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Practice comment

Metrics enable the profession to take control of nursing quality

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As the media spotlight focuses on quality of care, nurses need to use metrics to take control of the nursing quality agenda, says Mandie Sunderland

Our reputation as a profession has received an onslaught of unfavourable media attention in recent years. Nursing care has been severely criticised in several television documentaries, Care Quality Commission reports and peaked this summer with the Patients Association’s (2009) report.  

As a nurse with 25 years’ experience, I am extremely saddened by this view. As an executive director of nursing with accountability for the quality of care provided by 4,500 nurses and midwives, I am mindful of my responsibility to assure both my board and the community we serve that nursing care is of the highest standard.

I also think it is important to put all this adverse publicity into perspective. The NHS treats many millions of patients every year, the majority of whom are extremely happy with their experience, and nurses are often instrumental in this – but how do we actively demonstrate that?

The development of a set of nursing metrics by several acute trusts in the north west of England has enabled an increasing number of hospitals across the country to implement a simple but effective method of providing such assurance and identifying areas of poor performance.

‘Many years of investigating serious untoward incidents and complaints about patient care have shown me that if we getthe process of care right and follow policies and procedures we willprevent virtually all harm to patients’

The metrics encompass seven areas pivotal to delivering high quality nursing, including medicines management, observations and infection control. At Heart of England Foundation Trust we have developed two additional metrics around continence care and end of life care.

All the metrics have been developed using national guidance or recognised best practice. Trusts have tailored them to meet local policies and developed their own reporting mechanisms. However, what is important is that fundamentally we are all measuring the same thing – nationally recognised best practice.

I have had several debates with academic colleagues since the introduction of the metrics about the fact we are measuring process and not outcome. I absolutely agree and make no apologies for that. Many years of investigating serious untoward incidents and complaints about patient care have shown me that if we getthe process of care right and follow policies and procedures we willprevent virtually all harm to patients.

In reality many of the metrics link to alternative data collection processes - such as falls and medication errors - so linking good performance with the metrics should translate into reducing such incidents. Indeed, work from trusts implementing the metrics is showing exactly that.

Quantitative outcome measures are a welcome and necessary tool to measure the efficiency of what we do but we need to recognise that patients’ perceptions are vital measures too. That is why at Heart of England we have linked a patient satisfaction questionnaire on “softer” issues such as privacy and dignity and information about medication into our metrics project to give a more holistic view of quality. The triangulation of data around the process, outcome and patient feedback of onnursing care by individual wards is an extremely powerful performance management tool.

As the largest professional group in the NHS comprising the largest pay bill, and as the only staff group consistently with patients 24 hours a day, seven days a week, we should be demonstrating the quality of care we provide.

Measuring nursing standards and acting on the results are a key leadership function of senior nurses at every level. As a profession we need to take control of nursing quality once again, monitor compliance with best practice and take heed of feedback from patients – if we do not I fear we do so at our peril.

MANDIE SUNDERLAND is chief nurse, Heart of England Foundation Trust, Birmingham

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