The Quality Review Visit (QRV) is designed as a cyclical and on-going process to check adherence to quality standards based upon:
- The Care Quality Commission's (CQC's) Key Lines of Enquiry (KLOEs);
- Review of service performance;
- The service’s own self assessment.
The QRV process aims to promote safer patient care by:
- Improving quality, experience and safety;
- Providing a level of assurance about the quality of care and standards of each service;
- Supporting clinical managers to understand how they deliver care; identify what works well and where further improvements are needed.
QRVs also help the Trust prepare for inspections by the CQC which could happen at any time. The overall aim is to answer the five key questions associated with CQC regulatory and compliance framework for the fundamental standards:
- Are the services safe?
- Are the services effective?
- Are the services caring?
- Are the services responsive to people’s needs?
- Are the services well-led?
A refreshed accreditation process to enhance the established QRV framework commenced 1 July 2024.
Accredited teams will be notified in due course. Accreditation status lasts until date of next QRV.
Some unannounced QRVs may take place for any clinical team Trust wide at the discretion of the Quality & Compliance Team Heads of Nursing and Quality Matrons.
However, a majority of teams are notified of the date of the QRV approximately 2 months in advance by way of a diary invite which the team leader should accept.
* It is important that your service’s manager or their deputy is available to assist the reviewers throughout the visit *
A reminder is sent a couple of weeks before the QRV via email.
On the day of the QRV, the QRV Lead arrives to meet the team leader around 9 am, often earlier. The QRV may last all day. The QRV may last all day however there's always time for breaks.
* No cancellations are permitted unless approved by the team’s Divisional Director, their Deputy, or the Lead Nurse *
*NOTE: Unannounced QRVs commenced in June 2023 - effected team leaders will be notified on the working day before the QRV*
The QRV inspector, also known as the QRV Lead reviewer, is employed by Mersey Care and works in the Quality & Compliance Team. Their role is to support services within the Trust by identifying areas of best practice and also areas which may require improvement to ensure action is taken where required. The QRV Lead will manage arrangements for the QRV, and another member of the QRV Team will attend as QRV Support.
The team/ward manager will be on hand to assist in gathering evidence to support the QRV Leads findings. If the team/ward manager is unavailable, a deputy should be available instead.
The QRV Lead will be supported by a Peer Reviewer. The Peer Reviewer will be a manager from another service similar to yours who is familiar with the recording systems in your service, required standards, etc. The Peer Reviewer is appointed by your division’s governance team.
Some members of staff within the team will be interviewed as part of the QRV – they may be asked to complete a questionnaire.
Some service users will be interviewed as part of the QRV – this participation is voluntary, with the service users consent.
There may also be a governor and/or volunteer service user/carer representative present at the QRV, again to assist the QRV Lead in any way they can, possibly by speaking with other members of staff or service users/patients and carers. They will be invited by their contact within the Trust and they personally chose whether to accept or decline the invitation.
The Peer Reviewer will support the QRV Lead. The QRV Lead will email the Peer Reviewer in advance to confirm their role and requirements.
Peer Reviewers will usually be a manager from another team/ward similar to the one having it’s QRV, and should therefore already have access to and be familiar with the recording systems, required standards, etc.
The Peer Reviewer will be required to review a sample of care records including care plans/risk assessments/MDT notes. This can be completed at the site or remotely.
The QRV Lead will email (usually the week before the QRV date) to arrange a meeting - via phone or Microsoft Teams - to run through the QRV arrangements and requirements. The Peer Reviewer will then carry out the record check before the QRV date preferrably.
On the day of the QRV, the QRV Lead will arrange a meeting with the Peer Reviewer and the team leader – via phone or Microsoft Teams - at the start and/or end of the day to feedback their findings. The feedback to the team should be objective.
It will help you prepare, and the QRV run more smoothly, if you can evidence (electronically or in paperwork) at least the following:
These will also be elicited through discussion with you and team members and checking any other records you hold, together with a sample of care records that will be audited on the day of the QRV.
See the 'Further Information' tile for a full list of everything a team leader can prepare in advance.
The QRV Lead will complete their report based upon the information they, the QRV Support, the peer reviewer, and the governor and/or volunteer service user/carer representative have fed back
The team will be rated as one of the following –
A link to the QRV report will then be sent to the team/ward manager and the division’s governance team and lead nurse team
QRV report template (1.4.2022 ongoing)
From 1st March 2023, a refreshed QRV reporting system is available.
This consists of a combination of two systems –
- A new QRV SharePoint site where QRV Leads input QRV ratings and comments and where everyone Trust wide will be able to view completed QRV reports and input into QRV Action Plans; and
- A new QRV Power BI site including a QRV Report dashboard and a QRV Themes dashboard where everyone Trust wide will be able to view and analyse data from completed QRV reports.
Data has been retrospectively input onto these systems for all QRV reports undertaken since 1st April 2022 to enable some historical overview and analysis.
Training videos are available to support colleagues accessing the systems (SharePoint training / Power BI training) however if you’ve any queries over the coming weeks and months as the new system is embedded then please contact CQCTeam
QRV report template (Jan 2020 to Feb 2023)
The QRV report in Excel had 3 key sections –
- The ratings tab
- The 5 Domains tabs (Safe, Effective, Caring, Responsive, & Well Led)
- An Action Plan tab
Following each QRV, the QRV Lead completes the 5 Domains tabs by marking a Y next to the most applicable rating against each standard – Good Plus, Good, Requires Improvement, & Needs Support
The ratings tab and Action Plan tab are then automatically completed (due to embedded formulas in the Excel document) depending upon the ratings given.
