After a successful pilot season of Voyage Care’s first ever podcast, we are excited share our second season with everyone! Relaunching as Voyage Care Voice, our podcast will be showcasing real people with real insights.

In this season, we’ll be focusing on how important quality is in the social care sector. This week, we’re hearing from Yvonne Mujeri, Clinical Services lead, Hannah Eastwood, Clinical Nurse Manager and Valaine Wilson, Clinical Nurse Educator. They’ll be discussing clinical excellence, training, and developing good relationship to provide high quality care and support within the Children’s Complex Care specialism.

Children’s Complex Care

We’re experts in providing nurse-led, personalised care at home. We care for children and young adults aged 0-25 with complex care needs in Greater London and surrounding counties. To learn more about our Children’s Complex Care specialism, please visit our web page.

Catch-up on Voyage Care Voice

Are you all caught up? Visit our podcast hub to find all previous episodes, find out how you can listen on the go and enquire using our helpful form.

Can’t listen right now?

Read the transcript of the podcast below.

Yvonne Mujeri:

Hello, and welcome to season two of the Voyage Care podcast. And today we’re going to be discussing quality within Children’s Complex Care. My name is Yvonne Mujeri, and I’m the Clinical Services Lead. And I’m joined once again by Hannah and Valaine.

Hannah Eastwood:

Hello, my name’s Hannah Eastwood. I’m the Clinical Nurse manager in the Southwest region for Children’s Complex Care.

Valaine Wilson:

Hi, I’m the Valaine Wilson and I’m the Clinical Nurse educator for the Northwest region.

Yvonne Mujeri:

Thank you, Hannah and Valaine.

Yvonne Mujeri:

So as you know, I’m so excited to be talking about quality and how high quality care and support is done at Children’s Complex Care. So for me, quality is intrinsic in care and support services. It’s fundamental and an underpinning aspect of clinical governance, which is a system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment which clinical excellence will flourish. And as you both know, and can attest to, Children’s Complex Care by Voyage Care, we strive for excellence and high quality care delivery.

Yvonne Mujeri:

So Hannah, I’ll start with you, as a Clinical Nurse manager for Children’s Complex Care. When we talk about high quality care and support, what does this mean to you?

Hannah Eastwood:

So, if we look at the World Health Organisation’s definition of quality of care, that is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. So, I feel that the key words here really are the desired health outcomes. We need to ensure that our families are satisfied with the provision of care and support that we’re providing, as well as the commissioning bodies. So by safely meeting the needs of the person we support, that ensures high quality of care.

Yvonne Mujeri:

Thank you so much, Hannah. I love that with a definition! And Valaine, as a Clinical Nurse educator at Children’s Complex Care, what does high quality care and support mean to you?

Valaine Wilson:

I agree with Hannah. High quality care and support to me not only means maintaining a consistent patient centred care, but also to continuously improve the outcomes of the persons we support. As a provider Children’s Complex Care are very responsive to the health and social needs of children and their families. This is the key aspect of service, the clinical team deliver to maintain high quality care and support.

Robust training pathway

Yvonne Mujeri:

Thank you so much. That is so true, Valaine. So for you, as a Clinical Nurse educator, what are some of the ways that you ensure high quality care and support?

Valaine Wilson:

Well, the training at Children’s Complex Care is of high quality.

Yvonne Mujeri:

Yes, it is.

Valaine Wilson:

We have a robust training pathway program for our healthcare systems. This is delivered by a team of highly skilled and knowledgeable Clinical Nurse educators. In addition to that, following on from the training, we complete staff competency assessments to ensure delivery of the skills taught is a high quality and safety of the persons we support is maintained.

We also complete annual reviews of our training program that we deliver to ACS, as well as our competency documents to ensure we are meeting their learning needs continuously. As educators, we keep our continuous professional development, true training as, as resume ventilator training. It offers that sort of refresher as well because we’re continuously delivering the training, things are continuously changing. And this allows us as educators to disseminate up-to-date information to our staff, to ensure quality of care remains high.

We also organise training workshops for healthcare systems and nurses to improve the quality.

Yvonne Mujeri:

Wow, thank you so much Valaine. That sounds like such a journey in terms of education and training. And I think the quality of the education program really shines through there.

