1.8 Discuss the importance of reviewing and evaluating decisions made and the decision-making process to improve quality

This guide will help you answer 1.8 Discuss the importance of reviewing and evaluating decisions made and the decision-making process to improve quality.

Reviewing and evaluating decisions is a process that strengthens the quality of care in adult care settings. Leadership often involves making choices that affect people’s wellbeing, staff morale and organisational outcomes. By taking the time to look back and examine how and why decisions were made, and the impact these have had, you build a foundation for ongoing improvement. This is expected at Level 5. You are not just responsible for making choices, but for ensuring that those choices lead to the best possible results.

Why Reviewing Decisions Matters

Every decision in adult care has consequences. These might relate to service user safety, staff workloads, resource use, or safeguarding. Looking back on decisions helps you:

• See if your actions had the intended impact
• Spot any unexpected problems
• Find ways to prevent the same mistakes in the future
• Recognise and repeat what worked well

This reflective approach supports high standards and keeps people at the centre of what you do.

Legal and Regulatory Demands

Health and social care services in the UK operate within strict rules. The Care Quality Commission (CQC), local authorities and funding bodies require clear evidence that you monitor and improve outcomes. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out requirements to assess, monitor and mitigate risks relating to the health, safety and welfare of people using the service.

Failure to review and evaluate decision-making can:

• Put people at risk
• Lead to poor inspection ratings
• Bring legal or regulatory action against your service

This creates a strong incentive for leaders to put review systems in place.

Improving Quality through Regular Evaluation

Quality in adult care means meeting or exceeding the standards expected by people who use services, their families, staff and inspectors. Reviewing and evaluating decisions helps drive up quality in a number of ways.

Identifying What Works

Every setting and every situation is different. Approaches that succeed in one care home, for example, might fail in another. By analysing the outcomes of your decisions, you can:

• Build on best practice specific to your service
• Learn from successes
• Spread effective approaches to other areas

Highlighting Areas for Improvement

Even a well-reasoned choice may not lead to the best results. Evaluating decisions helps uncover areas where:

• Further staff training is needed
• Procedures could be safer or more efficient
• Communication could improve

This ongoing feedback loop supports a culture where quality is always developing.

Adapting to Change

Adult care services face constant shifts – in the health of service users, organisational priorities, legislation and available resources. Reviewing past choices lets you:

• Respond effectively to new challenges
• Adjust your decision-making process in light of fresh evidence or events
• Stay flexible and resilient

Building Accountability and Trust

Transparent evaluation of decisions builds trust within a team and with people who use the service. When workers know that every big choice is reviewed and explained, they:

• Feel respected and involved
• Can voice concerns or ideas
• Are more likely to buy into action plans

At the same time, service users and relatives develop confidence that the organisation is capable, safe and responsive.

Encouraging Reflective Practice

Reflective practice means thinking carefully about your own actions and their effects. Leaders who build evaluation into daily work encourage staff to:

• Question their own decisions
• Share insight without fear of blame
• Learn from mistakes

Reflective practice strengthens leadership at all levels and makes continuous improvement a reality rather than just a goal.

Accountability to Stakeholders

Decisions in adult care can affect a wide range of people and agencies. Stakeholders may include:

• Service users and their families
• Frontline staff and managers
• Local authority commissioners
• NHS partners
• Regulators (such as CQC)
• Voluntary organisations

Each group has a stake in how well decisions are made and reviewed. Involving them in the review and evaluation process can:

• Make sure all viewpoints are considered
• Lead to more balanced, inclusive decisions
• Improve relationships with inspectors and partners

Methods for Reviewing Decisions

Systematic review is the backbone of improvement. Here are some ways leaders go about it:

Audits

Regular audits check whether you are meeting agreed standards. Audits may focus on areas like medication management, infection control, care planning or staff training. By reviewing the results, you can:

• Track progress
• Benchmark against similar services
• Highlight priority areas for change

Team Meetings

Discussing major decisions, incidents or complaints at team meetings encourages open communication. You might:

• Use case studies to look at decision-making step by step
• Ask what went well and what could be improved
• Invite staff at all levels to contribute

Supervision Sessions

Individual and group supervision provides a private, structured setting for review. Here, you can:

• Support staff to reflect on key decisions
• Explore the impact of choices on people receiving care
• Agree actions for future development

Incident Investigation

When things go wrong, investigation is needed. This involves:

• Gathering all available evidence (records, witness statements, policies)
• Analysing what led to the decision and its outcome
• Identifying how similar situations could be managed better

Surveys and Feedback

Collecting feedback from staff, service users and families highlights the effects of big decisions. Surveys, suggestion boxes or informal chats all provide useful information.

Policy Review

Regular reviews of policies and procedures guide big decisions in everyday practice. Checking these for gaps or weaknesses is essential.

Evaluating the Decision-Making Process Itself

It is not enough to look only at what was decided. Leaders must think about how decisions are made – and who is involved. This means:

• Checking whether the right people are consulted
• Ensuring staff and service users can raise concerns or viewpoints
• Reviewing the information available at the time
• Considering how pressures (like workload, budgets or deadlines) affected the choice

A good evaluation looks at both outcome and process.

Common Barriers to Reviewing and Evaluating

Some leaders are reluctant to review decisions because they worry it will lead to blame, conflict or extra work. Typical barriers include:

• Lack of time or resources
• Limited staff engagement
• Inadequate records or data
• Defensive workplace cultures

Overcoming these blocks means building a supportive, non-punitive approach where evaluation is a normal part of the job.

Building a Culture of Continuous Improvement

Services with a “learning culture” see mistakes or poor outcomes as opportunities to grow.

You can encourage this by:

• Celebrating when staff share learning from decisions that didn’t go as planned
• Making regular review part of everyday practice
• Providing training on reflective skills
• Showing strong leadership and modelling openness to feedback

Using Lessons Learned to Improve Quality

Once you have evaluated a decision and the process, the most important step is to act on what you learn. This might mean:

• Updating policies or procedures
• Providing additional training
• Introducing better communication systems
• Involving staff, service users or families in decision-making going forward

Change is hard without strong leadership to carry it through. Recognising and rewarding positive change helps improvement stick.

Tools and Frameworks

There are several established approaches to reviewing and evaluating decisions that you may find useful:

Root Cause Analysis

A method for drilling into why something happened, especially after incidents. It avoids blame and focuses on finding causes to prevent recurrence.

Plan-Do-Study-Act (PDSA) Cycle

A four-stage cycle for making improvement part of everyday work:

• Plan: Identify a goal and plan the change
• Do: Put the change in place
• Study: Review what happened
• Act: Refine the change and start again

SWOT Analysis

Standing for Strengths, Weaknesses, Opportunities and Threats. This tool helps you take a balanced view when looking at complex decisions.

Regulatory Expectations

The CQC expects providers to be proactive in monitoring and improving quality. Their inspection framework expects you to:

• Have clear systems for reviewing care and making changes
• Collect and act on feedback from people using the service and staff
• Show evidence of reflection, learning, and improvement in practice

Being able to discuss and show how you regularly review decisions is an important part of leadership practice.

Promoting Inclusion and Empowerment

Reviewing decisions helps promote dignity, independence and choice. Involving service users directly, or through advocates, improves outcomes and shows respect. This:

• Encourages communication and feedback
• Reduces complaints and safeguarding issues
• Supports person-centred care

Final Thoughts

Reviewing and evaluating decisions is about learning from experience, not placing blame. Leaders who do this well create safer, more effective, and happier adult care settings.

Reflective, evidence-based management will support you in meeting and exceeding the requirements of your Level 5 role. It will also make a real difference to the lives of people using your service.