Commissioning for Quality Assurance and Improvement using an Appreciative Enquiry Approach ...

119 Pages·2015·1.54 MB·English

by  Emma Carling

Commissioning
for Quality
Assurance and
Improvement
using an
Appreciative
Enquiry
Approach
Policy/Procedure
December 2014
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South Yorkshire & Bassetlaw Commissioning for Quality Assurance and
Improvement using an Appreciative Enquiry Approach Policy/Procedure
December 2014

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Contents
1. Introduction ......................................................................................................................... 5
2. Purpose ............................................................................................................................... 6
3. Scope .................................................................................................................................. 6
4. Accountabilities and Responsibilities .................................................................................. 7
5. Procedure ........................................................................................................................... 8
6. Distribution and Implementation .......................................................................................... 9
7. Equality Impact Assessment ............................................................................................... 9
8. Associated Documents ....................................................................................................... 9
9. Policy review ....................................................................................................................... 9
10. Version Control Tracker ................................................................................................. 10
Appendix 1- Quality Assurance Framework ............................................................................. 11
Appendix 2 ............................................................................................................................... 16
a) Risk Assessment .............................................................................................................. 16
c) Risk Profile ........................................................................................................................ 22
d) Risk Threshold Matrix ....................................................................................................... 24
Appendix 3- Toolkit .................................................................................................................. 25
Appendix 4 – Confidentiality Agreement .................................................................................. 99
Appendix 5 – Equality Impact Assessment ............................................................................ 101
Appendix 6 Principles for managing quality in specialised commissioning including the RASCI
template ................................................................................................................................. 108
Glossary ................................................................................................................................. 118
References ............................................................................................................................. 119

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1. Introduction

1.1. South Yorkshire and Bassetlaw (SY&B) Area Team and its constituent Clinical
Commissioning Group (CCG’S) are committed to achieving high standards of patient care for
the services it commissions. Furthermore, ensuring high standards of care is one of the core
values within the NHS Constitution (DH 2013) and therefore places a requirement on all
providers of health care to strive to deliver high quality and safe care to patients. In addition,
commissioners of health care have an important role in securing continuous improvements in
the quality of services provided to individuals. Improvements will be measured in terms of the
actual outcomes achieved for patients including those that show the effectiveness of the
services being provided, the safety of the services being provided and the quality of the
experience undergone by patients. The National Health Service Act 2006 (as amended by
the Health and Social Care Act 2012) also places a duty on the NHS England to exercise its
functions effectively, efficiently and economically and a duty as to the improvement in quality
of services provided to individuals. Clinical Commissioning groups (CCGs) are also under a
duty to assist and support NHS England in discharging its duty so far as relating to securing
continuous improvement in quality of primary medical services. CCGs are also under a
similar duty as to improvement in quality of services. The principle of collaborative working is
embedded to understand and support the quality improvement agenda across South
Yorkshire & Bassetlaw with CCGs and the Area Team working in partnership to ensure high
quality provision across the area and in it wider commissioning responsibilities.

1.2. Gaining Quality Assurance, places Commissioners in a specific dilemma, over how far they
should check and validate Quality data and how far they should trust Providers to make
available the Assurance as part of the contracting processes. The (Mid Staffordshire Inquiry
2010) exposed a number of failings for both providers and commissioners in how they gain
assurance that high quality care is being delivered to patients. More recently the lessons
learned following the review into the quality of care and treatment provided by 14 hospital
Trusts in England (Keogh Jul 2013) has led to a number of developments to strengthen how
we assess the standards of services provided.

1.3. Within SY&B a number of processes and checks are in place to triangulate evidence in order
to help gain assurance across the footprint. We are working to a quality assurance
framework (Appendix 1), which enables us to scrutinise Serious Incidents, Serious Case
Reviews, Never Events, HSMR rates, complaints, staffing issues, CQC reports, patient and
staff survey reports, clinical audit reports etc. Whilst each organisation may have different
ways of demonstrating this level of scrutiny the principles remain the same across SY&B
Quality is everyone’s business and this is evident in our Board and Committee structures and
is embedded into all of our contracting processes.