Should any areas of improvement be recommended in the report, an Action Plan will be generated.
For QRVs which took place prior to 1st March 2023, a copy of the completed QRV Action Plan should be sent to CQCTeam@merseycare.nhs.uk within 1 month of receipt of the report. For QRVs which take place from 1st March 2023 onwards, the Action Plan will be generated in the Action tile on the QRV SharePoint site.
Completion of the actions within the QRV Action Plan should then be monitored by the division’s governance team.
Any teams rated overall as Requires Improvement or Needs Support will have a debrief session with the QRV Lead, and support from the division will be ascertained at monthly divisional meetings between the Quality & Compliance Team and divisional lead nurse and governance teams.
The QRV Power BI site includes a QRV Report dashboard and a QRV Themes dashboard where everyone Trust wide will be able to view and analyse data from completed QRV reports. These will go live from 1st March 2023 with a view to the system being consistently reviewed and developed to meet the needs of the Trust.
Data has been retrospectively input onto these systems for all QRV reports undertaken since 1st April 2022 to enable some historical overview and analysis.
We’re keen to receive feedback from system users to identify areas where further development may be necessary to ensure the systems are helpful to everyone Trust wide, meaningful and accessible. If you’ve any feedback, positive or negative, please contact CQCTeam
The frequency of QRV’s depend upon the overall rating achieved at the team's last QRV -
|
Good Plus or Good (previous QRV rating Good Plus or Good) |
12 months from date of last QRV |
|
Requires Improvement |
6-8 months from date of last QRV |
|
Needs Support |
4-6 months from date of last QRV |
An earlier QRV can be accommodated at the request of divisional leads / Nurse Directorate for teams/wards where issues of concern have been identified.
|
The QRV Lead emails the Team/Ward Manager a link to complete feedback on SharePoint shortly after the QRV has taken place. Feedback data is reviewed to identify potential areas of improvement within the QRV process, as well as areas of good practice. |
* We wanted to remind teams that part of the QRV Process is an environmental check. This includes a review of the disposal of waste, adhering to Mersey Care policies.
It has been noted that there are issues with use of sharps boxes at times, and we would advise teams to read the policy below, which ensures service user and staff safety:
Disposal of Pharmaceutical Waste MMP49: https://yourspace.merseycare.nhs.uk/policies-and-procedures/summary/3153/13774
For further information, please contact Jane Spicer, Darren Westley or the CQC team.
* The Quality and Compliance team have improved the debrief process for Quality Review Visits (QRV’s). Debriefs have been renamed 'Action Plan Reviews' and have been streamlined to 30 minutes to improve accessibility to team and senior leaders. This will better support teams to understand and manage their action plans following a QRV. Details on how to access this offer will be in the email when your next QRV report is published.
* If asked to undertake the role of QRV Peer Reviewer, we would ask that you support the QRV Lead by providing valued information regarding documentation which is an integral part of the QRV. As a peer reviewer, you will usually be a manager from another team or ward, similar to the team having their QRV, so that you have access to records and be familiar with the recording systems and required standards. You will have been appointed by your division’s governance team and will be required to review a sample of clinical records including care plans, risk assessments and MDT notes in order to complete the record keeping audit provided by the QRV Lead. We ask that you put as much detail in the audit as possible, explaining your rationale for ratings, so that the QRV Lead has robust evidence for the report and the team are aware of any possible areas that need addressing. The role may be carried out remotely or on site and preferably in advance of the QRV date, which will benefit the team as they can then receive their documentation review feedback on the day of the QRV. There is an expectation that you will be available on the day of the QRV in order to feedback your findings.
* We realise there has been lots of movement across the Trust recently, leading to changes in Service Leads and Team Managers. With this in mind, if you know of any changes, can you please email CQCTeam@merseycare.nhs.uk so that we can ensure that all the right people are included in QRV invitations.
* A gentle reminder that during your QRV, the Lead will ask for evidence regarding fire safety checks which include:
- Has your building had an evacuation report within the last 12 months with any significant concerns which may have an associated action plan?
- Is there evidence that weekly fire safety tests are taking place?
- Has a fire risk assessment taken place within the appropriate timescale? (Inpatient areas annually and community/office areas bi-annually - where teams share the same building there should be separate reports)
* The QRV team has piloted an anonymous Staff Feedback Questionnaire (SFQ) and feedback so far has been positive. From 12th September all staff where a QRV is scheduled will receive a link to complete the questionnaire from your team leader prior to the visit. We welcome honest and detailed feedback about what it is like to work on your team and would like to take this opportunity to assure staff that your responses are anonymous, although themes will be escalated to support services to address any concerns. If you have any questions, please contact Jane Spicer, Quality Matron (jane.spicer@merseycare.nhs.uk).
* Don’t forget, the QRV is a supportive process to benchmark and to celebrate good practice, as well as identifying areas for improvement. We want to support you to be CQC ready and to have oversight of where your team fits in with your service line and overall division.
* It is very important that the Team Manager is available for the entirety of the review, to provide not only team data and compliance, but the ‘soft intelligence’ of teams matter - quality improvement and innovative practice can often make the difference to ratings.