In my role as Standards and Indicators Lead for Healthcare Improvement Scotland, I’m sometimes asked, “What impact do standards have?”
On hearing this question, two key answers spring to mind: the quality of health and social care services that our standards work to improve, and also the people who use those services and the impact our standards can have on their lives.
But, first of all, let me explain what we mean by standards.
A set of standards is primarily a document setting out what people who use services should experience, and how organisations and services can demonstrate how they have met these standards. So they impact on the planning, design and delivery of services, and support both national consistency and improvement. And with our commitment to ensure they are focused on real outcomes, they have huge potential to impact on people’s experience of care and support. When we develop standards for health services (and more recently social care services), we work with experts (including those who are experts due to their experience of particular services) from across Scotland. Services and people, therefore, are closely connected.
“With our standards for people who have experienced rape, sexual assault and child sexual abuse, already we are seeing improvements in care and support with compassion and responsive care driving changes in the training of staff.”
Take the development of our neurological care standards as an example. A key driver for Sue Ryder championing for our organisation to develop standards for people living with neurological conditions was their belief that our standards positively impact on bringing about changes and improvements in the delivery of care and support. This expectation was founded in part through our work on HIV, where our standards have led to direct improvements in care and support for people living with HIV in Scotland, such as the development of integrated care pathways, which tell care providers, people using services and their carers, what should be expected at any point along a journey of care. NHS boards welcomed them as an opportunity to focus on the key quality issues relating to HIV care.
Similarly, with our standards for people who have experienced rape, sexual assault and child sexual abuse, already we are seeing improvements in care and support with compassion and responsive care driving changes in the training of staff. For example, work is being undertaken to recruit and train more female forensic examiners which would enable people’s request for a female examiner to be fulfilled. Another example is our work to develop the Health and Social Care standards, which included targeted engagement with young care experienced children. As a direct result of their feedback, the standards were revised and updated to include the importance of feeling ‘valued, loved and secure’.
A vital part of our standards development process is reaching out to ‘seldom heard’ groups to capture their feedback, and to use this feedback to further develop our standards. Every comment is heard. Every comment is responded to. This week I met with survivors of child sexual abuse to hear their views and ensure the things that we think are important and have identified as priorities in our indicators, matter to them. In the summer, when we were consulting on our pregnancy and newborn screening standards, we met with parents and carers of children born with fetal anomalies. Again, we wanted to hear from them, first hand, to make sure our standards are focusing on the things that are important. And we’re sharing all these comments with our development groups and ensuring that our standards are revised to reflect this feedback.
“When we were consulting on our pregnancy and newborn screening standards, we met with parents and carers of children born with fetal anomalies. Again, we wanted to hear from them, first hand, to make sure our standards are focusing on the things that are important.”
And for me, this is a really important area of ‘impact’. Our standards reflect and echo the voices and experiences of people who use services. They give people the opportunity to help shape what high quality care looks like. And that feedback sits alongside evidence, practice and professional judgement. Through this approach, we connect with people with lived experience (and their families), we build relationships, raise awareness of our work, the work of our organisation and the value of collaborative working. When we evaluate our processes there is a constant theme saying, “We felt heard”.
Moreover, following publication of our standards for people who have experienced rape, sexual assault and child sexual abuse, we received very positive feedback from individuals who could see their specific suggestions and comments had been incorporated throughout the document. For example, one young woman had noted during consultation the importance of being able to have a shower, a cup of tea and replacement clothing after her forensic examination. She contacted us to say how grateful and proud she was to see her words included in the standards. An unexpected impact, but imperative to delivering truly person-centred care.
But in thinking about the impact on standards, I’m also acutely aware of the impact that they have on me personally. Hearing someone say, “Thank you for listening. I hope my story makes something better for someone else” is a gift. It keeps me enthused, motivated, connected to my work and also connected to the impact we can have on real people and their lives.
Dr Fiona Wardell is Standards and Indicators Lead at Healthcare Improvement Scotland
Healthcare Improvement Scotland Blog 