Improvement Strategy 2019-2022

Improvement support section

The Care Inspectorate is a national scrutiny body which supports and drives improvement. This means we look at the quality of care in Scotland to ensure it meets high standards. Where we find that improvement is needed, we support services, providers, and partnerships in a variety of ways to take positive steps to make changes that improve the quality of care.

We work across early learning and childcare, integrated health and social care, social work, social services and criminal justice social work. We regulate around 13,000 care services and carry out joint inspections with other bodies of services for adults and children across local partnerships, as well as thematic inspections and community justice.

Our improvement support section is focused on how we can grow our capacity to further embed a culture of continuous improvement across the care sector in Scotland that supports improved outcomes for people who experience care.

Primarily our strategy is for us in the Care Inspectorate, to appreciate what has been accomplished so far through the evaluation of our work, and what requires to be done in relation to our improvement support role to support the outcomes of the Corporate Plan 2019-2022 .

Our interim strategy builds on the Improvement Strategy 2017-2019 and 2019-2022 with a continued focus on three key objectives: growing improvement support, growing innovation and growing involvement. An Interim Strategy was necessary to take account of the ever-evolving picture as we move through Covid-19 which has had an impact on the delivery of previous work proposed. In addition, the implementation of the Adult Social Care Review and individual changes within the Improvement Support section. This includes the inception of a Health and Social Care Improvement team that was developed through the lessons learned from Covid-19 and the Involvement & Equalities work moving into the section in 2020.

Within the improvement support section we have a number of distinct teams. You can find out more about each team by clicking the links below.

Quality improvement support team

Improvement support is a collaborative, continual and sustainable activity leading to positive outcomes for people, services and organisations.

We work on a variety of improvement projects and programmes for our organisation.

Our expertise supports inspection staff and others with the development and application of improvement science. We also recruit specialists to work with us on a short-term basis.

The second Improvement Strategy sets out the organisation’s approach to improvement support both internally and externally for the period 2019-2022. This strategy consolidates achievements made to date and aims to embed a culture of self-evaluation and continuous improvement in the social care sector.

The team also build on existing improvement alliances and support to individual care providers and local health and social care partnerships.

We work in collaboration with other networks and organisations to develop their knowledge and skills of using the Model for Improvement to enhance quality of life and care experiences for people receiving care. 

Health and social care improvement team

We play a critical role in supporting services to provide safe, high quality care and support. This includes ensuring that health related clinical needs are met, alongside the safety and wellbeing of people experiencing care, while maintaining a human rights focus. The health and social care improvement team is a multi-disciplinary team based within the strategy and improvement directorate. We provide professional skills and knowledge in specific topic areas, along with general health and wellbeing support across the life span of people experiencing care. The senior improvement advisers will lead and develop aspects of our health and social care quality support functions based on current and emerging models of delivery. This will facilitate improvements in practice in care services and improve outcomes for people experiencing care.

Core functions of the team include:​​​​​​​

  • Leading on the Growing a Good Life portfolio of improvement practice
  • providing subject matter expertise on specific health and wellbeing areas both internally and externally and appropriate to the care sector
  • building subject matter expertise across the organisation, with support from OWD, to ensure that inspectors from across the organisation have the right level of skills and confidence to carry out their role, and considering learning from the pandemic
  • leading and developing intelligence led improvement initiatives in health and wellbeing across social care, social work, and early learning and childcare, using improvement methodology to support sustained improvement
  • linking services into local and regional subject matter expertise, helping to build relationships for continuous improvement and expert clinical support
  • developing guidance related to specific health and wellbeing areas
  • supporting the development of quality illustrations to support the sector to implement good practice and self-evaluate well
  • supporting implementation of national guidance by translating it for the care sector and developing improvement support resources to assist
  • collaborating with national improvement bodies on topic specific improvement support work, such as Living Well in Communities and with local and regional resources at health board and HSCP level.
  • influencing and shaping local and national policy from a social care perspective
  • collaborating with national provider organisations to support and sustain improvement​​​​​​​

Involvement and equalities team

The Involvement and equalities team is a multi-disciplinary team that shapes and guides the organisation forward to ensure quality improvement, co-production, equality and fairness are integrated into all our work across the organisation. These are not just nice to do’s, or add on’s, they support quality improvement.

