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The NHS is continuously looking at ways to improve patient choice – giving people more control over their care was a cornerstone of the NHS Long Term Plan and, in addition to giving people the right to ask for treatment elsewhere, NHS England recently announced it is now also proactively contacting patients on long waiting lists to offer them the chance to be treated elsewhere in the country where the wait is shorter.

A hospital’s rating is key to informing patient choice, and to maintaining high standards of care across the board, quickly taking action where poor standards are found.

CQC ratings and the new framework  

Ratings are set by the Care Quality Commission (CQC), which is the independent regulator of health and adult social care in England. They regularly inspect services and publish reports with ratings ranging from ‘outstanding’ to ‘inadequate’. 

In November 2023, the CQC started rolling out its new single assessment framework. The new framework will continue to use five key questions (is the service safe, effective, caring, responsive and well-led?) and its existing four-point ratings scale (outstanding, good, requires improvement and inadequate). But the CQC will introduce six new evidence categories, which will form the basis of answers to their five key questions.

CQC evidence categories, staff engagement and continuous improvement

Services will be assessed on their evidence and metrics around:

  1. People’s experience of health and care services
  2. Feedback from staff and leaders
  3. Feedback from partners
  4. Observation
  5. Processes
  6. Outcomes

Crucially, half of these new CQC categories (one, two and three) rely on feedback. It’s already well documented that staff engagement is crucial in improving CQC ratings. A review of CQC reports between 2012 and 2016 found a clear link between high employee engagement scores and higher CQC ratings. But the CQC’s new categories are giving services an extra incentive to prioritise staff engagement in a way that can be measured and evidenced – both in terms of showing they are listening to feedback and in terms of demonstrating they are improving how people feel about coming to work.

The other categories (four, five and six) require not just a snapshot of sentiment or engagement, but a focus on continuous improvement. Frontline staff often have the best ideas for improvements based on their experience of the challenges faced, which are constantly changing, so it’s important that organisations show evidence they are improving observations, processes and outcomes on an ongoing basis. 

How ImproveWell can support different aspects of the CQC framework

Many services run internal surveys to capture feedback, but these are often a snapshot of how people are feeling. They also rarely allow room for frontline staff to put forward ideas for improvements outside of the moment they are being surveyed, and in a way that is convenient for them.

The ImproveWell solution can be set up in a bespoke way to suit the needs of a team or service, capturing feedback and ideas at any time of day, and tracking on-going sentiment. This will allow a service to provide more robust evidence to the CQC for their new categories that are based on feedback and demonstrate that they have used ideas from staff to improve outcomes and processes.

One NHS trust’s journey

The nurses and midwives from the Maternity Department at Royal Cornwall Hospitals NHS Trust (‘the Trust’) have supported the Trust moving out of special measures through their exemplary innovation and teamwork, in less than three years.

In 2017, the CQC rated the Trust as ‘Inadequate’. The report rated the Maternity Department as ‘Inadequate’ overall, saying decisions were traditionally made at the top and then communicated to staff and that management of the maternity service was reactive rather than proactive.

The Trust responded with an action plan and made a commitment to take a radically different approach to quality improvement. In early 2018, the Trust began using ImproveWell to engage all staff in improvement, recognising that those on the frontline are best-placed to identify areas for improvement and recommend solutions.

After the first phase of ImproveWell’s introduction in the Maternity Department, 75% of staff reported feeling able to improve their area of work compared to the 53% scored by the Trust as a whole (2018 NHS staff survey). Over 85% of users of ImproveWell felt it empowered them to implement ideas for change. 

Ideas put forward were often small changes that had a big impact. Security tags were added to filled emergency boxes, saving time that would have been spent regularly checking that those boxes contained all the necessary equipment. Digital clocks were installed in every delivery room, ensuring midwives recorded times that are accurate and can confidently prove, where needed, that there were no delays in care. Savings of around £40-£80 a week have been made by introducing amnesty boxes where midwives can easily drop off equipment they may have forgotten they had in pockets. Before ImproveWell, there were staff working 12-hour shifts without access to a dedicated staffroom for breaks. This changed following feedback from staff via the Improvewell app. Another suggestion saw the introduction of photos of coastal landscapes to make the delivery suite and birthing rooms more relaxing. Staff were told families later visited the beach which their birth room was named after. 

Patient experience scores were consistently high after ImproveWell’s roll out. When the next CQC report was published in September of 2018, the Trust and the Maternity Department had both improved their overall ratings to ‘Requires improvement’ and in November 2019, the Maternity Department won the International Maternity Expo Transformation Innovation Award to recognise achievements made through ImproveWell. 

In the most recent CQC report published in February 2023, the overall score for the Trust remained at ‘Requires improvement’, but its ratings on services being safe and well-led were ‘Good’. This report also revealed significant continued improvements in the Maternity Department, with its overall and well-led ratings increasing to ‘Good’. 

If you want to explore how ImproveWell can help improve your CQC rating, get in touch for or a demo on 


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