Case Study 5 - From development to implementation

Gillian McAuley, Nurse Director of Acute Service, NHS Lothian

The benefits of a national approach

In this case study, Nurse Director Gillian McAuley shares their experience in developing and implementing a ‘Once for Scotland’ care assurance approach, which is operationalised as the Quality of Care (QoC) review and Care Assurance Visit (CAV) guidance. She highlights the inconsistencies in care assurance approaches used across NHS Scotland, which led to the commissioning of these resources by the Scottish Executive Nurse Directors (SEND). This initiative was a collaborative effort between Scottish Acute Nurse Directors and the Healthcare Improvement Scotland (HIS) Excellence in Care (EiC) team, with participation from nurse directors, clinical representatives, and quality improvement staff.

This care assurance approach, which utilises existing national resources (e.g. EiC Framework, Quality Assurance System) ensures a consistent structure and language around care assurance, enabling shared learning across Scotland. The national endorsement of this approach was seen as a positive feature when the approach was implemented in NHS Lothian. When addressing concerns raised by an external organisation about a ward, the support from SEND and HIS contributed to the robustness and rigour of the process, assuring those involved of the care quality and safety in that ward.

“Then writing that up in the format that was in the document really helped me stay focused on the ask and come up with some sensible recommendations to feedback to the organisation. It was also helpful when feeding back to HIS as the report and methodology was in a structure that was recognisable as it had been agreed nationally, demonstrating the rigor of the methodology.

The standardisation of these templates was also highlighted as a positive factor in reporting and sharing review outcomes, particularly with national organisations such as HIS.

Implementation in NHS Lothian

Since developing this approach, this Nurse Director has commissioned and conducted a QoC review. This review was prompted by an external concern raised about one of the wards, leading to a comprehensive QoC review using all sections of the guidance to assure care. This also provided an opportunity to test the review process in a real-world context and familiarise the Lothian care assurance teams with the approach.

In another case, this Nurse Director was asked to lead a review of maternity services given concerns raised by internal and external individuals. This approach was especially useful in Lothian maternity services as a framework to review all aspects of care with a particular focus on the essentials of safe care. This review consisted of a table top exercise with key stakeholders in the service. Through this review, it was identified that there were “gaps in data collection, understanding systems, and processes of people” within this service. The review processes provided a framework for assessing the service in a triangulated way and advising on recommendations and actions.