The development phase showed that the synergy between these two projects can drive improvements in practice and that successful implementation of the framework for SCNs is achievable. Senior charge nurses and other stakeholders have welcomed the framework, but its success is dependent on a number of factors, including:
- the existing knowledge, skill and attitude of individual senior charge nurses
- the level of support and access to development opportunities available within the organisation
- the degree of flexibility within existing ward or department establishments.
The following implementation framework has, like the two projects, been informed by the views of the stakeholders expressed through written feedback, the consensus conference that was held in January 2008, and the experience of the clinical facilitators.
Clinical Facilitator Network informing implementation
A key stakeholder group is the Clinical Facilitator Network. This has contributed to the development of the SCN exemplar job description, NHSKSF outline, the CQI dataset and the e QUIPS programme. The network worked with senior charge nurses, managers and other stakeholders in the development sites on individual change packages that helped Senior Charge Nurses make the necessary changes to their role.
It was therefore important to incorporate the views of the clinical facilitators in implementation plans. These were based on their experience of working at board level regarding the key points for success. These are listed in Table 5 (these have not been prioritised).
Key points for successful implementation
Corresponding action in implementation framework
Effective leadership at national level
Transitional Steering Group with key stakeholders
Facilitation within boards
Funding to support the appointment of clinical facilitators
Peer groups for facilitators and charge nurses
NES to develop a network for SCN implementation
Support and learning across NHS boards
Continue with clinical facilitator meetings during transition and implementation
Potential resource gap as SCN role revised
Pilot of Productive Ward to "release time to care"
Education and Development Framework for SCNs
Exemplar job description
Need director level support in the boards
Implementation plans to have named "executive sponsor"
Key Stakeholder Groups informing implementation
Stakeholder involvement was integral through the project phase and this has included gathering views from key stakeholders in developing an action plan for implementation. The views outlined below were gathered from written feedback to the stakeholder report and verbal feedback from the consensus conference in January 2008.
The key areas that were agreed to be important to implementation are listed below:
- To enable NHS boards to include implementation into their corporate objectives.
- For use at NHS board level to maintain ethos of the CQIs as measures of improvement, not judgement.
- Develop further links with other national programmes to demonstrate how implementation of SCN Role and CQIs supports NHS boards with delivery of key targets.
- Qualitative and quantitative measures should be included.
- Formal evaluation of initiative both at national and board level linked to the achievement of performance measures.
- A national steering group should co-ordinate national evaluation.
- Local evaluation led by nurse directors.
- Timescale of evaluation to be on an annual basis for a three year period.
Centres of Responsibility for development of CQIs
- Implement a model for NHS boards to develop further CQIs.
Timescale for implementation
- A lead in time should be included to allow time for boards to plan implementation.
- After this lead in time, a two year period is allowed for implementation.
In summary, analysis of both the responses to the stakeholders, feedback report and qualitative and quantitative data from the conference demonstrates a consensus of opinion. They asked that the final report and action plan should include plans for national coordination of implementation with detailed timescales. The model of a nationally coordinated model of clinical facilitators in each NHS board, implementation of the model of NHS boards as Centres of Responsibility, implementation of performance measures for NHS boards and an evaluation strategy were also supported.
Implementation and Action Plan
Implementation of the Framework for the SCN Role and the Clinical Quality Indicators for Nursing and Midwifery will support NHS organisations to deliver corporate objectives and strengthen organisational approaches to improving patients' experience of care. This supports the development of a culture of continuous quality improvement.
The framework for implementation is outlined in the action plan in Table 6. The overall aims of the action plan are:
- for all senior charge nurses working in hospitals across NHSScotland to be working in the context of this revised role by 2010.
- to have CQIs in place in the majority of in-patient areas by the end of 2010.
The implementation of both the SCN Role and Clinical Quality Indicators has the potential to bring benefits to not only senior charge nurses, their teams, and their organisations, but also to patients, carers and their families.
Table 6. Action Plan for Implementation
To implement the Senior Charge Nurse Role and Clinical Quality Indicators by the end of December 2010.
NHS coards to submit implementation plans to CNO Directorate by end of July 2008.
(Implementation to commence in NHS boards in September 2008.)
CNO Directorate to release funding once implementation plans received.
Funding will be released on submission of implementation plans.
To develop a national infrastructure to support implementation of revised SCN role and introduction of CQIs across hospitals in NHSScotland.
Transitional Steering Group has been formed to establish the required structure of support for the implementation of both the SCN role and CQI roll out.
CNO Directorate in partnership with executive nurse directors
To maintain strong communication links between NHS boards and Transitional Steering Group
To have regular information sharing at the Scottish Government Nurse Directors Meeting on progress.
Chair of Transitional Steering Group in partnership with CNO Directorate
To monitor progress towards full implementation.
NHS boards to submit regular progress reports and contribute to annual evaluation.
CNO Directorate (for sending reminders and template for submission)
Nurse directors (for submission to CNO Directorate)
Baseline of measures to be submitted by December 2008, then timescale for further submissions to be agreed.
Transitional Steering Group to develop performance measures to support evaluation process.
Transitional Steering Group
During implementation phase, Recommendation 17 of the NMWWP project report (Scottish Executive, 2004) will continue to be taken into account while progressing implementation of the SCN Review; as boards achieve full role redesign, the protected time allowance will no longer be required.
The NMWWP Programme will ensure there is ongoing monitoring of the implementation of Recommendation 17 in the 2008 annual review of NHS boards progress
To support the continuation of the clinical facilitator role within boards and continue the network of support.
To release funding to support appointment of clinical facilitators.
On submission of Implementation Plans from NHS boards.
National Network for Clinical Facilitators to continue to meet monthly for peer support and joined learning. This is intended to support continuity and communication between project phase and implementation period. NHS boards may wish to support this until funding is released.
Ongoing from April 2008 to December 2010
To develop formal networks of peer learning and support.
NES, in partnership with NHS boards, CNO Directorate, and other partners is to lead on development of these networks.
To ensure robust links continue to develop with all national programmes that have overlaps with SCN/ CQI work.
Transitional Steering Group
To develop a consistent process for Centres of Responsibility in the development of further CQIs.
Transitional Steering Group
To test and refine the eQIPS programme and dataset for CQIs for robustness in a ward setting.
Two NHS boards have agreed to test and refine this.
ISD and NHSQIS with the two partner boards
To pilot Productive Ward Programme with the aim of releasing SCN time by using quality improvement methodology.
NHS boards have been asked to note their interest in participation in this pilot.
Improvement Support Team, CNO Directorate, NHS boards (pilot sites) and overseen by Transitional Steering Group
December 2008 (with potential for roll out, if pilots successful)