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CQC should assess 'culture' during inspections

The Care Quality Commission should focus more on the culture of the organisations they inspect and the “essential quality of care” provided and not just “easily measurable inputs”, an influential group of MPs has said.

The Commons’ health select committee today published a report on the healthcare regulator. It is the second in a series of annual reviews.

It concluded there were still issues with the regulator’s consistency of inspection judgements, use of resources and clarity of purpose.

The committee called on the CQC to undertake an open consultation on its methods, which should include asking how inspectors could assess the prevailing culture among staff within individual care providers.

Committee chair Stephen Dorrell said: “An inspection should be much more than a review of facilities and records. It should include an assessment of the quality of the professional culture within the organisation.

He added: “Care providers need to show they have robust procedures which foster a culture of challenge and response in which the requirement to recognise and address service shortcomings is a standard process for all staff in pursuit of their professional duties.”

The committee welcomed the CQC’s recent introduction of a bank of clinical advisers who can be called in to help with inspections.

However, it noted that only 13% of inspections had drafted in one of these individuals since the facility was introduced.

The MPs also called for an “overhaul” of the CQC’s governance structures “as a matter of urgency” to provide proper “strategic direction”.

The report vindicated a CQC non-executive director, Kay Sheldon, for contacting the Mid Staffordshire Foundation Trust Public Inquiry with her concerns about how the regulator was being run in late 2011, describing her concerns as “legitimate”.

Mr Dorrell said: “It is regrettable that [Ms Sheldon] felt compelled to approach the Mid Staffs Public Inquiry to secure a hearing for her concerns.

“It is essential that the CQC reforms its culture and working practices to address these shortcomings.”

Last year was a turbulent time for the regulator’s leadership. Its chief executive, Cynthia Bower, resigned in February on the same day that the Commons health committee published its first annual review of the regulator.

Its chair Dame Jo Williams resigned in September. She had faced calls to go since she tried and failed to have Ms Sheldon sacked.

In response to the report, current CQC chief executive David Behan said the regulator had already held a strategic review, which had included consulting widely on a “clear statement of our purpose and role”.

“We also set out our intentions to tailor the way we regulate different types of organisations based on what has the most impact on driving improvement. We will put people’s views at the centre of what we do,” he said.

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “We know that the culture of healthcare organisations cannot be regulated, however, we agree with the report that the CQC can play a vital role in ensuring that organisations support staff in raising concerns without fear of retribution.

“We look forward to continuing our work with the CQC in this area to make sure staff are fully supported.”

He added: “It is significant that the CQC is now giving attention to the importance of staffing levels and highlighting the effects of inadequate staffing on patient care.”

Readers' comments (20)

  • michael stone

    I've gone on about the difference between 'sensible measures' and 'easily measurable measures' before ! The NHS seems to regard only 'countable things' as being important - not true, even if assessing hard-to-measure things is much more difficult.

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  • michael stone

    I've commented about the difference between useful metrics and easily measurable metrics, before.

    The NHS seems to normally only bother to consider those things which are 'easily countable' and pays much less attention to other 'harder to measure' things, which are in some cases more important !

    This introduces a sort of 'analytical/conceptual bias' into the analysis of NHS issues - not very helpful !

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  • michael stone

    Grr - site crashed and appeared to have not posted my first comment, then after I'd typed and entered the second, both appeared !

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  • the intangible in nursing care is just as important as the tangible as is intuitive thought as much as deductive reasoning.

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  • tinkerbell

    Anonymous | 9-Jan-2013 10:51 am

    well said. We need to be able to 'sense' as well that something is not quite right and use that inner teacher to keep our eyes open to see so that we can observe what is going on around us that might give an indication that all is not as it might seem on the surface. It's about remaining alert and nipping things in the bud.

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  • Is it implied in the report that the CQC still has not got adequate resources. I see the private sector itching to get in like Ofsted.

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  • tinkerbell

    Perhaps a few more nurses like Terry working for them would help.

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  • looks like cqc need to engage deeper and more effective critical thinking skills.

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  • why wasn't this being done in the first place?

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  • I am Canadian and going through the same.......
    As said about easily measurable vs. less easily....
    Worked for 2 decades with staff that knew of my mental illnesses and managed to almost complete PhD...
    until moved hospital and voluntarily disclosed......I am in the process of being investigated....a nurse I had after cholecystitis from my old hospital said you were always the "go to nurse".......
    The Positive-I lived and worked in an amazing environment for over 20 years, then no-but has led me on a crusade to change mental health for health care professionals in all aspects..Patch (Dr. Adams) sent disciplines right out of our magazine...I will be polite and not tell you his reply.
    NURSE/KATE MIDDLETON-likely dysthymic or some level of depression, but as a previous researcher and educator and nurse.....I believe this statistically could be proven to be the cliff to suicide.I know .......
    I received my documentation from the College of Nurses 2 weeks after an intensive long program IMAP(integrative mood and anxiety)-I was feeling better than I had in 2 years-ready to take on all that life had to offer, then I opened that document. I can not tell you how that affected me. I can not describe.......

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  • Rather slow to notice the need for cultural assessment but at least its a start. What I do not trust is that staff will be able to be honest during these assessments without knowing they will be nebulised in the next org restucture. Today, you are not sacked for raisng concerns, there is a time delay and then you disappear! Nurses know this!