Involvement and equality are at the heart of all we do and will drive us towards our vision for world-class care that is characterised by individuals receiving high quality care, experiencing positive outcomes and having their rights respected. The Care Inspectorate exists to further improvements in the quality of social care and social work, and we can only do that with the involvement of people who experience care, many of whom will have protected characteristics or face disadvantage and exclusion.

We believe that the people who use services are the experts in knowing what works for them and that using the information they share will ultimately strengthen the scrutiny and quality improvement work that we do. Their unique knowledge and skills lead to high quality, safe and compassionate care which reflects the rights, choices and individual needs of people.

We have two important strategies the Involvement Strategy "Working Together, Improving Together” and the Equality, Diversity and Inclusion Strategy 2021-2025 which explain our work and plans in more detail.

Early learning and childcare improvement programme

To find out more about the Early learning and childcare (ELC) improvement programme, you can visit their page on the Hub - please click here

Safe staffing project

To find out more about the Safe staffing project, you can visit their page on the Hub - please click here

Quality improvement tools and resources

Key things to remember

  • The aim of improvement activity in your service is to make the care you provide better
  • Improvement in the quality of care doesn’t happen by accident; it needs to be planned and structured and takes time
  • Making improvements should benefit everyone
  • Essentials for achieving successful improvements include a belief that there is always the potential to improve, strong leadership, support, adequate resources, a dedicated improvement team and making improvement everyone’s business
  • A well-planned approach to improvement will give you a better chance of being successful and maintaining improvements
  • The Model for Improvement is a tried and tested approach to achieving positive change
  • Consideration needs to be given to how improvements will last in the longer term

Quality improvement is the term used to cover specific activities that can improve the quality of care. The aim of improvement activity in care services is to make the care you provide better. That might be safer (less errors, infections, falls), more effective, more efficient (less waste) or more person-centred (caring, compassionate, fitting with resident/family wishes). Quality improvement involves individuals, teams and organisations looking at how making changes to the way they work can improve care. Improving care is often about changing habits. Sometimes a small change can make a huge difference. Making improvements should benefit your residents, your staff and the organisation.

word cloud

A structured approach to improvement

Project charter

A well-planned, structured approach to improvement will give you a better chance of being successful. The first step is to identify where changes can be made in your service to improve care.

The image below summarises a structured approach to improvement we recommend. The first step is to identify where changes can be made in your service to improve care.

The model for improvement

This model offers the following benefits:

  • It is a simple approach that anyone can apply
  • It reduces risk by starting small
  • It can be used to help plan, develop and implement change
  • It is highly effective

What is the Model for Improvement?

The Model for Improvement (Figure 2) provides a framework for developing, testing and implementing changes to the way that things are done that will lead to improvement.

Model for improvement

The model consists of two parts that are of equal importance. The first, the ‘thinking part’, consists of three fundamental questions that are essential for guiding improvement work.

The second part, the ‘doing part’, is made up of Plan, Do, Study, Act (PDSA) cycles that will help you make rapid change.

What are the three fundamental questions for achieving improvement?

The three fundamental questions for achieving improvement provide a useful way to frame your improvement work.

1. What are we trying to accomplish?

This question helps you to be clear about what you aim to achieve with your improvement activities. What will success look like in your care home? How will things be different? It is crucial for everyone involved to have a clear understanding of your aims.

2. How will we know that a change is an improvement?

While every improvement is a change, not every change results in improvement. Without measurement it is impossible to know whether things have improved. Agree what information you need to collect to measure whether or not the changes you make are improvements.

You can do this in terms of the way in which your results or outcomes might be different (for example, the number of falls in the care home), how the care that your residents receive will be better (for example, the number of residents receiving yearly eye health checks), or how your processes might change (for example, the number of residents receiving a multifactorial falls risk screen within 24 hours of admission).

A key element of successful improvement is collecting data which can be measured to show what improvement has taken place. If this is done by front line staff they see the changes that matter to people. They will then be motivated and inspired to identify and make improvements which will last.

How do you know that your improvements are making a difference?

  • Be clear about what it is you are measuring and that everyone is measuring the same thing in the same way
  • Be specific about roles and responsibilities of those collecting the information. Who does it and when?
  • Determine the frequency of data collection. Will it be collected daily and then displayed monthly? The data will need to be collected continuously over the life span of the improvement project
  • Understand the current state by taking a baseline before you test any changes
  • How have the changes you have tested impacted on your data? Is there any improvement?
  • Continue to review the data throughout testing to understand if the changes you are testing are resulting in achieving your aim

3. What changes can we make that can lead to an improvement?

Finally, you need to decide what changes you will test to achieve the results you are looking for.

