Quality Improvement11 min read21 September 2024
Improving from Requires Improvement: A Provider's Roadmap
By Jack Andrew Green, AJG Advisory
Receiving a Requires Improvement CQC rating is a significant moment for any provider. The announcement affects staff morale, commissioner confidence and the organisation's reputation. For some providers it comes as a shock; for others it confirms concerns that had been building for some time. Whatever the circumstances, the question that matters most in the days after the rating is published is not how this happened, but what happens next.
Understanding What Drove the Rating
The first essential step in improving from Requires Improvement is developing an honest, evidence-based understanding of what drove the rating. This sounds straightforward, but it requires a level of organisational candour that can be difficult to achieve, particularly when the instinct is to dispute the findings or attribute the rating to the inspection process rather than service quality.
Reading the CQC report carefully and identifying the specific evidence that inspectors cited for each finding is the starting point. Understanding whether findings reflect systemic issues, one-off incidents, documentation weaknesses or genuine practice concerns requires a different response, and conflating these different types of finding in a single action plan is a common mistake.
Developing a Credible Improvement Plan
A credible improvement plan is specific, evidence-based, time-bound and owned. Generic plans that describe aspirational outcomes without specifying the concrete actions that will achieve them, the evidence that will demonstrate improvement, the individual responsible for each action and the timescale for delivery do not demonstrate to CQC that improvement is being taken seriously.
Each action in the improvement plan should be directly linked to the specific finding it addresses, should describe a concrete change in practice or governance rather than a commitment to review, should specify who is responsible and by when, and should identify the evidence that will demonstrate completion. The plan should be reviewed regularly and updated as actions are completed.
Communicating With Staff, Families and Commissioners
The publication of a CQC report rating a service as Requires Improvement creates communication challenges that, if handled poorly, can compound the original difficulty. Families may feel anxiety about the quality of care their relatives are receiving. Commissioners may begin to question whether they should place new referrals with the service. Staff may feel demoralised or defensive.
Open, honest communication that acknowledges the findings without excessive defensiveness, explains the improvement actions being taken and conveys confidence in the service's ability to improve is typically the most effective approach. Families and commissioners who receive a clear, credible communication plan are generally more reassured than those who receive silence or defensiveness.
Governance Changes That Sustain Improvement
Sustainable improvement from Requires Improvement requires changes to governance structures and quality assurance systems, not just to the specific operational practices that were found wanting. Services that address the surface findings without addressing the underlying governance weaknesses that allowed them to develop will often find that they improve in the areas CQC assessed but develop new concerns elsewhere.
This is why an independent governance review is often one of the most valuable investments a provider can make after a Requires Improvement rating. An external review of governance systems, quality assurance processes and leadership effectiveness can identify structural vulnerabilities that are not visible from within the organisation.
Preparing for Re-Assessment
CQC will return to assess improvement, either through a focused assessment of the key questions that were rated Requires Improvement or through a full re-inspection. The timing of this re-assessment is within CQC's discretion, but providers should not assume they have a year or more to improve. CQC may return more quickly if concerns increase, and providers should aim to have demonstrable improvement in place within three to six months.
Commissioning a mock inspection before the CQC re-assessment is one of the most effective ways to test whether improvement is genuine and evidenced. A mock inspection that is uncomfortable is far more valuable at this stage than one that provides false reassurance.
Related Services
AJG Advisory provides expert support across all the areas discussed in this article. Speak with Jack Andrew Green directly to discuss your organisation's specific needs.
CQC Consultancy → Governance Reviews → Interim Management →
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