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  • Nancy,

    We are all here for you
    If I lived in Canada and I fell ill...
    I would want you to nurse me

    I will prey for you

    Love you lots

    PDaveANGEL

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  • ///

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  • Yes But

    Anonymous | 9-Jan-2013 1:07 pm

    Yes, the problem is protecting staff who raise concerns about 'behaviour created by higher management' from being victimised by that higher management, if they challenge behaviour that looks wrong - this is very different from ad hominem or person-specific, concerns.

    It needs a system, so that the person who raises the concern, has to be engaged with, but cannot be 'punished' by his/her employers. In other words, perhaps a system that allows for concerns to be raised via 'neutral 3rd parties' ?

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  • The CQC are in my view not fit for purpose. They have spread themselves far to thin and do not provide a service which the general public can rely on.

    When Dr Carter says that “We know that the culture of healthcare organisations cannot be regulated, however, we agree with the report that the CQC can play a vital role in ensuring that organisations support staff in raising concerns without fear of retribution", l have to ask the question, if the RCN do support this philospohy, then why did they not do more to support their members in Mid Staffordshire, when they were in trouble.

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  • maybe I need this mini-mental test after all. When the title above caught my eye I read 'asses' and had to read it again!

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  • indeed there is a time delay . . . then you . . . dissapear. I stood up to my deputy manager when she personally verbally attacked me. I was then accused of being aggressive! I cannot stress how important it is to have an RCN membership. The RCN Regional representative was a huge support and was aware of this happening across the organisation. I wasn't alone. others were going through similar difficulties too. After various meetings with management it became clear that it was an attempt to constructively dismiss me / forcing me to resign. Either way my hands were tied. Management could not be specific with their concerns, they simply said other collegues were carrying me - erm we all carry each other it is after all 24 hr care that is provided, it's called team work. There had been many shifts were I had worked alone, I should've reported it but didn't. I also worked half a night shift until bank staff arrived. There has been a significant change in values, culture and professionalism during the last decade. Management have to some degree a judgemental and aggressive attitude towards their staff and discuss this openly in the staff room with their clique. They judge a book by it's cover, ignore their peers practice and bully the nurse's who are deemed as being 'too nice' . . . this was actually said to my face. . . I hate to say it, but it has to said these people ruin the reputation of those who are professional, caring and kind. . . that is after all what nursing is about . . or am i missing something?

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  • tinkerbell

    Anonymous | 13-Jan-2013 8:28 pm

    it's hard but hang in there. When i first qualified as a psyche nurse in 1990 i was told by my senior manager that i was 'too soft' to be a nurse. He use to tell us to restrain patients who wouldn't take their meds because it would 'teach them a lesson'. His mentality was it was 'them and us'.

    He tried to make my life a misery and took me and my manager to a room after my late shift one evenng to 'interrogate'me about my 'attitude' and how 'others had concerns about me too'. It was all pretty vague. After the meeting my ward manager apologised to me about what he had said to me. Of course it wasn't true but he was out to get me cos' i didn't fit his clique and mentality of abusive nursing.

    He was eventually disciplined because he physically abused a patient who put in a complaint about him dragging her across the floor by her hair and then we wrote statements supporting our concerns. He was moved 'sideways' as they call it.

    Another institutionalised nurse told me my problem was 'you care too much'.

    Well i would much rather be me than them.

    In some respects i am glad that i had this experience early in my career as it mentally armed me that there are a minority of staff who will try to undermine you anyway they can because they are 'jealous' and also very inadequate personality disorders. I was stunned at the time that so called 'adults' could be so cruel and unkind to one another in a so called 'caring profession' but it certainly opened my eyes and now i am much wiser for the experience.

    Don't let the bastards grind you down.

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  • I was told by a nursing officer on my first post-qualification job that i was unsuited to nursing. since then I have followed my dream and had a 30-year glorious nursing career outside the UK.

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  • We must relearn how to practice basic kindness
    JORDAN GRUMET, MD | PHYSICIAN | JANUARY 15, 2013

    The dictates of human kindness are fickle.

    The eruption of papers fluttered to the linoleum floor of the bustling hospital corridor.  Important persons with grey pressed coats and stethoscopes bouncing against clavicles rushed by without rotating necks downwards to notice.  Loosely fitting scrubs clung to contracting muscles, and pudgy abdomens directed bodies hurriedly around the corner with a misplaced sense of purpose.


    And the poor woman bent down helplessly, and struggled to collate the papers that had once fit nicely into her carrying case.  Was she a hospital administrator? A researcher?  A family member, back from the library, trying to study up on her loved one’s illness?

    No one took the time to find out.

    A transporter pushing a gurney sped by and trampled an errant artifact that had flown away from the safety of the herd.  The women wiped the sweat off her face, and blotted a tear with a crumpled hankie.

    I was no less guilty.  A few steps past, my mind swirling with one patient conundrum or another, I stopped mid-stride.  I turned around and silently knelt toward the ground.  I gathered what was left on the floor and feebly handed it to the struggling woman.  She looked up with injected conjunctiva and smiled anemically before I raised from the floor and moved on.

    Am I any better?  I have given myself a pass.  I have used the nobility of a profession to deny the basic humility of grass roots kindness.  How many times have I refused a donation to some odd cause or another by thinking, “Haven’t I given enough?”

    Yet there is a strange lightness of heart that comes from the unrequired act of selflessness.

    We health care professionals must remember that it doesn’t take years of education or fancy gear to help our fellow man.

    We must relearn how to practice basic kindness.

    Jordan Grumet is an internal medicine physician



    January 21, 2013
    MEDPAGE TODAY | NEWS

    MedPage Today Professional


    Terms of Use | Disclaimer | All Content © Kevin Pho 2012 site by Out:think Group

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