Ensuring that we are delivering a high quality service is, or should be, the preoccupation of geriatricians and specialists in health care for older people. But how do we know if we are? As we consider the ongoing implications of the Francis Report, the BGS will be seeking to develop tools and services which help in this quest. There is much more to do but the BGS has assisted with the development of a Quality Mark for Elder Friendly hospital wards in collaboration with the Royal College of Psychiatrists and others. Dr Chris Dyer, the BGS representative on this project (with Peter Crome) shares more details.
At a single ward level, the Quality Mark for Elder Friendly Hospital Wards is a method that hospitals can use to raise standards of care for its most vulnerable group of patients. Indeed, as part of its response to the Francis Report the Royal College of Physicians has recommended use of the Quality Mark.
The Quality Mark was developed by the Royal College of Psychiatrists’ Centre for Quality Improvement in collaboration with the BGS, the Royal College of Physicians, Royal College of Nursing and Age UK. Its laudable aims are to help ward teams identify the standard of care being delivered to older, frail patients, and implement an improvement plan.
The first wave of pilot hospitals tested the Quality Mark in 2012-13 and the first awards are due to be made in 2014. A second phase of hospitals will start in March – a minimum of two wards per hospital is required.
What is required to achieve the Quality Mark?
It is quite exacting and I can say that the accreditations won’t be given out willy-nilly. There are two stages: firstly, data collection through questionnaires from a range of sources including ward manager, lead clinician, ward staff, governors and senior management. Importantly feedback is obtained from patients, and their families or carers. Data is collected locally but a dedicated team at the RCPsych, led by Chloe Hood, analyse the results and provide feedback. Information collected includes important elements such as communication, nutrition, personal care, pain and end of life care.
Of particular value is the staff and patient interactions made through PIE (Person, Interaction, Environment) observations which aim to describe the culture around the care of patients with dementia and help ward teams develop their approaches in this area. A specific one day workshop for two ward members is laid on by the RCPsych for ward staff to learn the PIE observation methods, and then two shifts of observations are conducted by them. Following this, an action plan is devised and the ward teams may progress to stage two which involves the completion of the same assessment tools as in stage 1 to assess the changes made. The results of these are then scrutinised by the Quality Mark’s Awards and Advisory Committee who establish if the criteria have been met to achieve the Quality Mark. If not, the ward can work on a new action plan and make further improvements before resubmitting data and hopefully attracting plaudits!
The Quality Mark is held for 3 years, provided an interim review and patient feedback is obtained, before stage 2 is repeated again.
In summary the Quality Mark is an excellent programme which ward teams can use to evaluate their own practices, reflect through direct observations of care, and deliver an action plan that will ultimately lead to recognition of their efforts in this award.The scheme does cost £1,200 per ward per year (which is ongoing) but this includes the PIE workshops and a team to review results and feedback.To me, at the cost of an agency RMN special for two days, this represents good value for money and having had a sneak preview of some of the results it looks like money well spent.
Interested parties can still apply for the March 2014 set – find out more at: http://www.wardqualitymark.org.uk
British Geriatrics Society 
Laudable but only continuous performance/quality information will give any sense of assurance. In a three year period staff changes/rotations, case-mix variance etc etc will make a one off accreditation potentially out of date in a few weeks (even if in the 3 year cycle it is revisited) CQC rightly lag Care Homes when leadership changes.