Quality at the service of mental health Dr Louise Boulter and Leslie McDonald share the benefits of a quality assurance approach to continuous improvement in a mental health charity. Mental health issues in the workplace are becoming more prevalent and equate to a cost of £3.6bn in the UK. Competing service priorities, juggling budgets during times of reduced resources, and a shifting sands approach to national and local policy means access to NHS mental health services is not straightforward. This is where the provision of a quality-driven counselling service by the charity Nottingham Counselling Service is making a meaningful contribution to the local and national community. Nottingham Counselling Service’s journey to excellence Established in 1875, Nottingham Counselling Service (NCS) provides therapy and support for adults living, studying and working in Nottinghamshire and in the East Midlands. The charity is recognised for its technical competence in providing psychotherapy through its British Association for Counselling and Psychotherapy (BACP) accreditation, and for the past several years has enjoyed a client satisfaction rate of 95% for the quality of its client therapy. However, it was only recently, in August 2018, that NCS realised its quality ambitions through accreditation to ISO 9001:2015 ‘Quality management systems’ and BS 76000 ‘Valuing people management system’. NCS believes the two standards are complementary and supportive. ISO 9001:2015 provides a robust frame for consistency and efficiency in service delivery, while BS 76000 ensures the charity nurtures and develops the talents of staff and volunteers. Despite ongoing challenges, including the global financial crises and associated austerity with a wholesale cut in the charity’s funding, NCS Executive Director Leslie McDonald was determined to meet his commitment to NCS’ formal strategic five-year plan, which was accreditation to recognised quality assurance standards. The charity’s journey to accreditation commenced with McDonald getting buy-in from key stakeholders including staff and counsellors by engaging them in the process, addressing any fears they might have and explaining how a quality management system (QMS) would positively impact their role and bring benefits to the work they do. To attain NCS’ quality ambitions, a quality management consultant was carefully selected, in line with the charity’s values, to support NCS’ implementation of a robust QMS. As part of this journey, NCS developed a quality manual, and established a quality management team with responsibility for overseeing the implementation of the new QMS. “Before ISO 9001 accreditation, there was, on average, around 33 client referrals per month. This has now increased to around 76” Early benefits from accreditation Since accreditation, NCS has experienced a number of early and significant benefits. One improvement introduced as part of the charity’s QMS is a standard practice log that captures information about NCS counsellors’ activities including clinical psychotherapy mode and number of hours spent with a client. This information is important because it provides NCS with data to measure the effectiveness of its counsellors’ clinical approach and the value of the work the charity does, including the contribution towards savings to mainstream NHS money. This information can now be incorporated within any bid for funding, signalling the effectiveness of the charity’s quality approach. The QMS also formally requires counsellors to track clients’ progression and is helping to drive improvements in clients’ successful progression towards improved mental health. All counsellors are required to use an intelligent software tool that tracks therapeutic approach and clients’ progression as measured by clinical outcomes. This data is now used to provide useful information regarding alignment between clients’ mental health problem and therapeutic approach. Importantly, it also helps identify where a client is progressing successfully but therapy continues, which may indicate a client’s unhealthy attachment to a therapist. Overall, the QMS is helping NCS understand the best approach in providing a client with an effective clinical journey towards good mental well-being, recovery, change and resilience. There is also now a standard operating procedure for client referral. Before ISO 9001 accreditation, there was, on average, around 33 client referrals per month. This has now increased to around 76, which is an indication that having a standard operating procedure pays dividends, given the process is more user friendly and prevents referrals to inadvertently fall through the cracks. In addition to the above benefits,accreditation to ISO 9001 and BS 76000 will continue to support NCS by: Assuring key stakeholders, including clients, staff, donors and the Charity Commission, are aware of the charity’s excellent governance. Giving counsellors, clients, commissioners and private sector organisations confidence in NCS’ commitment to providing a quality service to clients. Assuring clients that they have come to the right organisation. Putting NCS in a strong position to respond to tenders by having an internationally recognised and auditable QMS. Enabling NCS to manage its resources more effectively. Having efficient and effective standard operating procedures which enable counsellors to focus on the most important thing, which is improving clients’ mental well-being. Enabling NCS to continuously improve its service by regularly reviewing key processes that impact customer satisfaction. The benefits achieved by NCS demonstrate the value that quality can have on the third sector. The charity believes quality professionals can play a key role in educating and supporting small charities about the value of quality management practices. For instance, quality professionals can offer to do pro-bono work, such as volunteering to work on a quality project, to help a charity improve its service quality through improved processes, or offer to be trustees in order to champion a charity along the quality journey. NCS CEO’s top tips for realising quality aspirations Make a formal commitment to quality in your strategic plans so that quality becomes your way of ‘doing things’. Senior managers need to articulate their vision to staff, and other stakeholders about how the quality system will benefit the organisation as a whole and also organisation governance. Staff have intimate process knowledge. Get them to draw out current key processes and ask them to agree measures/improvements. Find as much information as possible on various quality approaches and quality standards. Establish which ones are the right ones for your organisation and why. Don’t be shy to ask other organisations about their experience and gain knowledge from their approach. Dr Louise Boulter is a Trustee of Nottingham Counselling Service, and a Senior Lecturer and Programme Leader in the Business School at Middlesex University London. She is the academic adviser to the CQI Advisory Council and has application knowledge of quality approaches, having gone through ISO lead auditor and European Foundation for Quality Management (EFQM) training. Leslie McDonald is Executive Director at Nottingham Counselling Service. He has over 30 years’ experience in senior management roles including SME development and is a member of the Nottingham City, Health and Wellbeing, representing the voice of the third sector. This article is published with permission from the CQI, and first appeared in the CQI’s membership magazine Quality World, December 2018. You can also open this article as a PDF.