!! defining quality in alternative futures...

QAF introduction and guidance V 2.0 January 2014

Defining Quality in Alternative Futures Group

The quality of services starts from what matters most to the people using them. A quality service also pays close attention to areas which may be invisible to people supported, such as medicines management or workforce development. Achieving quality should balance three “core components:”

• The individual experience of people receiving care and support and their personal expectations and outcomes

• Services which keep people safe through recognised standards, safeguards and the adoption of good practice

• The recognised processes that ensure the effectiveness of services including their value for money (Driving up Quality in Adult Social Care Statement of Quality Assurance Principles TLAP)

At Alternative Futures Group we define the quality of our services through

• Our ability to respond to the needs of people in achieving their outcome • Involvement of people who we support in service delivery and

development • The attitude, behaviours, skills and knowledge of our workforce • Transparency in our processes to review the quality of our services

We have in place a number of tools to assist us in delivering, assessing and continually improving the quality of our services these components make up our Quality Assurance Framework ‘QAF’


Quality Assurance

Framework

AFG Quality Assurance Framework

Quality Assurance Framework (QAF) Guidance

The aim of the Quality Assurance Framework is to ensure that the balance is struck between delivering the service people want and being safe, but equally ensuring people are supported to partake in ordinary life experiences. The suite of audits within the QAF has been developed to provide quality assurance around the Care Quality Commission (CQC) 16 outcomes relating directly to quality and safety and Supporting People/Local Authority QAF. The audit cycle cross references organisational policy and other methods of assurance. The audit system links to key government strategies / documents to promote best practice. These include:

• No Health Without Mental Health

Notifiable

Events/

Policy & Procedures

Supervision & Appraisal

Finances

Training & Staff Development

Line Manager

Visits

Audit

Internal/

KPIs Carista

Information

Management

Inspection

Findings

Engagement

Staff and

Clinical

Practice

Governance


• Working together for Change • Progress for Providers • Think Local Act Personal • Manager Induction Standards (Skills for Care) • Driving Up Quality Code

The Way we work – Guiding Principles

As a Person Centred Organisation we aim to work in ways that enable:

1. Visionary leadership

2. Shared values and beliefs

3. Evidencing positive Outcomes for individuals

4. Community focus

5. Empowered and valued staff

6. Individual and organisational learning

7. Partnership working

The QAF has been developed to evidence the guiding principles and provide line managers with a suite of audit tools to monitor compliance and quality in any given outcome area within a flexible framework.

The QAF vision of excellence is:

• A flexible, skilled and competent workforce who embody the organisational values in their behaviour and deeds.

• A personalised approach to all that we do • Users of services have choice and control • Staff have choice and control - their efforts recognised and rewarded • Risk enablement is embedded as a positive element of ordinary life

experience • Value for money is demonstrated in all that we do • Evidence is in place to measure success through outcomes • Vulnerable people are safeguarded • Consistently achieving positive inspections with no required actions

The purpose of our Quality Assurance Framework:

Our framework seeks to:

• Promote quality services which are monitored through audits that are set at all levels in the organisation through our Outcome Focussed Planning processes.

• Ensure that service delivery is consistently high demonstrated through sound evidence. Our Key Performance Indicators (KPIs) set within our


Performance Management Framework (Carista) supports us in this process and the audit cycle identifies areas of improvement monitored through actions within the framework.

• To embed an organisational culture that can learn from experience and use this towards continuous improvement by quality monitoring within the audit cycle gaining line management reassurance.

• To demonstrate delivery on the Promise we make to our service users through monitoring the quality of direct support that our services are providing

Quality can be applied to everything we do; from leadership and management practice to our ability to deliver value for money. As an organisation we are required to meet a range of statutory and regulatory standards in particular the framework for quality and safety. The baseline audits within the QAF link directly to this framework for quality and safety and are designed to monitor and evidence quality and excellence.

The system has been developed in response to an operational quality assurance review within which (Area Managers) AMs and (Head of Operations) Community Services Directors requested an audit calendar to mirror the outcomes within the Essential Standards of Quality and Safety.

How do we make sure we are providing Quality Services? Governance A board of trustees give their time freely to oversee the governance of AFG as a charitable company. As part of the governance structure there are a number of committees that report to the board, e.g. finance, risk and performance. Working groups (these include Service User Representative Forum (SURF) and Employee Representation Forum (EPF)) and management forums feed issues into committees on which board members are represented. Information Management The organisation has a number of systems in place to manage information for our people and the running of the business.

