Originally posted in 2017

The Care Quality Commission has an unenviable task.

No-one likes them – everybody hates them, and wishes they would go down to the bottom of the garden and eat worms…For example, Roy Lilley (2017) states:

“What’s the point of inspecting?  Turn-up, inspect; if it’s bad, it’s too late.  If it’s good you’ve wasted your time…It’s politics.  Inspection is a political construct.  It looks like we are busy sorting stuff…. it is nothing of the sort.  It creates a bogus sense of security.”

Lilley claims “Inspection was abandoned when Edwards Deming came up with his 14 Points for Total Quality Management  (TQM) Only the NHS persists.”

This last point could be a tad over-indulgent though, as what Deming actually recommended was to avoid being totally dependent on inspection to achieve quality. Also, I’m sure Ofsted and the like would claim that the task of inspection also falls within their remit…??

So how do we follow Deming’s advice to avoid being dependent on inspection to achieve quality?

If we look at what the CQC deem to be worthy of a focus on quality, we have working practices that are:

• Safe
• Effective
• Caring
• Responsive
• Well-led

…and the way they do this is to pop in (often unannounced) and take a snapshot picture. They present this to the care home provider and recommend they develop an action plan to resolve any areas that ‘requires improvement’ or are ‘inadequate’.

The provider has licence to develop an action plan that is tailored to their own ways of working and resources, just so long as it addresses the issues highlighted.

What this does, is give the provider an opportunity to:

• Stop and think, in the midst of an environment where the ‘Important’ is often overlooked due to the ‘Tyranny of the Urgent’
• Examine trends and key themes arising from inspections in their establishments
• Develop their strategy to align their working practices and culture with their stated aims and espoused values.

This all sounds fine, but still everybody hates the CQC…So what’s missing?

Well, referring to Deming again, we need to move around a continuous cycle of ‘Plan-Do-Check-Act’…

• PLAN: Design or revise business process components to improve results
• DO: Implement the plan
• CHECK: Assess the measurements and report the results to decision makers
• ACT: Decide on changes needed to improve the process

So The CQC asks the provider to develop a PLAN, and then they will pop by to CHECK its effectiveness.

The provider needs to create a PLAN, then DO the plan and ACT on anything after the next checking.

Deming’s cycle therefore helps to develop a ‘snapshot’ into a ‘video’, and in principle this provides a valuable insight for an organisation that is committed to continuous improvement in their service provision.

What might make this work better? Again, taken from Deming’s 14 points for TQM…

• Drive our fear
• Break down barriers between staff areas
• Eliminate numerical quotas for the workforce
• Eliminate numerical goals for management

So here is the challenge…

• The relationship between the CQC and care providers needs to be based on mature partnership model
• Leadership needs to be embraced at levels of the organisation – from strategy to day-to-day tasks
• Providers need to develop insightful ways of managing ‘underperformance’
• Providers need to be capable and confident in establishing routine safe staffing levels

It’s fairly evident we are quite a way from this (more conducive) climate for inspection to fulfil its potential in search of safe, effective, caring responsive, quality and well-led care.

Care providers need to evolve and mature – Inspectors need to develop their role (and the perception of care providers) as a partnership relationship.

It’s fairly safe to say that the way inspections of care providers is currently done, isn’t a done deal – it’s more of a moving feast…and to help us all move along the journey, we probably need to focus on the extent inspections are actually supporting TQM.

So what should inspect when inspecting the inspectors?

• Is it a partnership (Are the developing mature working partnerships with providers?)
• Is it strategic? (Are they able to develop their ‘snapshots’ into a ‘video’?)
• Is it valid? (Are they measuring the important things in their inspections?)
• Is it reliable? (Are their findings likely to be about things happening on an ongoing basis?)

To achieve ‘outstanding’ in all of these, the CQC will need genuine insight in the discipline of ‘Organisational Development’.

…and if things move in this direction, then the CQC will be welcomed by many to come up from the bottom of the garden.