CAREMORE is a registered and award winning method of collaborative commissioning developed by the National Collaborative Commissioning Unit based within NHS Wales.
At the heart of the CAREMORE method is a commitment to real collaboration and coproduction with the people who have a stake in the service area. As such the methods that are used in the production of a shared framework involve widespread engagement, data collection, distributed sensemaking and the design and delivery of a series of participative development sessions with stakeholders. These workshops create the space for participants to share learning; test challenge and evaluate the products; and update, amend and literally compose the detailed specifications within what becomes a published Quality and Delivery Framework: guided and supported by an expert Production Team.
The Quality and Delivery Framework (QDF)
In short, a QDF will describe a comprehensive specification for delivering high quality services within a structure that incorporates from the outset and enables in the long term, rigorous evaluation. However, the production of a QDF itself is not the purpose of the work. The purpose is to engage with the people who experience and deliver services. The production team must ensure that local delivery teams can participate and coproduce the QDF providing dedicated support, coordination and expertise throughout the process. Therefore, from its initiation the QDF is designed to continue to develop and evolve beyond the initial production stages, providing local operational and strategic management with a robust and sustainable method for delivering, monitoring and improving services going forward.
A Quality and Delivery Framework delivers a series of products within the CAREMORE® methodology:
|Care standards||An evidenced set of care standards to ensure that the right expectations are defined for quality and safety|
|Activities||An accurate description of the activities to ensure that the right capacity is available to meet the right demand|
|Resource Envelope||A comprehensive description of the assets which may be utilised and affected with the ambition of making the best use of all existing resources|
|Model of care||A common high level model of care to ensure that people can access the right staff, at the right place, at the right time|
|Operational arrangements||The establishment of robust local mechanisms to ensure effective delivery with the right interaction between the public, professionals and organisations|
|Review of performance||An agreed system of performance measurement to ensure the right monitoring and management to deliver continuous improvement|
|Evaluation||An agreed set of methods and criteria for judging the achievement of the right outcomes, from the right experience, at the right cost|
Information is gathered in each section of CAREMORE to create a rich and granular description of the service. As this description becomes more complete and refined the products reach a level of maturity that is signed off by the participants and added to the Framework, in the form of a series of discrete documents called Schedules. The production follows a three stage process:
- A baseline evaluation of readiness and recommendations for full implementation
- Full production and implementation of the QDF based on the recommendations.
- Handover to be embedded locally as the ongoing management arrangement.
This may seem a little old school, but the QDF begins life as a simple physical Workbook: a folder structured into CAREMORE and given to participants as a sensible and simple way to collate information. Therefore, its contents are always draft reflecting the latest position from within the development process.
The Workbook is a development tool and is iterated in many places, many times throughout the project. As area of the Framework become sufficiently mature, they inform the development of Schedules that are signed off and adopted as formal products within the Framework. Effectively the workbook eventually becomes the framework. The central production team maintain a master copy and distribute updates, but we have found that people really own and personalise their own workbook throughout the project. For each section of CAREMORE the blank workbook contains a number of standard explanations and open questions:
- What is the intended product?
- What is the reason for defining (the section)?
- What are the guiding principles in developing …
- What work has been undertaken on …
- What are the key questions to understand …
- What else should be considered within …
- Working Examples
- Draft Schedules
The development process begins with a very simple set of initial production documents that are appended to the workbook:
- Baseline Questionnaire
- QDF Index
- CAREMORE Plan on a Page
The questionnaire is designed to begin the process of engagement with local teams and prompt participants to think about the sections of a CAREMORE Framework. Initial responses often identify existing structures, documents and practice that are added to the Reference Materials in each section of the Workbook. Occasionally, participants cannot answer some of the questions and that in itself helps to focus attention on the area of quality and delivery that require greatest development.
A high level explanatory video is available here:
The most critical factor in the successful production and implementation of the QDF is the commitment to collaboration. Stakeholders should understand, accept and commit to leveraging the entire production process as an opportunity for personal and team development for all those involved. This requires a small dedicated resource but more importantly the freedom for anyone interested, to participate.
As such, the baseline evaluation is not a review of performance. It is a knowledge gathering exercise, to describe in detail the current structure of the service in terms of the demands placed upon it and its capacity to respond. We have learned that sticking to this discipline is critical, albeit difficult, to stay focussed on the descriptive space and avoid from the beginning, the natural tendency to judge the worthiness of that description. Stage 1 delivers a ‘CAREMORE light’ establishing a shadow framework that includes to some degree, just enough information to adequately inform the full QDF production stage. Effectively, this describes a patchwork quilt that we agree to work on, together.
This baseline will identify areas for accelerated development that would prevent or enable successful adoption of the QDF. This may take the form of new information systems or service developments that may be required prior to the completion of Stage 2. This milestone also provides a sensible juncture in the production for sponsors to review progress and provide an opportunity to ensure that the scale, scope and timescales align with strategic priorities, prior to full implementation.
The full production plan at the end of Stage 1 takes into account the readiness of participating organisations and sets out in detail the requirements to tailor the Shadow QDF to the local structures and practices. Stage 2 then combines production the full QDF to a high degree of maturity with its practical, operational implementation with service delivery teams. The level of detail and timescales are clearly dependent on the scale and scope of the service area.
CAREMORE is not just a casual acronym, it is a logical structure that formalises a way of collating information to create a transparent and detailed description of service and how that service is to be delivered and monitored. The first stage produces a Baseline Evaluation that informs a shadow framework. The second stage produces a Framework Agreement that provides local teams with a practical structure for the third stage, embedding the discipline of CAREMORE into the ongoing and sustainable management and improvement of a service.
Stage 1: Conduct Baseline Evaluation
Produce Baseline Evaluation Report
Sponsor to consider report and recommendations to proceed to Stage 2
Outline timescale for Stage 1 is 6 to 9 Months from initiation
Stage 2: Establish QDF Task & Finish Group
Production of full QDF Schedules
Signed Quality & Delivery Framework Agreement in place
Outline timescale for Stage 2 is 9 to 12 Months from initiation
This product development is outlined on the Production Matrix below, with the Product Flow identified in Purple. Stage 3 is bespoke to each programme and each individual participant as the shadow QDF is replaced by the QDF Agreement that is formally adopted into ‘business as usual’.