• Carista – Service and Service User • PAL – Staff • SUN/Adapted Planning – Finance

These systems enable us to capture and report information to inform service improvement. Inputted into Carista are significant events including those notifiable to our regulators. This allows us to identify any trends through central and local monitoring. On an annual basis the organisation agrees a set of KPIs in the areas of:


• Staffing • Finance • Risk • Service User Outcomes

Supervision and Staff Development The organisation supports staff from the moment they start with AFG through Support Essentials (induction) and coaching our staff at a local level to orientate them to the service they will provide and testing knowledge through the Common Induction Standards. We provide a framework to prove competency through the use of various levels of QCF. The Manager Induction Standards are one of the key referenced documents and provide key guidance in line with the Essential Standards of Quality and Safety for managers new in post and as reference thereafter. All staff receive support through their line management via on the job coaching and mentoring and in one to one formal and informal supervision. Regular communication with our people (people supported, their families, agencies and staff) is a vital part of ensuring the quality of our services. This provides opportunity for people to be listened to and their voice to be heard. All staff are provided with an annual appraisal which reviews what has worked well, areas for development and planning for the next year. Management Presence Essential to checking the quality of our services is “being there” being present, visible and approachable to our people. This enables us to be the seeing eyes and the listening ears of the organisation. To assist managers in this we provide a number of tools as a framework to guide quality assurance:

• Line Manager Visit (Set Questions in Carista) • Set of audit tools that have been developed against national standards

and best practice. • Quarterly Assurance Reporting (Carista)

Audit and Inspection We work in partnership with Mazars who carry out an agreed annual schedule of audits, these are approved by our Board to test our controls in various areas e.g. finance. Quality Assurance and Practice Development Team (QAPD) carry out audit across operations and corporate services on a planned and responsive basis to test compliance and quality. Area Manager/Registered Manager audit tools which can be used as required.


Routine local audit is also carried out at a local level by our operational teams, e.g. medication, health and safety and clinical. We are inspected at each of our registered sites by the Care Quality Commission (CQC) through unannounced annual visits. Within our hospitals we are also inspected for Mental Health Act compliance on an annual unannounced basis. Many of our community services are inspected by local authority contract and quality compliance teams. These are carried out against local standards and national requirements. Other inspections may include fire, environmental health and H&S Executive. In response to all audit and inspection where areas of improvement or non compliance is identified action plans are developed and monitored at a local level. Engagement of Our People Hearing what is important to our people and understanding what is working and not working is fundamental in the continuous improvement of our services. We do this through numerous processes including:

• Team Meetings • Supervision and Appraisal • SU / Staff Forums • Family events • Comments & Complaints • Whistle blowing • SU Reviews/SU Feedback • Staff Surveys • Working Together For Change Events • Contract Monitoring Meetings • Service Visits

Policies and Procedures The organisation has a number of policies which set boundaries for actions and decisions ensuring that a common path is being followed to achieve the organisational objectives. It sets a framework in which people can get on with their day to day routine operations without the need for constant management intervention. The process for development, review, ratification and discontinuation of organisational policies and procedures is coordinated centrally, however it is essential to improving the quality of what we do and how we do it that our people are part of the review cycle. Audit There are a number of audits that have been developed to promote actions and outline clear outcomes to promote these principles. They help us to identify what is working and what is not working. Those things that are identified as not working need action. If we only identify things that aren’t working without any


action we will fail to meet minimum standards or to improve our services. Audit in isolation will not provide a framework of assurance. The audits contain a combination of baseline, observational, person centred working and line management reassurance.

Annual Audit Calendar

This sets out audit activity for the year for the organisation. Included in this is:

• MAZAR

• Quality Assurance and Practice Development Team

• Operational Audit

• Clinical Audit

• Human Resources

• Health and Safety

The QAPD Team will facilitate 6 weekly QAF Meetings for each Director of Community/Clinical services.

QAPD Leads: Community Services Directors and their allocated Area Managers

QAPD Lead: Clinical Services Director, Operational Manager and Registered Managers of Independent Hospitals and ACHN

The calendar will be launched in August each year

Roles and Responsibilities

Managing Director of Community Services: Will receive quarterly reports from Community Service Directors and key themes reported through organisational governance groups.

Community Services Directors: Will visit 2 times monthly completing a minimum of 2 line manager visit set questions.

The Line manager visit set questions will act as a framework to guide and evidence these visits.

A quarterly report will be completed and monitored through Carista.

Area Managers/Registered Managers: Will complete audits in line with calendar.


A quarterly report will be completed and monitored through Carista. AMs will attend QAF meetings with the QAPD leads as agreed.

The Line Manager Visit function remains available for use by AMs as required.

Visits to services by AM’s are to be captured as a service diary event. This will enable us to track frequency of management presence across our operational services.

Team Leaders: Will complete audits in line with calendar. All audits are available to Team Leaders for quality improvement.

Quality Assurance & Practice Development Team: Will complete audits in line with calendar to test the organisation’s QAF.

Routine QAF groups will be facilitated with Directors of Community/Clinical Services. The purpose of these meetings is to:

• Review audit tools in line with calendar

• Identify themes as a result of audit activity

• Review progress of compliance actions from internal and external inspections

• Consider national and organisational review for learning and improvement

• Scrutiny of management information at a local level

QAPD Team along with HR will conduct quarterly Schedule 3 audits as per calendar.

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