Quality Assurance in Dementia Services: From Assurance to Improvement
Quality assurance (QA) in dementia services is most effective when it goes beyond reassurance and actively improves practice. A well-designed outcomes, evidence and quality assurance framework provides leaders with confidence and staff with clarity, while alignment with dementia service models ensures QA activity reflects how care is actually delivered. This article sets out how to build a QA system that identifies risk early, embeds learning and supports continuous improvement.
What quality assurance really means in dementia care
QA is not just auditing. It is the system by which leaders know:
- Care is safe, person-centred and lawful.
- Risks are identified and managed proportionately.
- Learning is embedded and sustained.
Core components of a dementia QA framework
Most effective frameworks include:
- Performance dashboards and KPIs.
- Audit and observation programmes.
- Incident, complaint and feedback review.
- Governance oversight and escalation routes.
Operational example 1: QA identifies early deterioration
Context: Several people experienced sudden health deterioration without clear early warning.
Support approach: QA reviews linked daily records, incident reports and clinical escalation logs.
Day-to-day delivery detail: The service identified gaps in recording subtle changes (hydration, appetite, confusion). Staff were coached to record and escalate early indicators.
How effectiveness is evidenced: Earlier interventions increased, and unplanned admissions reduced.
Operational example 2: QA driving safer restrictive practice
Context: Low-level restrictions were in place but not consistently reviewed.
Support approach: QA checks focused on authorisation, review dates and alternatives.
Day-to-day delivery detail: Reviews were embedded into monthly governance, with staff encouraged to trial less restrictive options.
How effectiveness is evidenced: Restrictions reduced, review compliance improved, and staff confidence increased.
Operational example 3: QA improving supervision quality
Context: Supervision occurred regularly but lacked reflective depth.
Support approach: QA reviewed supervision content against practice issues and incidents.
Day-to-day delivery detail: Supervisors used real scenarios to reflect on decision-making, risk and communication.
How effectiveness is evidenced: Staff practice improved and repeat issues reduced.
From assurance to improvement
QA must feed into action. Effective systems ensure:
- Clear ownership of actions.
- Time-bound review and re-testing.
- Escalation of persistent risks.
Commissioner expectation
Commissioners expect QA systems that identify risk early and demonstrate learning and improvement over time.
Regulator / inspector expectation (CQC)
CQC expects robust governance, effective oversight and clear evidence that QA activity improves care quality and safety.
Why strong QA matters
Strong QA systems provide confidence: to leaders, commissioners, inspectors and families. Most importantly, they ensure dementia care is safer, more consistent and more humane.