Consider:

  • Ideas and tools available in this resource that can improve care
  • Evidence you have from elsewhere about what is most likely to work
  • What you and your team think is a good idea
  • What other people have done that you could try

This is where you can adapt ideas or be completely creative. Remember that you know your own service best, so use your knowledge and experience to guide you.

Gather together as many ideas as you can. These will form the basis for the next step – your tests of change, otherwise known as PDSA cycles.

PDSA cycles

PDSA stands for ‘Plan, Do, Study, Act’. A PDSA cycle is sometimes referred to as a test of change. Once you have decided exactly what you want to achieve, you can use PDSA cycles to test out your ideas developed from the third question, ‘What changes can we make that will lead to an improvement?’

PDSA

First ‘Plan’ your PDSA cycle - what, where, when and who. Think what information (data) you need to collect to learn whether or not your test is successful. Predict what you think will happen – reflecting on this later will help your learning.

The key is to try out your change on a small scale to begin with. You might, for example, like to run your cycle over one day, with one staff member or one service user. You can carry out a number of cycles to build up information about how effective your change is.

Taking this approach makes it easier to get started, gives results rapidly and reduces the risk of something going wrong and having a major impact. If what you try doesn’t work as well as you hoped, you can always go back to the way you did things before. When you have built up enough information to feel confident about your change, you can then implement it as part of the routine in your care service.

After you’ve carried out your Plan (‘Do’), the ‘Study’ part of the cycle gives you the opportunity to reflect on what happened, think about what you have learnt and build your knowledge.

Finally, you can move on to your next step – the ‘Act’ part of the cycle. Do you need to run the same cycle again, gathering more evidence or making some changes based on what you learnt? Or do you need to carry out further cycles to move your work forwards?

PDSA template

 

Always remember:

  • PDSAs cannot be too small
  • One PDSA will almost always lead to one or more others
  • You can achieve rapid results
  • PDSA cycles will help you to be thorough and systematic
  • PDSA cycles will help you learn from your work

Anyone can use them in any area

How do you move from testing things out to implementation?

If the data gathered from the tests of change is showing consistent improvement, set a date for implementation. Make sure all staff know about the change, when it will happen, how it will happen and where it will happen. Involve staff in your care home throughout the process.

Update written guidance and policies to include any new way of working if appropriate.

Further tweaks may be required during the implementation phase using PDSAs. Regularly review any data and processes to ensure improvements do continue.

Remember effort will be required to ensure improvements are maintained over time.

Things to consider:

  • Celebrate successes
  • Provide ongoing, supportive leadership
  • Always include all relevant information on improvements in your induction process
  • Keep everyone informed and involved and identify the best way to do this
  • Embed continuous improvement into the culture of your service
  • Your quality improvement and health and safety monitoring should include monitoring any improvements

Establish a local network of interested people to share knowledge, learning and ideas

PDSA stands for ‘Plan, Do, Study, Act’. A PDSA cycle is sometimes referred to as a test of change. Once you have decided exactly what you want to achieve, you can use PDSA cycles to test out your ideas developed from the third question, ‘What changes can we make that will lead to an improvement?’

PDSA

First ‘Plan’ your PDSA cycle - what, where, when and who. Think what information (data) you need to collect to learn whether or not your test is successful. Predict what you think will happen – reflecting on this later will help your learning.

The key is to try out your change on a small scale to begin with. You might, for example, like to run your cycle over one day, with one staff member or one service user. You can carry out a number of cycles to build up information about how effective your change is.

Taking this approach makes it easier to get started, gives results rapidly and reduces the risk of something going wrong and having a major impact. If what you try doesn’t work as well as you hoped, you can always go back to the way you did things before. When you have built up enough information to feel confident about your change, you can then implement it as part of the routine in your care service.

After you’ve carried out your Plan (‘Do’), the ‘Study’ part of the cycle gives you the opportunity to reflect on what happened, think about what you have learnt and build your knowledge.

Finally, you can move on to your next step – the ‘Act’ part of the cycle. Do you need to run the same cycle again, gathering more evidence or making some changes based on what you learnt? Or do you need to carry out further cycles to move your work forwards?

