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Nurses face increased public scrutiny

  • 21 Comments

The performance of nurses is to be exposed to routine public scrutiny for the first time under a “transparency” pilot scheme that senior nurses hope to roll out across the country.

Eight hospital trusts will publish monthly scorecards across five areas of nursing performance (see below for summary). The first batch of data was published on 28 February.

The pilot scheme, set up by NHS North West, is designed to “pioneer a new level of openness” in order to drive improvements in the quality of nursing care.

Trusts around the country have increasingly begun to record and internally share data on nursing performance, often referred to as metrics, over the last few years. But the new pilot is claimed to be the first time such information will be routinely put in the public domain.

Each trust will publish data on the number of falls during the previous month which have resulted in moderate or severe harm and the number of pressure ulcers – grades 2,3 and 4 – acquired after 72 hours of admission. Details of root cause analysis into each pressure ulcer or fall will also be revealed.

In addition, each trust will publish scores for both patient and staff experience. Whenever an incident of harm is recorded, the trust will collect and publish views from 10 patients in the ward that the incident occurred on subjects such as dignity, interaction with nurses and pain control.

Trusts will also collect views from 10 nurses on the relevant ward, asking them about the quality of care they feel they give, their confidence in the ward to care for a loved one and whether they would recommend their ward as a place to work.

The North West Transparency pilot is based on the Energise for Excellence scheme, an existing programme designed to encourage frontline nursing staff to improve care quality through data monitoring and innovation.  

Announcing the start of the pilot, NHS North West chief nurse Jane Cummings said the pilot meant “nurses are reaching a new level of openness and honesty, and reaffirming their commitment to the communities they serve”.

“The North West will be the first region to collaboratively talk to patients and staff about the nursing care that was provided at the times when pressure ulcers and falls have happened,” she said.

But Royal College of Nursing head of policy Howard Catton said it was important to avoid the “blame game” if such performance data was to be made public.

“It’s is absolutely right that nurses are at the forefront of providing patients with more information about their care, however organisations must publicly stand alongside their nurses and provide them with the resources to deliver great care,” he told Nursing Times.

Unison head of nursing Gail Adams warned that concentrating on root cause analysis, such as a drug round being interrupted, failed to “look below the surface” at underlying causal factors such staffing levels and the acuity of the patients.

Toby Knightley-Day, director of Fr3dom Health, a company specialising in NHS data analysis, said issues like staffing levels could be “uncontrollable factors” for nurses to tackle.

He said: “There will be people in teams who contribute to a score without responsibility to enhance or improve it. They are held up as being responsible when they are unable to effect change.”

Mr Knightley-Day cautioned that when performance data was put in the public domain “people will naturally grab hold of one or two headlines” without understanding the context of events.

He said: “Staff need to be given a fair chance to respond and give the context, but are generally denied that opportunity.”

 

Trusts taking part in pilot
Aintree University Hospitals NHS Foundation Trust
Blackpool Teaching Hospitals NHS Foundation Trust
Royal Bolton Hospital NHS Foundation Trust
East Lancashire Hospitals NHS Trust
Liverpool Heart and Chest NHS Foundation Trust
Salford Royal NHS Foundation Trust
St Helens and Knowsley NHS Trust
Wrightington, Wigan and Leigh NHS Foundation Trust

 

Each trust will publish a monthly scorecard showing:

  1. Number of patient falls – This is number of patients who have suffered moderate or severe harm as a result of a fall whilst in hospital.
  2. Number of pressure ulcers – This is the number of grade 2, 3 and 4 pressure ulcers acquired in hospital within 72 hours of hospital admission.
  3. Actions taken to prevent harms in each case – In-depth root cause analysis is undertaken for all pressure ulcers and falls to establish what happened, why it happened and how care can be improved.
  4. Patient Experience – Whenever harm is recorded, trusts collect views from 10 patients in the same ward. Informed by the Patients‟ Association about what matters most to those in NHS care, patients are asked six questions relating to their involvement in treatment decisions and quality of interaction with nurses, their privacy and dignity, control of pain, and nutrition.
  5. Staff experience – Whenever harm is recorded, trusts collect views from 10 nursing staff in the ward, on the quality of care they feel they give, their confidence in the ward if it was caring for a loved one, and whether they would recommend their ward as a pIace to work.

 

 

  • 21 Comments

Readers' comments (21)

  • Anonymous

    More openness can in theory be a powerful driver of service improvements, for many things including the NHS. Not just the performance of nurses, but the performance of everybody, and of every organisation.

    It is true that some people will not be equipped to sensibly interpret such data, but many others are perfectly able to interpret the data, but are unable to do so because it isn't available to scrutinise. At least if the information is published, anyone sufficiently interested is then able to look at it and to attempt to comment about it: discussion of such data, is usually informative and useful.

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  • good idea, as standards of nursing appear to be at an all time low this will show where good practice is being achieved hopefully and improve peoples perception of the things we are getting right.

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  • Nurses who take pride in their work and are concerned about the standard of care provision to patients will welcome this pilot. Similar data is collected as part of the criteria for Magnet hospitals in the US. Data collection and publication can only be a forward step to increasing better patient care outcomes. Other significant benefits seen from introducing matrix measurements in hospitals include increased efficiency from nurses, staff wanting to stay with their employers and higher standrds of care for patients. All positive. well done!

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  • Openness and transparency in anything is essential in any services as we have all learned recently to the detriment of many - such as the financial crisis, mortgage scandals, banking scandals and a failures in the NHS, and it would be good if people outside the profession were more aware of the work nurses do but I find it disappointing that the resources used for this project are not being invested in direct patient care instead where they are so desperately needed. with adequate resources providing adequate care there would be no need for all this scrutiny, measurements and data collection. it seems that focus is always being taken away from the patient as an individual with the holistic care they require and being directed instead towards an obsession with administrative instruments designed to demonstrate the meeting of specific targets.

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  • What about the doctors? They need to be scrutinised too, as some of them can be pretty sloppy in their attitude, and the quality of their work. Why does it always have to be nurses that are regularly demonised, criticised and blamed when things either go wrong, or are just not right.

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  • Also, things like staffing levels are a contributing factor when things are wrong, but the nurses can't do a lot about that. My ward regularly has staff moved to staff other areas, particularly at night leaving us with poor staffing levels, and unsafe too. When things go wrong, we get the blame.

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  • the public scrutiny should apply to all staff in the hospital and not to one particular group. Nurses are not responsible for everything!

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  • Why is it that the nurses get put up for inspection and no one else. As usual.
    Should be everyone held up for inspection.

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  • Anonymous | 6-Mar-2012 7:41 pm

    Should be both doctors and nurses held up for scrutiny i agree then we will get a true picture of where we are failing and where we are achieving. Honesty is paramount.

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  • In relation to point two on the monthy score card which states.

    2.Number of pressure ulcers – This is the number of grade 2, 3 and 4 pressure ulcers acquired in hospital within 72 hours of hospital admission.

    We are one of the participating hospitals and have reported all pressure ulcers not just those aquired within 72 hours in order to be fully transparent.

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