The late Claire Rayner, as president of the Patients Association, was passionate about nursing and the nurse’s role in providing high quality, compassionate care in all settings.
Healthcare providers can achieve this through QIPP - Quality, Innovation, Productivity, Prevention - and work with teams to ensure that nursing is influential and effective.
The High Impact Actions and the Productive Ward scheme can enable us to make sustainable changes. By setting targets such as eliminating pressure ulcers, reducing falls among older people and reducing sickness absence, these tools can help us contribute to QIPP priorities. They also help us identify risks. As falls, pressure ulcers and infections result in a poor patient experience, longer hospital stays and poorer clinical outcomes, early identification of risk is crucial.
Health secretary Andrew Lansley has a saying: “No decision about me, without me.” At Chelsea and Westminster, patients are asked what they think of their care; they often did not feel involved in decisions about it.
Clinical effectiveness is about measuring activities and benchmarking performance; nurses have a role in this through auditing the effects of the High Impact Actions. We focused on pressure ulcers and urinary tract infections.
The environment should encourage innovation. This is about ideas that will improve patient care and experience. Each year organisations have to produce business plans that set out their objectives; everyone should feel able to contribute to achieving these through innovation. As frontline staff, you understand just how systems affect both patients and pathways.
‘Nurses need to take on leadership roles and expand their scope of influence’
One of our senior nurses realised that the operating theatre could work in a more productive manner. Patients who arrived on the day of surgery were sent to any available bed, causing a “safari” ward round for the anaesthetist and late calls for a porter that, ultimately, led to a late theatre start time. She secured some capital to convert a room to receive surgical admissions. The pathway was redesigned with two patients providing advice from their perspective. Portering time was saved by patients walking to theatre and theatres now start on time - this has proved to be a success for patients, clinical teams and the trust’s reputation.
We must also demonstrate value for money. While this can be about procurement, it is also about deploying staff, which could include rostering and managing sickness absence.
Highly trained nurses need to take on leadership roles and expand their scope of influence. Healthcare assistants have much to offer and are able to provide care and compassion just as well as a nurse can. As one healthcare assistant said to me: “I try to provide the same environment to patients as I do for visitors to my home.” She works in an elderly care ward where patients are often frail and their relatives are, naturally, anxious. Her contribution is essential.
By focusing on the High Impact Actions - particularly falls, pressure ulcers, discharge planning and infection control - ward nurses can improve productivity by ensuring that length of stay is kept to a minimum and discharge is not delayed. We all promote public health. Effectiveness here is linked to less hospitalisation.
Many organisations will be focusing on cutting costs. By focusing on QIPP, we can achieve efficiencies in a less painful way, while improving services. Nurses are central to this.