1.4. NHS England has in place in each of its Area Teams a Quality Surveillance Group (QSG)
which in turn reports to the regional QSG The Quality Surveillance Groups are a place
where all the regulatory and commissioning bodies come together locally, where shared
concerns can be highlighted and action agreed. The role of Quality Surveillance Groups is
principally about alignment, not accountability. The Quality Surveillance Groups enable all
parties in the system to meet, share intelligence on current quality concerns, receive updates
from participating organisations and provide co-ordinated feedback
1.5. Specifically the NHS Standard Contract for Acute, Ambulance, Community and Mental
Health and Learning Disability Services states at that the Provider shall not restrict access to
any Authorised Person for the purposes of auditing, viewing, observing or inspecting such
premises and/or the provision of the Services. In addition, Section E, paragraph 47 (Contract
Management) allows for issues to be escalated where performance is not meeting the
contractual requirements.

1.6. When Quality concerns are raised or identified and they are not being addressed through the
normal routes adequately, the commissioner may need to take specific actions to investigate
the scale of the problem. Where serious concerns are being identified a structured and
purposeful Quality Assurance Visit (Appreciative Enquiry) to the Trust may be required to
enable further scrutiny to take place.

2. Purpose

2.1. To strengthen SY&B, routine quality assurance processes and drive continuous quality
improvement by supporting providers and working in partnership with commissioners.

2.2. To formalise the process for escalation of quality concerns

2.3. To formalise the process that should be followed when there is a need to conduct a Quality
Assurance Visit in the form of an Appreciative Enquiry.

2.4. Provide a structured process which ensures that the rationale to conduct a quality assurance
visit is justified and it has Senior Leadership Team and executive sign up from a
commissioning perspective.

2.5. To enable SY&B to better understand and proactively be involved in identifying quality
concerns early and working supportively with providers to take actions promptly to prevent
potential harm to patients.

2.6. To describe the escalation process to the Regional process

3. Scope
3.1. This policy is intended to provide a point of reference when a Quality Assurance Visit is being
considered and can be used to aid that decision.

3.2. This policy describes the process of determining and conducting a Quality Assurance Visit to
a provider organisation delivering patient care within SY&B.

3.3. The policy applies to NHS and Independent provider organisations.

3.4. The policy applies to all commissioning staff employed within NHS England SY&B and
constituent CCG’s
4. Accountabilities and Responsibilities
4.1. NHS England SY&B Senior Leadership Team has the responsibility to consider and ratify
the content of this policy. It has the responsibility to make the decision when it is appropriate
to conduct a Quality Assurance Visit in the form of an Appreciative Enquiry. This is in
conjunction with the relevant CCG

4.2. The Quality Surveillance Group key role is the sharing information and intelligence about
quality and risk within provider organisations across the system as part of a ‘culture of open
and honest cooperation’. This will be key to spotting any quality problems at an early stage
and the operation of an effective early warning system for quality in the NHS These groups
will bring together commissioners, regulators and other parts of the system on the footprint of
the NHS England local area and regional teams to share information on quality and to raise
concerns where they arise. They are designed to foster collaborative working relationships
and support a culture of open and honest cooperation between different parts of the system,
without impinging on the statutory responsibilities and independence of member
organisations.

4.3. NHS England Director SY&B has the overall accountability for gaining quality assurance for
commissioned services within SY&B.

4.4. The Director of Nursing & Quality has the delegated responsibility from the Director SY&B
to implement the policy in full across SY&B.

4.5. The Medical Director has the responsibility to support the Director of Nursing and Quality in
implementing this policy.

