Case Study 2 - Assuring care in community settings

Quality of care review guidance
Healthcare Improvement Scotland

Using Quality of care reviews beyond Health Boards

Lead Nurse, Highland Council

This case study explores how a Quality of Care (QoC) review has been conducted out with NHS Highland, focusing on insights from staff from Highland Council staff. The Lead Nurse, who oversees community-based healthcare professionals was new to her position and heard about the approach through the webinar (A National Approach to Care Assurance: Quality of Care Review Guidance) and believed the resources would provide a structured method to assure nursing care quality.

The QoC review was conducted in a residential children’s home, prompted by an inspection report indicating a decline care quality in what was previously a high-performing environment. Led by an Associate Lead Nurse, and the review involved members of the multi-disciplinary team, including Nursing Managers and Social Work Leads. Feedback was provided in real time to staff informally, with a more formal report to be shared more widely across the organisation. 

Impact of setting

The context of the QoC review was noted as a unique combination of health and social care in a residential setting. The multidisciplinary team had varying levels of familiarity with healthcare structures and care assurance methods. The tool provided a common language and structure that could be shared and understood across the team regardless of discipline.

“It was a really good way to articulate what we were doing in a nursing sense to people who don't understand nursing.”

Given that the resource was designed for national use across all healthcare settings, the multidisciplinary leadership team were confident that it could be used in their setting. Although initially used in response to a concern about nursing quality, the leadership believed the resource it could be applied more widely across the nursing service within the organisation.

Outcomes of the review

An area identified for improvement during the review concerned the availability of data for care assurance purposes. While processes were in place to include the ‘child’s voice’ in care plans, there was no mechanism to collect data on this, making care assurance more difficult. This finding was also noted in violent incident reporting and complaints.

“The guidance is asking for data, improvement data, but there isn't any mechanism to gather that data. That tells us something in itself. […] we have learned through this process that we need to get a better system in place for audit and data collection.
In my role, I'm thinking about the whole service, not just this one.
So there's been a lot of learning for us on many levels doing this.”

The review revealed that this setting lacked established mechanisms for gathering essential data sets needed for care assurance and improvement processes. In response, the Lead Nurse has begun work to collate this data for use in future reviews.

Despite the challenges, the review highlighted many positives within the residential home. The Lead Nurse appreciated that the tool highlighted good areas of practice alongside areas for improvement. This helped ease initial anxiety about the review among the staff.

“This staff group were very anxious and very worried about a number of things because of everything that's happened.
So being able to use the tool to help us look for the positives, for me was great, because you worry about staff well-being at this time.”

The review identified examples of positive person-centred care and a strong culture of teamwork.

“Well, the positives were definitely that the nursing staff really cared about the families. And the frontline care was actually really good. We could demonstrate that it was really good team working as well.
So then when there was a crisis, they would come together and cover staffing. There's a real commitment to the care, that shone through. I think that was really important feedback for the staff, given that the centre had been assessed as being weak”

This case study demonstrates how this guidance can be used across health and social care settings in Scotland. While care assurance approaches may be more familiar to those working in health boards, this resource provides a shared language and structure that is applicable in a variety of settings and can used by professionals within a multidisciplinary team.