Exploring CQC’s well-led domain

Following the Francis Report into the failures of care at Mid Staffordshire NHS Foundation Trust, and the government’s response to the report, the Care Quality Commission (CQC) has introduced a more rigorous and wide-ranging approach to inspecting health care providers. The main purpose of inspections is to assess the quality of care delivered to patients. In making this assessment, CQC now also analyses the leadership and organisational culture of providers.

The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. These lines of enquiry derive from research undertaken by staff at The King’s Fund and the Center for Creative Leadership into leadership and culture and draw on a strong evidence base.

Key findings

The five areas that boards should focus on to ensure their organisation is well-led are:

• inspiring vision – developing a compelling vision and narrative

• governance – ensuring clear accountabilities and effective processes to measure performance and address concerns

• leadership, culture and values – developing open and transparent cultures focused on improving quality

• staff and patient engagement – focusing on engaging all staff and valuing patients’ views and experience

• learning and innovation – focusing on continuous learning, innovation and improvement.

This paper sets out what boards can do in these five areas and draws on examples of good practice in leadership and culture in health care. It has been written as a practical guide for board members in strengthening leadership and culture and in preparing for CQC inspections.

How can we help?

Leaders need to achieve shared agreement about the direction of the organisation, align people around this vision, and get commitment from all staff to make its success a reality. Part of the answer can be found in the development of leadership strategies within NHS organisations that encompass not only the development of individual leaders but also the development of collective capability in the organisation as a whole.