Ensuring high quality care

Yvonne Mujeri:

So, Hannah, as a Clinical Nurse manager, what else, some of the ways that you ensure high quality care and support at Children’s Complex Care? I think that there’s probably a lot.

Hannah Eastwood:

Absolutely there is a lot. So firstly, we would ensure that three clinical assessments. So, when we first meet with the families, we spend quite a lot of time getting to know all the needs of that person we support. So, this includes the clinical interventions that are required, the routines that the person we support might have, as well as a bit of an all-round picture really of how the child or young person is best cared for.

Hannah Eastwood:

We then attend any discharge planning meetings. We understand that in further detail, any requirements for care and any changes that might have occurred since we initially met with that family.

Following on from that, we need to make sure we have effective identification and management of any potential and actual risks. So, for example, maybe an identified risk of aspiration for a person we support that has dysphasia, so difficulty with swallowing. That might result in us making a risk assessment and sending that over to the community team, the community speech and language team, or we would ask for an urgent reassessment and put a plan of care in place.

Hannah Eastwood:

So where required, we might then need to wait an incident on our internal reporting system just to discuss that that is an identified risk. We also have really succinct and robust care plans. So, these capture all of the information that we gather at that initial assessment, but that also a comprehensive plan for our care staff to follow. So, we update these yearly as a minimum, but we often update them much more frequently than that, if there are any changes in needs.

We also complete home visits and regular telephone correspondence with our families. So that really helps us to keep that good therapeutic relationship with those families. But it also allows us to get regular health updates on that person we support. So, this allows us to intervene timely and liaise perhaps with the IT, for example, regarding some changes in mobility needs, we can then work jointly with the Clinical Nurse Education Team, wouldn’t we Valaine?

Valaine Wilson:

Absolutely Hannah, the educators will also go into the home to complete any training and competency assessments required to deliver care of high quality and ensuring that is also safe.

Hannah Eastwood:

Yvonne, is there anything else that you’d like to add?

Yvonne Mujeri:

Well, thank you, Hannah.

Yvonne Mujeri:

For me, I feel that the Clinical Team at Children’s Complex Care is so dynamic and we’re always looking to improve the quality of our services by benchmarking against best practice and to ensure that our practice is up to date and in line with current legislation, this ensures that our standard operating procedures and our clinical policies are over high quality and standard, and basically safe because that’s what we’re looking for; safe care that is of a high quality.

I mean, as a Clinical Team, we attend training programs delivered by specialists, hospitals in London. And this also enhances the quality and safe care delivery, when we are imparting this knowledge to our healthcare assistants and nurses in the community.

As you both know, we hold regular Clinical Governance meeting, which primarily centre on quality improvement, and our Clinical Team meetings are also focused on quality improvement where we discuss the issues and concerns and any identified risks, and we make sure that we manage, and explore and address some of these issues collectively as a Clinical Team.

Yvonne Mujeri:

And what I am really proud of, and I think it’s something that we need to continue here at Children’s Complex Care, are the significant event analysis meetings, where we analyse and audit a significant event using a quality reflective cycle and where we also tried to implement change that is effective and sustainable when it comes to practice and service delivery, so that you have those events not occurring again. And I also feel that standardisation of key clinical procedures is an integral part of quality assurance in service delivery.

Yvonne Mujeri:

So, Hannah, do you have a package of care to share where you feel that we, as Children’s Complex Care have showcased exceptionally high quality care and support?

Hannah Eastwood:

So, we do have a young girl that we support. So, she moved from one CCG to another and CCC ensure that all current staff were able to support her while the new staff were introduced. So, this really helps to ensure effective continuity of care for that child. When we moved to that new CCG, they discussed how usually they provide the care locally themselves, and they hadn’t worked with an external provider before.

So, we did work a little beside their local team initially, however, we were able to showcase the level of high policy care that we provide, and they were then converted to remove their local team and allow us to provide our own support. So, since the transition fully to our team, the CCG has referred new business to us, which I really do think is a benchmark of the good quality that we were providing.

