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Nurses need to influence the choice of quality indicators in order to 'own' them

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Walk on to a ward that is involved in the Productive Ward initiative and the first thing you are likely to see is a noticeboard covered in charts. These will measure a range of indicators from falls to healthcare-associated infections to staff absence.

A similar experience can be had at hospitals trialling other improvement programmes.

These charts are a sign of a quiet revolution taking place in nursing. Nurses are taking responsibility for measuring the quality of the care they give to patients. They are also, crucially, prepared to share those measures with the public and colleagues and to commit to driving the indicators in the right direction.

Typically for nursing this work is happening 'under the radar', without the ballyhoo which attended publication of cardiac mortality rates for instance, but it is no less important. Using these measures to, for example, reduce the incidence of healthcare-associated infections or pressure ulcers will have a profound impact on patient experience.

In our article on the national work to develop metrics which measure the nursing contribution, the point is made that
the choice of indicators must be heavily influenced by nurses themselves.

This is not simply 'apple pie and motherhood', if these metrics are to be adopted across the NHS, nurses must believe that what is being measured is what matters to patients and can be influenced by good nursing care. They must 'own' them at every level; from the staff nurse knowing that their good practice can help combat healthcare-associated pneumonia to sisters organising their ward layout so as to reduce falls, all the way to the nursing directors demonstrating to their boards how nursing care is increasing patient satisfaction.

The work carried out in the North West shows that nurses can use metrics to help improve patient care - as the 26% drop in falls they achieved demonstrates. Nurses not yet touched by this revolution should take heart - and perhaps spend time making sure they are comfortable with data collection and interpretation.

But, however relatively rosy the picture, we must not miss the one big cloud on the horizon. There is a danger that, yet again, primary care could be left behind. Work to help community nurses develop their own metrics must begin as soon as possible.

Alastair McLellan editor, Nursing Times

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