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CQC Inspection ‘specialist advisor’ Sandra Flynn gives a flavour of how we can get ready to showcase what we do well

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By the end of March 2016, every hospital will have been inspected under the new model of inspection adopted by the Care Quality Commission (CQC). Our patient safety team is working closely with staff across the trust to get the Countess ready for the visit. I’m also hoping that I can add value to the preparations since securing a secondment to the CQC in March 2014. To date I have been released for a week at a time from my clinical duties at the Countess to take part in four CQC inspections in the Northwest and Midland region.

I am seconded to the CQC in the capacity of ‘specialist advisor’ working as part of a multidisciplinary team that includes professional Care Quality Commission inspectors, other specialist advisors such as nurses, physiotherapists and consultants patients, experts by experience and data analysts.

The inspections starts day 0, this is where the full team meet off site at a base hotel to plan the on-site inspection. This day is an opportunity to get to know team members, discuss methodology and the data provided by the trust. The team also gets to meet the trust CEO and some members of the executive team who come along to give a presentation overview on the trust.

Depending upon the size of the trust, the inspection team may be on site between 2-3 days, and during that time I can be expected to visit a number of different wards and departments, help run focus groups or participate in staff interviews.

Because of my background as a consultant nurse in orthopaedics, I am usually allocated to the surgical team. Surgery is one of the 8 key service areas inspected by the CQC, the others are urgent and emergency care, medicine, critical care, maternity, children and young people, outpatients and diagnostics and end of life care.

My day consists of observation, talking with patients and visitors and interviewing staff. I also review case notes, look at trust protocols, check expiry dates on equipment and much more besides so there is a lot of ground to cover.

At the beginning and end of each day the inspection team meet in their groups to feedback and discuss preliminary findings and any areas that may require further exploration. They are long days because the teams need to inspect as many areas as they can and cover as much of the working day as possible. Time permitting, most staff groups will be approached as part of the inspection process, from porters and domestics to secretaries, therapists and consultants. It is only natural for staff to feel nervous about this but remember you are not going to be asked something you shouldn’t know. CQC inspections are not about tripping people up; they are about getting under the ‘skin of the trust’ in order to get a feel for the culture.

Staff are invited to attend focus groups which are held throughout the inspection period, this presents an additional opportunity for staff to speak with the CQC inspection team about their experiences of working for the trust.

When taking part in an inspection I am always looking for good, sometimes I come across outstanding and other times I may see practice or services that require improvement or are inadequate. I look to explore the reality of the practice across the surgical areas – from checking whether patient charts are up to date, to establishing whether people know how to escalate a safeguarding concern or access up to date policies. A comprehensive inspection is important and the evidence I gather will help support a fair and balanced view of the surgical service area. My evidence, along with the evidence collected by other members of the team, is used to establish whether this service area is caring, safe, effective, responsive and well-led. We will then provisionally rate each of these ‘domains’ as either outstanding, good, requires improvement or inadequate for the surgical service area. This process is repeated for each of the service areas and modified throughout the inspection period as additional information is gathered and existing information is enhanced. At the end of the inspection week an overall provisional rating is agreed and fed back to the trust executive team.

The role is fascinating and I really enjoy talking with the various staff groups, patients and visitors along with observing practice in clinical areas. I have met some wonderful people along the way and I have acquired a great deal of respect for the work of the CQC. My experience has given me a richer insight into how hospitals operate and work in partnership with other organisations. Working for the CQC has also heightened my sense of awareness about day to day practice and I now scrutinise everything I do by asking is it safe, caring, effective, responsive and well-led? Working for the CQC has taught me that some of the simplest actions can have the biggest impact such as not leaving our computers unattended without first logging off, ensuring we evidence how we are listening and acting on patient and staff feedback to improve care at all levels, and that we have relevant and current information on our notice boards.

We don’t yet know when our inspection will be, but we understand that it is likely to be early 2016. If you see me out and about in our Chester and Ellesmere Port hospitals, I’ll be happy to tell you some more about my experiences – so please do stop and ask me! I’ve worked at The Countess for more than 35 years, and am hugely proud of the organisation. I know first-hand that this is a fantastic place to work, and I want us to be ready to showcase the great work we do when the inspectors arrive.

Sandra Flynn Sept 2015

With best wishes – Sandra

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