Evaluation through measurement is key to improving quality but how ready are we to be transparent about nursing performance, asks Anne Cooper.
The aspects of nursing that really matter to patients, such as kindness and compassion, are difficult to record and as a result we have difficulty assessing performance.
This presents a challenge when we are increasingly expected to show evidence of outcomes. So how can we be transparent when so much of what we do is difficult to quantify?
We have known about this issue for some time. An excellent report from King’s College London set out some of the challenges (Griffiths et al, 2008). The report noted that “neither effectiveness (positive contributions to wellbeing) nor compassion (elements of patient experience) are strongly represented in the existing measures”.
Moving on from the report, we now have the NHS Outcomes Framework (Department of Health, 2011), which already specifies an outcome measure for pressure ulcers. More metrics are likely to develop that are close to the ones detailed in the King’s College report, which informed the list of high impact actions for nursing and midwifery (NHS Institute for Innovation and Improvement, undated). The safety thermometer work gives more information at tinyurl.com/nhs-safety.
Good work is also taking place in the North West, where nurses’ performance is to be exposed to routine public scrutiny for the first time under a “transparency” pilot scheme (Ford, 2012).
I have no doubt that transparency in public services is a good thing.
Nurses and midwives should be able to demonstrate publicly that they are providing quality services and be able to benchmark their performance.
I’ve always believed that evaluation through measurement is key to improving quality. High-performing teams should be able to explain how they are performing and it should include the aspects of care that matter not just to managers but more specifically to patients.
We need to start considering how ready we are to be transparent about nursing performance. Do we have robust data-collection systems that are accurate and consistent? Are we capitalising on technology to reduce the burden of data collection so that showing our performance doesn’t take us away from actual care delivery?
Some of these questions are difficult and demand creative thinking and new ways of working.
Finally, we need to continue thinking about how we capture what matters about nursing and midwifery to our patients. If you look at what patients say in the feedback about nursing through NHS Choices (www.nhs.uk) or Patient Opinion (www.patientopinion.org.uk), they are not usually commenting on MRSA or falls; yet our performance measures often focus solely on these types of issues.
The fact is both aspects matter, so how can we capture and measure the things that really matter to patients? Issues like their confidence in the nurse caring for them, the professionalism of the team, and how they are spoken to?
This is, I believe, the real challenge in moving from the invisible to the visible. If we do this, we will be able to shine a light on the things nurses do really well and that have such a big impact on patients.
Anne Cooper is national clinical lead for nursing, informatics directorate, Department of Health.
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Department of Health (2011) The NHS Outcomes Framework 2012/13.
Ford S (2012) Nurses face increased public scrutiny. Nursing Times, 6 March 2012.
Griffiths P et al (2008) State of the Art Metrics for Nursing: A Rapid Appraisal.
NHS Institute for Innovation and Improvement (undated) High Impact Actions for Nursing and Midwifery. High Impact Actions: The Essential Collection.