Reflections from St Columba’s Hospice Care in Edinburgh on being the first Hospice to achieve three exceptional grades by Healthcare Improvement Scotland
St Columba’s Hospice Care in Edinburgh had an extensive two-day inspection carried out by its regulator, Healthcare Improvement Scotland (HIS), on 17-18 April 2024.
Overall, HIS inspections focus on ensuring that independent health services in Scotland are person-centred, safe, well led, and complying with the necessary standards and regulations.
Evaluating independent health services in Scotland against its Quality Assurance Framework and the National Health Services (Scotland) Act 1978, HIS assessed the Hospice against three key areas:
• Direction: How clear is the service’s vision and purpose and how supportive is its leadership and culture?
• Implementation and delivery: How well does the service engage with its stakeholders and manage/improve its performance?
• Results: How well has the service demonstrated that it provides safe, person-centred care?
The Hospice was awarded an ‘Exceptional’ grade across all areas for all quality indicators reviewed during this unannounced visit.
The inspection highlighted a clear vision and purpose, effective leadership, robust processes and procedures and an excellent quality of care delivered both in the Hospice and in the community.
Below we outline the summary findings for each of these areas alongside illustrative feedback from staff, patients and families.
Direction: How clear is the service’s vision and purpose and how supportive is its leadership and culture?
HIS summary findings:
“The service has a strategic plan, which clearly sets out the hospice strategy, including its culture, values and strategic aims.
A performance review system helped measure how the service performed. A governance framework was in place with clear structures. Leadership was visible and staff felt able to speak up. A shared leadership involved all staff participating in a wide range of aspects of the service.”
In 2022, we redesigned our internal leadership structure in partnership with staff and moved to a model of distributed shared leadership. Staff feedback included:
“There is a positive culture at the hospice. I believe this is shown working with our colleagues we are interested in supporting each other and our wellbeing.”
Implementation and delivery: How well does the service engage with its stakeholders and manage/improve its performance?
HIS summary findings:
“The service has expanded significantly in the last 5 years, initially responding to patients whose care was impacted by the pandemic.
It has developed a hospice at home service to respond to patients wanting to be cared for and to die at home.
Patients, families and staff are widely engaged.
Effective processes and procedures helped support the safe delivery of care. Staff and volunteers were recruited appropriately, with evidence of staff support and training. Risk assessments and an audit programme were in place. ”
Our Hospice-at-Home team has recently developed a Virtual Ward Service. Evaluation findings from the pilot service development have been shared widely with other palliative care providers within and beyond Scotland and have already informed similar developments in other hospice care provisions in Edinburgh.
During the inspection, staff commented:
“I work in a very open team and make regular suggestions to my managers about our team processes.
”Official Results: How well has the service demonstrated that it provides safe, person- centred care?
HIS summary findings: “The environment was clean, uncluttered and in a good state of repair. Patient and staff areas were decorated to promote a feeling of calm and tranquillity.
Staff working in the service spoke positively about their experience of working there and felt supported and valued. All staff we spoke with were enthusiastic about the service.
A thorough process was in place of recording the patient’s journey while in the care of the hospice. Patients and families told us the care they received was ‘excellent’.”
St Columba’s commitment to person-centred care was evident in all aspects of care. Professionals across hospice teams are having conversations with patients and families to understand what matters to them and how best the hospice can support not only their physical but also their psychological, social and spiritual needs and interests.
Patients and families who spoke with HIS inspectors said:
“Staff go out of their way to help you. ”
“Excellent care. ”
“A happy place. ”
Throughout the inspection, staff spoke enthusiastically about the Hospice and its new service developments. They felt supported and proud to work for, and with, the Hospice.
Comments included:
“I feel extremely proud to work at the hospice and I believe strongly the service we provide is important and delivered to high standards. ”
“I would whole heartedly recommend the Hospice as a very good place to work.”
“I think St Columba’s is a brilliant place to work. ”
To our knowledge, this is the first time a hospice in Scotland has been awarded three individual awards of exceptional leading to an overall exceptional award!
Dot Partington, Deputy CEO of St Columba’s Hospice Care, said:
“I am incredibly proud to see this HIS Inspection report for St Columba’s Hospice Care published. Like most organisations, we’ve been through a challenging few years and the exceptional quality of care described in the report, is a result of the dedication, expertise and unwavering commitment of our staff and volunteers.
Every day, we focus on supporting the individual needs of people acrossOfficial Edinburgh and the Lothians facing the impact of life-limiting illnesses and their families. To have this care rated as exceptional reflects the compassion and dedication that we all put into our work, so I’d like to thank our outstanding team for their hard work, adaptability and dedication.”
Jon Heggie, Director of Income Generation, said:
“I am delighted to see the results of this inspection, the team work tirelessly to deliver services throughout the community so it’s great to see everyone’s efforts recognised in this way.
I think it’s important to highlight that with just 24% of our running costs funded by the government, results like this wouldn’t be possible without the generosity of our amazing supporters and local community. Without them, we wouldn’t be able to provide our vital services across Edinburgh and the Lothians.”
The inspectors commended our person-centred approach to care, our team working and how we embed our values in our day-to-day culture. This is a reminder that being ‘exceptional’ is not about the two days of the inspection visit. It is about everything a hospice does daily, the services it delivers, and the impact it has in their local community.
Although no requirements or recommendations were made by the inspectors, we know there is always room to become better.
As Maya Angelou, American civil rights activist, once said, “Do the best you can until you know better. Then when you know better, do better.”
Commitment to exceptional care requires an organisation that is willing to lead, to take risks, and to pause and make space for listening to the changing needs of its community and the shifting landscape of healthcare.
As we celebrate the ‘exceptional’ results of our recent inspection, we move forward with courage, curiosity and care to launching our new strategy in October 2024. This new three-year strategy will lead us into our 50th anniversary as the first modern hospice in Scotland.
References:
The full inspection report by Healthcare Improvement Scotland is available on our website:
https://stcolumbashospice.org.uk/who-we-are/how-we-run/key-documents
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