PDSA template

Always remember:

  • PDSAs cannot be too small
  • One PDSA will almost always lead to one or more others
  • You can achieve rapid results
  • PDSA cycles will help you to be thorough and systematic
  • PDSA cycles will help you learn from your work

Anyone can use them in any area

How do you move from testing things out to implementation?

If the data gathered from the tests of change is showing consistent improvement, set a date for implementation. Make sure all staff know about the change, when it will happen, how it will happen and where it will happen. Involve staff in your care home throughout the process.

Update written guidance and policies to include any new way of working if appropriate.

Further tweaks may be required during the implementation phase using PDSAs. Regularly review any data and processes to ensure improvements do continue.

Remember effort will be required to ensure improvements are maintained over time.

Things to consider:

Things to consider:

  • Celebrate successes
  • Provide ongoing, supportive leadership
  • Always include all relevant information on improvements in your induction process
  • Keep everyone informed and involved and identify the best way to do this
  • Embed continuous improvement into the culture of your service
  • Your quality improvement and health and safety monitoring should include monitoring any improvements

Establish a local network of interested people to share knowledge, learning and ideas

 

Six essentials for successful improvement Things to consider
1. Everyone in the care service recognises that there is a problem worth solving and believes that it is possible to make improvements  Consider anything specific to the problem area that would help such as raising awareness, learning and development sessions during induction, specific learning sessions and refreshers as appropriate. This would be on the topic area that required improvement such as medication matters, falls prevention, dementia.
2. Strong leadership to oversee improvement activities, give guidance and direction and monitor and sustain the introduction of improvements Leadership and support from managers is vital but remember there are other members of staff who can provide effective leadership too. 
3. Support from other organisations, services and the wider health and social care team.  Consider making contact with your wider health and social care team, other care services or champions in your area.
4. Adequate resource to plan test and implement improvements. 

Consider the following resources:

  • Time to identify, test out and implement improvements
  • Staff to support the improvement process including administrative support
  • Equipment required
  • Staff training requirements
  • Any financial requirements
  • Time to learn how to use improvement tools if you think they will help you
5. Have an identified improvement team in your service.
This can include staff in your service, members of the wider health and social care team, service users, families and friends, volunteers and other local community supports.

Include a minimum of three staff members from your service. This shares responsibility, allows for leave and provides some continuity.

6. Be clear about roles and responsibilities. This is important for your improvement team but also for everyone in your service – improvement needs to be everyone’s business.

Identify an improvement team lead to provide leadership for improvement work. It may be helpful to identify team members as champions so staff are clear about their role.

Useful links

Institute for Healthcare Improvement

Healthcare Improvement Scotland

iHub

IRISS - Improvement

NHS Education for Scotland

Scottish Patient Safety Programme

Social Care Institute for Excellence 

Quality Improvement Tools

Online course - Supporting older people to live active, healthy lives

Supporting older people to live active, healthy lives is a free online course consisting of 6 modules covering:

  • the benefits of people experiencing care moving more in terms of their physical, mental and social health, 
  • ways to think about helping blood circulation, stiffness, sore knees and continence and ideas for action.

The course is hosted on Turas Learn. It is particularly helpful for people who live with or work with frailer older people, although it is open to anyone in Scotland. If you complete all 6 modules, you can print a certificate.  

To find out more about the course and how to sign up to it, click here.

Health and Social Care Standards

The Health and Social Care Standards set out what we should expect when using health, social care or social work services in Scotland

Improvement guidance, advice and resources

A library of all resources on the site, including Care Inspectorate publications, guidance, and national strategies and frameworks

Research resources and skills

Social Services Knowledge Scotland library and Iriss resources to help you find and use evidence and research to inform and improve your practice

Latest Adult and Health Bulletin

A weekly bulletin produced by our policy team providing an update on the key developments in adult social care and health

Adult and Health Bulletin: 27 November - 3 December 2021

Adult and Health Bulletin: 27 November - 3 December 2021

Adult and Health Bulletin: 27 November - 3 December 2021

Latest Children and Young People Bulletin

A weekly bulletin produced by our policy team providing an update on the key developments concerning children and young people

Children and Young People Bulletin: 27 November - 3 December 2021

Children and Young People Bulletin: 27 November - 3 December 2021

Children and Young People Bulletin: 27 November - 3 December 2021