Variations in practice must be eliminated to drive up quality care and cut costs. Nurses are ideally placed to lead this challenge, argue Katherine Fenton and Julie Halliday
The dual challenge for nurses and midwives of improving quality and productivity in the NHS is arguably more important now than ever before. The last decade has seen unprecedented investment in the NHS, rising to £118bn in 2010-11. This investment was to improve outcomes while also improving productivity.
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The coalition government is committed to reducing the national deficit; all public services, including the NHS, are to play their part in this.
Our plea is that rather than respond to others leading the quality and productivity challenge, nurses and midwives should take the lead. Those who have experienced the slash and burn method will welcome alternatives that keep patients at the heart of services and improve quality while also delivering cost reductions.
Poor quality is common and costly and the need to respond quickly is imperative. Given the size of the challenge, nurses at or close to the front line are extremely well placed to respond. There is evidence supporting the view that savings can accrue from quality improvements, which is where the eight high impact actions for nursing and midwifery come to the fore.
We know that nurses and midwives can lead change and innovate to improve services for patients - but we also know there are undesirable variations in practice and standards, sometimes between wards in the same hospital or between different community nursing teams. We also know that one in 10 patients admitted to NHS care are harmed.
There is strong clinical evidence on what works best, so why is this not universally applied? Just think what nurses and midwives could achieve for patients if this variation and harm could be eliminated. And then consider the options if we do not do so.
The high impact actions, launched last November, are being led jointly by the Department of Health, strategic health authority chief nurses and the NHS Institute for Innovation and Improvement. The NHS Institute published The Essential Collection on 28 June to inspire nurses and midwives and provide a range of live examples where quality has been improved and costs cut. The eight actions are not new, but their universal implementation could reduce variations and reduce the costs associated with poor quality.
We should not assume all nurses and midwives are equipped for the challenges; improvement skills, including learning how to measure what we do, play a part. A refresher on the current key aspects of best practice in the eight actions is planned.
We want to make variations in practice and unnecessary harm things of the past. We all have a common aim: that whether patients are admitted to hospital or cared for at home, they all experience the highest quality of care.
Everything has its time - the time has come for nurses and midwives to take a lead in improving quality and reducing cost simultaneously.
Whether you take up the high impact actions or other alternatives, we look forward to seeing the benefits gained as a result of nurses and midwives showing what they are capable of.
KATHERINE FENTON is chief nurse and director of clinical standards and workforce; JULIE HALLIDAY is director of implementation, high impact actions for nursing and midwifery; both at NHS South Central.
- Click here for the Practice Review article on one of the eight actions, nurse led discharge