Professor Edward Baker, Deputy Chief Inspector of Hospitals at the Care Quality Commission writes why the views doctors in training, provided through the national training survey, is an important indicator for patient safety
Patient experience is essential to our assessment of health and social care services. However the views of staff who provide these services are just as important, as I have said in previous blogs.
Indeed the honesty of staff in telling us about the quality of care they are able to provide and their concerns about it has been essential to many of our reports.
During hospital inspections, we hear from staff in a number of ways. We hold focus groups with different groups from junior doctors, to clinical and managerial staff, and we look at the results of a range of surveys including the NHS National Staff survey and the GMC’s National Training Survey (NTS).
The national training survey results and intelligent monitoring
One of the indicators we use is the GMC’s annual National Training Survey (NTS). Our indicator is based on the overall level of satisfaction junior doctors have with their training. This takes into account things like handovers, workloads, clinical supervision and feedback.
More detailed information from the survey goes into a pack of information given to the inspection teams before each inspection.
Our inspections have confirmed my view that front line staff, including junior doctors, are an important indicator of what’s going on at the trust. They can be the eyes and the ears of the trust – they know what’s going on at the coalface, but also have access to consultants and other senior staff.
What is the relevance to us of the NTS?
The views of junior doctors, through the NTS, are important to us, as the CQC needs solid evidence not anecdotes when coming to our judgements.
Good training generally co-exists with good quality care. Trainee satisfaction can have a bearing on the care given to patients. The reasons why they are dissatisfied with their training are important to us if they relate to patients not receiving safe effective, compassionate, high-quality care. For example, if staff are demotivated or unsatisfied this may reflect poor clinical leadership or a poorly managed service.
Using the NTS, along with other information and what we find on inspection, enables us to build up an evidenced-based picture of services which we are then able to rate.
The most recent NTS results will feed into the next update of acute intelligent monitoring at the end of the year and will be used in forthcoming hospital inspections.
How we help to improve care
The Care Quality Commission’s job as the independent regulator of all health and adult social care services in England is to make sure that health and social care services provide people with safe, effective, compassionate, high-quality care.
We also encourage them to improve by monitoring and inspecting services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.
Our new approach, known as our comprehensive inspection programme, allows us to get under the skin of organisations. Our inspection teams are made up of inspectors, clinicians with specialist knowledge and members of the public with personal experience of healthcare.
One of the important elements of the approach is the way we use data to help us prepare for inspections. We have developed an intelligent monitoring tool to help us to schedule our comprehensive inspections and to inform the key questions our inspectors will ask.
Helping us to build a picture of quality
To build up an overall picture of quality in the intelligent monitoring tool, we rely on getting views from a range of people; including those who use the services and the people who work there.
In the acute sector, we use over 150 indicators in intelligent monitoring such as patient outcomes, incident reporting, patient survey results and staffing levels.
Intelligent Monitoring is not and never has been a measure of performance or a judgement on the quality of services. We know that data on its own can never give a complete picture of a hospital’s performance or the experience a patient may have when being treated there.
Over the next year, we are intending to build on our existing Intelligent Monitoring to introduce a comprehensive model where we will monitor and react to risks more in real time, which will enable us to better protect people who use services by triggering appropriate and proportionate actions where concerns are raised.
Professor Edward Baker is Deputy Chief Inspector of Hospitals at the Care Quality Commission