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Using the 6Cs as a competency framework

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As a set of values the 6Cs have resonance for many working in a range of health and care settings, with many people choosing to adopt them as a set of behaviours they display and aspire to.

Sarah Gunter and Donna Reeves

However, increasingly the 6Cs Live! team receives case studies from entire departments and organisations adopting the 6Cs and establishing quality models with robust measurement and quality reviews with the values as a framework.

Donna Reeves, Lead Nurse and Sarah Gunter, Lead Allied Health Professional in the Community Health and Wellbeing Directorate and colleagues at Coventry and Warwickshire Partnership NHS Trust, exemplifies this approach, putting in place a peer-review model to embed the 6Cs values in clinical practice across the directorate.

Teams led by Donna and Sarah fully embraced the requirements under Commissioning for Quality and Innovation (CQUIN) and developed a model using the 6Cs as a competency framework based on unannounced observational peer reviews into its own services.

Caring for frail elderly patients

The focus was on frail elderly patients, with the aim of seeking assurance that they were safe and care was of a high quality. The model also sought to ensure that the 6Cs were at the heart of everything they did and that best practice was shared with support in place for where they were not fully understood or embedded.

Donna explained what the challenges were: “Apart from finding time, as each review takes a day and usually another two to write a thorough report, we were challenged with securing stakeholder involvement and though this proved difficult at the beginning, we succeeded and now have GP and service user/patient representation at our reviews.”

“We designed non-prescriptive question sets based around the 6Cs and aligned them to our safety and quality agenda. We sourced review teams which included clinical and non-clinical colleagues from inside and outside our own Directorate,” she added


The journey began with setting milestones:

  • agreeing the terms of reference for the peer review team (including membership);
  • deciding which services to review, arrange two pilot reviews and decide number of reviews per quarter.

The team then sought to clarify the governance framework to ensure any immediate risks were able to be escalated appropriately and resulting action plans could be implemented, monitored and reported. They also decided what the programme of work looked like for the remaining quarters of the year and sourced review teams.

Rolling out the pilots

Between July and September 2014 the team revised the processes in light of learnings gained from a set of pilots held with the local Clinical Commissioning Group. Reviews started in July with the understanding that any revisions to the process would be made later in the year.

Peer reviews took place from October to December. The result was a report outlining issues identified and actions taken to change behaviours and culture and a service specific action plan with the result that service-specific improvement plans were developed.

And the work doesn’t stop there. A programme of peer reviews also ran from the start of this year with and evaluation of the impact to follow. The impact the reviews already undertaken already had were demonstrated as were learnings and changes to practice. Here are just a few quality improvements being shared across the Directorate and the Trust.

  • A health care assistant is currently undertaking the Assistant Practitioner course which will allow the nurse manager and team to review skill mix and roles and responsibilities.
  • Laminated diary-sized cards detailing safe lone working processes (Red Folder Process) are now available to all lone workers in the Directorate. The Trust Safety and Quality department are looking at rolling this out across the organisation.
  • Increased and robust incident reporting across the Directorate has identified trends which are discussed/monitored at local monthly safety and quality meetings and the Directorate Safety and Quality forum.
  • The Directorate now has a generic safety and quality agenda, which is being used by all clinical services.
  • The Directorate now has a risk management flowchart to help teams in understanding escalation processes and the Directorate/Organisational approach.
  • The 6Cs were reproduced on white boards and laminated onto desktop PCs as a way of encouraging staff to think about them in everyday practice.

Donna added: “We have now done 16 reviews, one of which included the CCG’s Head of Patient Experience. Most have either GP/service user representation (or both). A report summarising the findings for each of the 6Cs was developed following each review, then shared across the directorate through the Safety and Quality forum.

“We used incident reporting data, team performance reports, risk register, as well as formal complaints/compliments. The impact of changes is measured via service action plans/action tracker and is reported at Trust Board and the CCG.”

She said the Trust will continue these reviews as people have become to expect them – part of the process of becoming embedded.

“The 6Cs have become a focus of our quality goals now and that will continue. Best practice sharing has created positive change and improved patient care by facilitating reflection amongst our clinicians on their consultation styles which will make for a better, more compassionate patient experience where this is needed,” she added.

Marie Batey, Head of Acute and Lead for Compassion in Practice said: “This initiative, with its robust implementation planning and measurement, has the potential to transform the care provided to frail elderly patients. It really is an exemplar for other Trusts and organisations to study and adopt in their own settings.

“While the values embodied in the 6Cs are at the core of these peer-to-peer reviews, it is also encouraging to see partnership working in action - with both the Trust and the CCG playing their role in ensuring patient care is as good as it can be.

“I wish the project future success and encourage other Trusts to find out more and whether the lessons learnt here have relevance in their own organisation.”


Do you have a 6Cs in Action story?

If you would like your team to be considered for 6Cs in Action - featured on Nursing Times and the NHS England website - you can view the criteria and submit your story on the 6Cs website


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