Case Study 4 - A care assurance approach for everyone

Douglas High, Lead Nurse for Practice Development and Care Homes, NHS Forth Valley

Like many health boards, the NHS Forth Valley Practice Development Unit (PDU) recognised the need to update their care assurance governance post-Covid. Moving away from their previously used Care Assurance Visit (CAV) tools, which were seen as very prescriptive, quantitative and specialty specific, the EiC ‘Once for Scotland’ care assurance approach was seen as an opportunity to refresh and standardise their care assurance governance, and integrate it further into their quality management system.

“We had been looking for some time at refreshing our approach to care assurance visits in line with our Forth Valley Quality Management system which is still in early stages itself - our Care Assurance Visit programme has to meet our needs because our old model was starting to feel like it was no longer giving us assurance of quality- parts of our system had moved on and progressed, but our CAV programme still felt like it sat in a pre-covid era, which we know due to the pace of change was a very different landscape.”

Transitioning to a standardised approach

As the previous iterations of CAVs templates used in Forth Valley were unique to each speciality, the PDU felt that additional guidance was necessary in transitioning to the EiC tool which was designed to be applicable across health and social care settings. The team set up a development day to scope out the new tool and discuss relevant indicators of high-quality care in their context that could support completing the template.

Additionally, AHP Leads were included in the development day discussions.

“We wanted to take this opportunity of a refreshed programme to instil in our teams that Quality Assurance is for everyone, and therefore that our CAV framework isn’t just a Nursing and Midwifery tool that we are applying to AHPs - this is an NMAHP tool, designed by NMAHPs to cover the breadth of our services.
Leadership and culture work at every level in Forth Valley have been focused on making sure that we have a dynamic, supportive and effective NMAHP family. The NMAHP approach to Quality Management, and therefore care assurance, is key in this – it’s applicable to everyone. There’s still lots of work to do but there is progress everywhere.”

As a result of these discussions with the AHP leads, they identified that many of the AHP-led services had similar care assurance processes but these were not widely reported or shared with senior leadership. The multi-disciplinary design of the approach was received positively by the Forth Valley team and the AHPs were “really keen” to introduce the EiC CAVs into their governance.

After the development day, the EiC CAV template has been integrated into their existing performance management system, which displays quality indicators, safety metrics, and workforce information. Each element of the framework is given a RAG rating within the system to quickly display information, allowing to explore further details in the full report.

What's went well?

The EiC CAV guidance has been received positively by NHS Forth Valley staff. A key benefit was the dynamic interactions and meaningful conversations it encouraged with staff.

“The conversations have been in my experience really productive, and the feedback from our CAV support team has been positive. We would potentially never get the same depth of information if we hadn't asked the right questions - if we had stuck with our established, heavily quantitative CAV framework then we’d have nowhere near that richness of information and feedback from focussed conversations with staff. The psychological safety element of the CAV framework is absolutely integral to ensuring we have a valuable quality assurance programme, and not just something that ticks a box.”

In addition to facilitating rich discussions with staff, the CAVs empowered staff to escalate concerns identified during the visit.

“I think there is an element of our CAV programme which is about more than Quality Assurance, and about empowering Senior Charge Nurses, Midwives and Team Leads with another layer of intelligence, a fresh pair of eyes. In some cases, our SCNs have used CAV outcomes as a means of supportive data to escalate concerns or add weight to an ask for investment in improvements. CAV outcomes might help focus the local Clinical Educator’s efforts in one area rather than another for example”

In this way, the findings from a CAV can be used as evidence to bolster and justify suggested improvements to senior staff. Gathering patient and relative feedback as part of the CAV also went well, particularly in care settings where this was established practice. However, for community settings, such as district nursing and health visiting, which have not traditionally gathered this information, additional guidance around those conversations was required. With this support, community teams responded positively and engaged meaningfully with this aspect of the tool.

Next Steps

So far, the board has used the EiC CAV guidance to great success, demonstrating that a standardised approach to care assurance can be used across specialities and disciplines. Work is now underway to expand the governance to include the use of the Quality of Care review guidance:

“The next step is for us to explore the wider Quality of Care review and determine how this fits in to our system, what our flags, triggers and escalation points are for us to get there - it's an ongoing process. We’re at the point just now where we’re working on our QMS escalation and governance framework but it’s not yet perfect. I think Quality of Care reviews will play a key role in this as it evolves.”