, including the details above and who to contact if additional support is required.

Stage 2 - Data gathering

See Quality of care data gathering template and using the Elements of the Excellence in Care Framework.

  • Identify relevant sources of data sets, aligned to the elements of the EiC framework and how to access, interpret and present (with data analysis support if required)
  • Identify local care assurance processes which can inform the QoC review and incorporate relevant information. This may include information collected using validated tools such as infection prevention and control (IPC) and person-centred care
  • Consider whether local care delivery aligns with local and national standards relevant to the clinical area
  • Identify consistent timeframe for data across quality and safety indicators
  • Review data to identify key themes – initial triangulation of quality and workforce measures
  • Note one off signals in the data and any trends over time
  • Identify areas for further questions - what needs to be asked, who do you need to speak to in the clinical area?
  • Consider any current system improvement work (is there any impact, consider systems thinking, interdependencies).

Stage 3 - CAV or peer review to clinical area

See Care Assurance Visit tool and Care Assurance Visit template.

  • If undertaking a CAV as a standalone process, Stage 1 – Commission of the QoC review process will help define the scope of the CAV
  • Preparation for host team
  • Engagement of staff at different levels, from different disciplines
  • Engagement of people in receipt of care and family/visitors
  • Observations of care (staff and patient interactions) informed by elements of EiC framework
  • Identify and consider information that will ascertain the culture of the area - 15 steps challenge, psychological safety
  • Consider the physical environment – noise, IPC, integrity of the fabric of clinical area and equipment
  • Consider use of other validated tools.

Stage 4 - Triangulation of qualitative and quantitative data

See Quality of care review data gathering template.

  • What are the root causes/contributing factors of any issues?
  • Are there factors that impact the wider picture?
  • Are there further questions to gain clarity, understanding and additional detail of local context?
  • Analysis - consider if support needed or other measures that are available
  • Identify key themes – areas of good practice and areas for improvement.

Stage 5 - Create a draft QoC review report

See Quality of Care review final report template.

  • Summary of the QoC review – who writes it, how detailed?
  • Recommendations and key actions/messages – for discussion with the team
  • What areas of good practice have been identified - where can this be shared?
  • What are the areas requiring improvement - who will take responsibility and how frequently will updates be required?
  • Final report following discussion with the team – who is this shared with? Governance and oversight of findings and recommendations.

Stage 6 - Feedback to clinical team

  • Consider when, how and who will be involved
  • Support requirements - line managers/chaplaincy and spiritual care/staff side
  • Improvement plan discussion and agreement
  • Consider how to thank the host team for engagement.

Stage 7 - Governance

  • Consideration of final report by appropriate group
  • Monitor progress to implement improvement plan.