We know it when we feel it – but what exactly is ‘outstanding’ care? 

We know it when we receive it. But defining what exactly constitutes ‘outstanding’ care is surprisingly difficult. Lillie Wenzel reflects on The King’s Fund’s mission to do just that.

If I told you I’d received ‘outstanding’ care from my GP surgery or hospital, it would probably conjure up a sense of excellence. It’s likely I wouldn’t need to say any more for you to know that I was extremely happy with my experience, and that one word might well be enough for you to choose the same service next time you needed it. But if you asked me what exactly had made my care outstanding, would I be able to put it into words? Could I tell you why it was excellent, rather than just ‘good’?  

Last year we did some work for CQC focussed on exactly that question; what makes care outstanding, and how does it differ from care which is good? CQC asked us to develop a set of principles to help CQC staff and providers differentiate between the two, supporting their work to refresh their assessment approach. 

Our research confirmed that defining ‘outstanding’ care is not entirely straightforward. When we asked a range of people – those who had used services, staff in provider organisations and those working at CQC – to describe a time they had seen outstanding care, they were quick to offer examples. We heard lots of inspiring stories about excellent care in a range of settings, from nursing homes involving service users and relatives in personalising room décor, to an acute hospital which created a dedicated quiet room for families of children with life-limiting conditions. But when we asked people to tell us exactly what made that care outstanding, they often found it hard to pinpoint. Many resorted to metaphorical language to describe services or staff going ‘the extra mile’ or ‘above and beyond’. We found that for some people, it was easiest to define outstanding care by comparing it to care which was less good. Others acknowledged the difficulty of articulating exactly what outstanding care is, with one expert by experience telling us, ‘you can feel it, but [it’s] difficult to define’. 

However, when we brought the themes from our conversations together with those in the literature on excellent and outstanding care, we found that we could identify a set of common features. These features seemed to cut across different care settings and were consistent over time.  

For example, excellent leadership, which fosters an inclusive culture, and values and empowers staff, was widely recognised as fundamental to the delivery of outstanding care. This is partly about leaders’ ability to unite services and organisations behind a set of values that prioritise excellent care with, as one CQC stakeholder told us, ‘everybody... pointing in the same direction’. There was also a consensus across our research that outstanding care happens where there is a focus on learning and improvement. This was again linked with leadership and organisational culture; the evidence highlights the importance of a culture which promotes continuous reflection and learning, and an environment where staff feel empowered to try new things. 

The idea of being ‘innovative’ was considered by some as the hallmark of an outstanding service, although as one CQC stakeholder told us: ‘Innovation is important but… it’s not about the odd thing being done… outstanding should be across the board, not just one “whizzy” element.’ This connects with a broader theme in our research about the importance of consistency, and the extent to which the ways of working described above are embedded. For some, this consistency was critical in pushing care from good to outstanding. 

But the most prominent theme in our research was the idea that outstanding care is care which is truly person centred. The concept of person-centred care was described by the people we spoke to in different ways, and there are various definitions in the literature. But the idea that care can only be outstanding when it recognises the needs and preferences of the individual – when it ‘sees the whole person’ – came through time and time again. As one expert by experience put it: ‘To me, outstanding care is understanding and knowing the person as an individual…’ Many of the people who described this type of care spoke about the staff who delivered it, suggesting that person-centred care happens when staff build genuine connections with those they care for, remaining constantly curious about what is most important to them and the people around them. 

We found that the features of outstanding care were overlapping and reinforce one another – another reason, perhaps, that it is so difficult to describe. So, can I define outstanding care? Our research did not produce a snappy definition, and I don’t think there is one. But the five principles of outstanding care we developed represent one of the first attempts to bring together a range of perspectives on outstanding care, capturing its many, interlinked ingredients, with person-centred care at its heart.  We hope they will support CQC inspectors in making consistent judgements, aid decision making in CQC quality panels where ratings are ‘on the cusp’ between good and outstanding, and support providers developing improvement strategies by capturing, as one provider described it, ‘what we are aiming for’. 

How would you define ‘outstanding’ care? Tell us your thoughts in the comments.