Managing quality in health and social care

Implementing a process for managing and improving quality

One of the most effective ways to manage quality in Irish social care is through auditing. Audits help identify areas where standards may be falling short and where improvements can be made.

Before diving into audits, reflect on your mindset:

Do you see audits as a way to catch problems or satisfy HIQA requirements?
Or do you view them as a tool to enhance the quality of care?

The latter perspective is key. While audits are essential for demonstrating compliance with HIQA standards, their true value lies in their role as a Quality Improvement Process.

Methods of quality management in health and social care

Various quality improvement methodologies have emerged globally, but in Ireland, the Health Information and Quality Authority (HIQA) provides the regulatory framework for assessing care quality. Their standards can be integrated into your audit process to ensure alignment with national expectations.

One widely used model is the Plan-Do-Check-Act (PDCA) cycle, adapted for social care. This cyclical model is particularly useful in Irish settings when paired with HIQA’s National Standards for Safer Better Healthcare or the Standards for Residential Services.

An adapted Plan, Do, Check, Act cycle for quality management in health and social care

Stage 1: Plan & Prepare

Preparation for a care audit as part of an ongoing quality improvement cycle:

Determine which quality problem you will audit, e.g. a known risk to people using services, or to staff, a high cost or high-volume activity, or incident or complaint trend
Agree the criteria and standards of quality you aim to measure against
Involve people who use services, and other interested parties, in setting your objectives, standards, and the processes you will use

Stage 2: Review Quality

Data collection to review quality may be quantitative, capturing numerical data, or qualitative, capturing people’s experiences, to check whether standards are being met:

Determine the data you need to understand whether you are meeting the standards identified, e.g. to check nutritional care, one might use the criteria ‘All staff assisting people with their meals must have appropriate training to ensure people are given the time, help and encouragement they need to eat the food provided’
Prepare appropriate data collection form or system, and pilot before use
Collect the data
Analyse the data, to determine whether or not you are meeting the standards set, and if not, why not

Stage 3: Improve practice

Understand where and why performance is not as good as it should be, agree how it can be improved, and develop and implement changes:

Discuss the results with all those affected and develop a consensus on what needs to change, e.g. in the case of nutritional care, you might find that few staff have appropriate training and agree that the organisation should ensure staff are trained relevant to their role
Agree how to address all issues identified, taking into account what is likely to be effective, feasible and affordable
Prepare an action plan to address the issues, using a variety of methods designed to achieve better compliance – such as training, protocols, checking systems, e.g. in the case of nutrition, appetising food, provided in an environment conducive to eating well
Identify those responsible for making sure that each required improvement action happens
Implement agreed changes and ensure people take responsibility for the actions assigned to them in the plan

Stage 4: Sustain Improvement

Everyone with responsibility must ensure the changes they make lead to improvement, by reviewing changes over time in order to sustain them:

Integrate approaches to sustain improvements in the way the team, department or organisation works
Agree dates for further or ongoing review or data collection, considering how long it will take for changes made to impact upon people using services
Review performance further when changes have been made and time has elapsed, repeating the review as required and appropriate for continual improvement
Make sure the benefits of care audit are experienced by the people who use the services, e.g. in the case of nutrition, this might mean comparing people’s nutritional status after changes have been made, to that at the outset of the audit

Why should health and social care providers use this model?

This adapted PDCA framework is probably the one care providers should use.

Other generic quality management and improvement methodologies, such as Sigma Six, can be used instead of or alongside PDCA, especially by larger care providers who 1. May have more mature quality management processes already and 2. Have larger datasets to analyse.

The issue with using models like Sigma Six for social care audits, is that they inherit many characteristics of the industries they were born in – typically manufacturing. There the focus is on making repeatable processes more efficient, stable and effective. Therefore, models like Sigma Six focus on setting a benchmark, before spotting and correcting deviations from this.

While this works on the assembly line, it is less applicable, or even desirable in social care, where the focus should be on quality, personalisation and individualised outcomes, with unavoidable variety between each person receiving and delivering care.

The future of care quality management and audits: easier, more reliable, more effective.

The development of cloud-based software is starting to pay dividends in the practice of quality improvement, including in social care.

One such tool; Access Care Compliance, closely mirrors the audit framework spoken about in this blog. It also comes ready with a library of proven care audits, while still giving you the option to create your own audits too.

This audit library helps make Stage 1 and Stage 2 in the process above much easier, because it does the job of determining the audit and information criteria for you, in line with the Care Quality Commission’s Key Lines of Enquiry.

Another really valuable thing Access Care Compliance does is to use the information from your own audits to create specific action plans, so you know what needs to happen to drive quality improvement, what has been done so far and what is outstanding.