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:
- 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.
- 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.
- 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.
- 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.
- 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.