4.6. Clinical Commissioning Groups have the responsibility to identify areas of concern and be
actively involved in leading and implementing this policy

4.7. Chief Operating Officers have the responsibility to support the CCG Chief Nurses in
implementing this policy.

4.8. Quality Leads have the responsibility to prepare a policy implementation plan which includes
providing support and education regarding the use of the Appreciative Enquiry tools and will
play a key role in supporting the visit.
5. Procedure
5.1. Data and Document Review

In advance of any decision to undertake a Quality Assurance Visit a detailed data and document
review should commence taking account of both qualitative and quantitative sources of information.
A Risk Assessment (Appendix 2a) should be undertaken of each area of concern and this should
be used to form an overall Risk Profile (Appendix 2b) of the organisation. The Risk Profile should
be assessed against SY&B Risk Threshold (Appendix 2c) as this will help to determine the need
and rationale for conducting a Quality Assurance Visit.
5.2. Senior Leadership Team Approval

The Director of Nursing & Quality will prepare a Senior Leadership Team paper identifying the
rationale and scope of the enquiry in order to seek Senior Leadership Team approval. The Director
SY&B will inform the provider Chief Executive/Senior Manager of the decision to conduct Quality
Assurance Visits and the process that this will involve. This conversation will be followed up in
writing. CCG will be included in the decision making process
The Director SY&B will inform Monitor and CQC of the intention to conduct the enquiry.
5.3. Enquiry Team
The Director of Nursing & Quality and Medical Director will select appropriate individuals depending
on the scope of the enquiry. It is expected that the Nurse Director, Medical Director and CCG
representatives will be involved in these visits routinely. Consideration will be given to inviting
Monitor and CQC representatives on the enquiry team.
5.4. Visit Preparation
In preparation for the Quality Assurance Visits, packs containing key information will be prepared
based on the Appreciative Enquiry Toolkit (Appendix 3). The enquiry team will meet to assess the
information so far and use this to plan the site visits and prepare the questions that will need to be
asked. The team will be appraised of the sensitive nature of this enquiry and the need to remain
confidential at all times. A Confidentiality Agreement may need to be put in place for the purpose of
the enquiry if one does not already exist.
The Provider will be informed of the visit and a timetable will be prepared and shared in advance.
The initial visit will be announced, however, further unannounced visits may be required and the
Provider will be informed that this may be the case.
5.5. Quality Assurance Visit

The site visits will consist of speaking to Managers, Staff, Patients and Visitors, observing practices
and processes and examining pertinent records and documents.

5.6. Code of Conduct
The team will, at all times, act professionally, respectfully, confidentially, sensitively and supportively.
The team will be courteous at all times and be mindful of the privacy and dignity of patients,
relatives and staff during the visit. The team will ensure that it works within a formalised
Confidentiality Agreement for the purpose of the visits (Appendix 4).

5.7. Feedback

Immediate feedback will be given to the Chief Executive or most Senior Manager of the Provider
Trust/Independent organisation at the end of day, detailing risks requiring immediate action or
urgent attention. The CE/ Senior Manager will be informed of the headline findings and this will be
followed up in writing in the form of a report within 7 days of completing the Appreciative Inquiry.
5.8. Monitoring

The Provider will develop an action plan detailing any immediate and planned remedial actions
within 72 hours following receipt of the inquiry findings.

Monitoring against the delivery of the action plan will be done as part of the routine contract
monitoring processes.

6. Distribution and Implementation

o NHS England South Yorkshire & Bassetlaw Area Team
o All CCG’s in South Yorkshire and Bassetlaw

7. Equality Impact Assessment

There is a legal requirement to pay due regard to equality in all new, existing or updated policies,
strategies, services, projects, business cases and service specifications etc. This is done through
Equality Impact Assessment (EIA). EIA’s are designed to analyse equality impact, to identify
potential or actual negative effects on specific groups or people and to evidence how the
organisation has paid due regard to equality.
The EIA in respect of this policy is attached (Appendix 5).
8. Associated Documents
9. Policy review
This policy will be reviewed on an annual basis or sooner if appropriate guidance is published.
10. Version Control Tracker
Version Date Author Title Status Comment/Reason for
Number Issue/Approving
Body

1.0 December 2013 Updated in light of
NHS changing
architecture
Reviewed and
1.1 December 2014 dates updated
Mental Health
KLOE added
RASCI principles
added