Yvonne Mujeri:

Yes, I completely agree with you, Hannah. And I think that was such a triumph in terms of the quality that we produce because there was so impressed with our paperwork, our attention to detail, our mobilisation and training of carers. And I felt that by the end of the transition, they were very confident in how Children’s Complex Care managed packages of care.

Yvonne Mujeri:

So Valaine, do you have any stories that you might want to share on exceptionally high-quality care and support at Children’s Complex Care?

Valaine Wilson:

I do, for me would be a young boy we provided care for. Not only did we transition from another provider, but we also transitioned from Nurse Led Care to HCA Led Care. This young man had a really complex airway that required bespoke training program. His mother’s anxiety around transitioning from nurses to care as were eliminated by working closely in partnership with her, from introduction through to the robust signing off process.

This required me working 11-hour night shifts and day shifts with carers to ensure confidence and competence amongst all the staff. As a result, the commissioning body has been very impressed with the transition and the support we offered, and there hasn’t been any clinical incidents, which is a mark of the clinical excellence.

Hannah Eastwood:

I completely agree, but what about you Yvonne, do you have a story to share on any exceptionally high-quality care and support?

Yvonne Mujeri:

Oh my goodness, Hannah. I have so many stories to share, we would need a two-part series. But if I had to choose one, I guess it would be for a young person we support who initially was going to have the kid downgraded post an airway procedure. And unfortunately, the procedure had complications which left this young person with additional needs and rehabilitation.

And we were able to safely transition this young person from the rehab facility that they were in, once they would discharge from the hospital, and we organized the package of care with nursing staff during the height of the pandemic when there was so many unprecedented restrictions. And this child had gone from having healthcare support workers to now needing 24/7 nursing care.

Yvonne Mujeri:

And it was through meticulous planning, effective multidisciplinary team collaboration and communicating regularly with the parent, with the team of doctors and the nurses at the rehab facility, we highlighted the risks that were involved and all the adaptations that we needed, all the equipment that was going to be needed. And we worked diligently to get the home safely.

The package of care is now running smoothly one and a half years on and the family and CCG and the rehab facility as well. We’re really, really appreciative of the work that we put in to ensure a seamless transition. And they commended children’s complex care on the quality of our services.

Valaine Wilson:

Yes, I remember this case and currently there has been, again, no issues with this package is running smoothly. The child is getting the support that they require to meet their needs.

Measuring quality

Yvonne Mujeri:

Definitely. So, I think it’s always important to review and measure quality in any healthcare setting. So as part of the Clinical Team, Hannah, can you give some examples on how Children’s Complex Care measure the quality of all services?

Hannah Eastwood:

Of course. Yeah. So, we complete and we send off quarterly monitoring reports to a variety of CCGs. So those reports, we are reporting on quality care provision, including the individual person we support, their barriers and their achievements. So, we also hold quality review meetings with the CCGs. And we discuss management and packages, we discussed the ongoing service provision, and we look at the ways that we can improve that service provision.

There are also quality feedback questionnaires, so they’re completed every three months, they’re sent out by our business development team, and they monitor quality and client satisfaction. So, these allow us to analyse our performance and we look at the areas that we’re excelling in, and then we look at the areas where we have room for improvement.

Yvonne Mujeri:

Thank you so much, Hannah. Valaine, do you have any additional examples on how Children’s Complex Care measure quality?

Valaine Wilson:

Yes. So, we have clinical supervision and support shifts for staff in the community. Give the educators an opportunity to assess the quality of care provision and provide assurance of high standards of care delivery as well.

We also have evaluation and feedback from training delivered, and these are stored internally and reviewed, where required changes are made to meet the training needs of our staff, and we also have internal audits.

Yvonne Mujeri:

Thank you so much, Hannah and Valaine.

Yvonne Mujeri:

And I suppose just to act on, I would say that at Children’s Complex Care, we do have our internal organisational key performance indicators where we’re looking at percentages on how we’re performing as an organisation and in our Clinical Governance meetings, we also review our incidences, complaints and compliments, we look at trends and percentages, and we formulate action plans to audit and address this. And we use the dynamic reflective cycle to review and assess efficacy of our implemented actions.

