Nurses and other healthcare workers do not plan to go to work to do a poor job but, the truth is, care sometimes falls far short of what would be considered high quality.
In recent years there have been too many worrying stories about failures in health systems and failures to deliver even the basic care. Understanding the issues from all levels in an organisation could improve outcomes for patients, reduce harm and provide a fulfilling experience for staff.
So what are the key things that ensure the delivery of consistently high-quality, person-centred care that treats patients with dignity and respect? Recent experiences in Wales suggest constructive approaches can bring about lasting improvements. The most successful activities have been those that are fully owned and valued by frontline staff and where staff are supported and empowered to act by management.
One is the Fundamentals of Care audit tool launched in 2009 and designed for use by ward sisters and charge nurses for inpatient settings. It seeks evidence on performance, including patients’ views, against the 12 standards of essential care (such as communicating and information, and eating and drinking).
Data analysis automatically starts development of local action plans, which staff update; reports are collated organisation wide and used by the its board to monitor performance. Each board’s report is sent to my office annually so I can review performance on a national scale to identify areas that may need a national approach.
The key thing is that audits are done by staff not external inspectors. Compliance is good because staff see it helps them identify strengths and weaknesses in their areas. All boards in Wales think about patient safety and quality of experience; the evidence from the audits is vital to their work because it shares good practice and identifies where support for improvement is needed.
My second example is the 1,000 Lives Campaign. This ran from April 2008 to April 2010, saved 1,199 lives and prevented 50,000 cases of harm in NHS Wales. It has become 1,000 Lives Plus, a national scheme to drive improvements by reducing waste, variation and harm. Patient safety and a greater emphasis on person-centred care are now integral parts of mainstream long-term plans for NHS Wales.
The campaign’s success was empowering frontline staff to make small changes to improve care. This helped establish a culture in which situations are no longer accepted as unavoidable and solutions are sought. It was widely publicised across Wales using a “Count me in” message to engage staff. Successes include:
- The SKIN (Surface, Keep patient moving, Incontinence, Nutrition) checklist of good practices for managing vulnerable patients. This prevented pressure ulcer formation; in one health board alone, dozens of wards reported more than 100 days without a case and one ward over two years;
- Critical care bundles. These have helped reduce central line infections and ventilator- associated pneumonias; several units reported months without any infections;
- The cleaner commode project. This introduced a new cleaning regimen with a tape placed across the clean commode, just like toilets in hotel rooms. Welcomed by patients, this is helping to cut infection.
This analysis is encouraging as it demonstrates that every health worker can do something to improve care. Don’t accept that things are unavoidable or wait for others to act - we can all make a difference.