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 5 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?
Teams are notified of the date of the QRV approximately 3 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 Chief Operating Officer, their Deputy, or the Lead Nurse *
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.
Following the QRV, the QRV Lead will write up 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 –
- Good Plus
- Requires Improvement
- Needs Support
The report will then be sent to the team/ward manager and the division’s governance team and lead nurse
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.
Should any areas of improvement be recommended in the report, an Action Plan will be attached to the QRV report.
A copy of the completed QRV Action Plan should be sent to CQCTeam@merseycare.nhs.uk within 1 month of receipt of the report.
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 frequency of QRV’s depend upon the overall rating achieved at the team's last QRV -
Good Plus or Good
12 months from date of last QRV
4-6 months from date of last QRV
2-4 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.
QRV report template
The QRV report in Excel has 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.
Overall and domain ratings
The QRV Lead emails the Team/Ward Manager the Evaluation Form shortly after the QRV and invites them to complete and return to the CQC Team
The data from completed Evaluation Forms is gathered and reviewed to identify potential areas of improvement within the QRV process, as well as areas of good practice