And I also have to add that since we’ve been apart of the Voyage Care of Family, the Clinical Team, both collectively and individually have always received nominations for the Voyage Excellence Award. So, if that isn’t a measure of quality, I don’t know what is.

Valaine Wilson:

I agree. I think that’s an amazing achievement and it just shows the quality of care that we deliver on a daily basis. And how we work hard, and we’re committed to our roles and ensuring we meet the needs of the children we support.

Hannah Eastwood:

Thank you for that.

Hannah Eastwood:

Yvonne, do you think you could talk to us about how you might prepare for a CQC inspection or an internal audit? So what steps would you take, if any, to make sure we can ensure success?

Yvonne Mujeri:

So, for me, as a clinical lead at Children’s Complex Care, I endeavour to lead the clinical service as though there’s an imminent inspection. So, I always ask myself is Children’s Complex Care, safe? Is our care effective? Are we caring? Are we responsive as an organization? And are we well led?

So, that means that at all times, myself as a clinical lead, the clinical nurse managers and the educators and our two clinical administrators, are continuously ensuring that quality and safety is at the fore-front of all service delivery, and that at all times we are responsive and caring to our staff, to our families, and most importantly, to the persons we support and the commissioning bodies.

Yvonne Mujeri:

As the lead for Clinical Services at Children’s Complex Care, we’re always looking to improve on the quality of our service and getting that feedback from parents, children, and young people that we support and commissioning bodies, also gives us valuable insight on areas we’re doing good at and areas where we need to improve.

And I feel that all of this, will make us successful if we were to have a CQC inspection, but every day, we are always making sure that we’re safe and our quality of care delivery and standards remain high.

Clinical Nurse Managers

Valaine Wilson:

So Hannah, as you’ve worked with another provider within the last three years, what do we do at Children’s Complex Care that sets us apart in terms of quality of care? How are we different to other providers that you’ve worked with?

Hannah Eastwood:

I would say really the main difference is that Children’s Complex Care have dedicated Clinical Nurse managers for each of the people we support. So, having that single point of contact for the families, allows us to build that really strong relationship with them. And it helps us to identify any potential concerns, gain valuable feedback, and it allows us to improve upon our service delivery.

Hannah Eastwood:

So, as Clinical Nurse managers, we help to create bespoke support plan for each of the children and young people we support. We also create medication charts, which are cast off following the home. We also attend all of the relevant meetings, so maybe a child in need meeting or meeting with relevant professionals, such as the social workers, maybe the OTs, generally liaising with the multidisciplinary team.

Yvonne Mujeri:

Yes, Hannah, I agree with you. And I also think that annual reviews of full care plans and the Clinical Nurse manager being instrumental in facilitating such essential equipment, essential health reviews and organising physiotherapists and OTs to come into the home, multidisciplinary team involvement as the Clinical Nurse manager, you’re an integral part of the child’s or young person’s journey because you pull everybody together, because see the child or young person regularly, the parents rely on you and you are always their first point of contact. And the CCGs rely on you to make sure that there’s governance and quality in there.

Quality Reflective Cycle

Hannah Eastwood:

So Yvonne, you’ve mentioned a few times about the quality of reflective cycle. Do you think you could just explain to us a little bit about what that means and what that entails?

Yvonne Mujeri:

Sure. Hannah, I can.

Yvonne Mujeri:

So, we all know the reflective cycle from Gibbs Reflective Cycle Model. However, the quality of reflective cycle is more of a pathway whereby in your reflection, you’ve got quality at the forefront. So, when you’re looking at what happened, you are also asking yourself, and how did this affect quality?

And then when you think about your thoughts and the evaluation and analysis, what is central in that reflective cycle is how quality can be improved and ensuring that quality is never compromised and how we can safeguard against this. And in our action planning, it is again, centering on quality improvement.

Hannah Eastwood:

I completely agree, Yvonne. And by looking at all of these things, we can ensure that these things are not something that’s reoccurring.

Valaine Wilson:

So that concludes the Children’s Complex Care podcast on quality. I’ve really enjoyed myself. And thank you so much to everybody for listening and more information, please go to our website.

• 
• children's complex care
• podcast
• Real insights
• Real people
• season 2
• Voyage Care Voice