Excellence in Care: Group Work
Event participants were asked to discuss the idea of a national approach to assuring nursing and midwifery care, focusing on issues vital to success and potential challenges. The messages from spokespersons for each group appear below, followed by a summary of outputs from the groups on three key issues - why a national approach is necessary, what is needed to put one in place, and what challenges might be anticipated.
Why do we need a National Approach to Assuring Nursing and Midwifery care?
- There are gaps in current reporting systems.
- We need it to ensure there is no disconnect or disengagement from ward to board: the approach will promote ward-to-board communication and support.
- It will define clear standards for all.
- The approach will promote patient and public involvement in services.
- It will ensure nursing and midwifery contributions continue to be driven by the profession.
- A national approach will help to ensure consistency of care across Scotland.
- It will provide sufficient flexibility to allow clinical judgement to guide appropriate assessment to achieve person-centred care - it is not a one-size-fits-all approach.
What is needed to ensure the national approach is successful?
We need to:
- promote enthusiasm and vitality in teams.
- care for our staff, recognising that the workforce is ageing and taking steps to avoid exhaustion and burn-out.
- show our trust in staff and their skills.
- keep the approach simple and meaningful to the user.
- include service users - it cannot simply focus on nurses' opinions.
- clarify the purpose of the system.
- reduce the data burden through using appropriate electronic systems that "speak" to each other.
- ensure indicators are principle-based, not compliance-based.
- capture person-centredness and assure it is at the centre of care delivery.
- ensure alert systems are in place to identify problems early.
- promote the approach as a model of empowerment, not restriction.
- ensure the approach links with other systems, such as those of the Healthcare Environment Inspectorate and Healthcare Improvement Scotland.
- recognise that nurses are not data collectors.
What are the challenges?
- The potential to generate lots of complex data.
- Ensuring IT systems are integrated and support staff are in place.
- Measuring the wrong things for the wrong reasons.
- Getting the balance between assurance and improvement right.
- Making sure a model of empowerment is promoted, not a model of compliance.
- Keeping focused on what is core to patients' needs.
- Ensuring the system remains simple to use.
- Identifying elements of care currently measured that do not need to be measured.
- Getting consensus on the key standards.
Other comments …
- "There is enthusiasm and commitment in the room to find solutions and make this work."
- "This is about assurance, not judgement."
- "Can we stop using words such as 'performance' and 'compliance'? 'Empowerment' and 'ownership' are much more useful."
- "This mustn't be about measurement for measurement's sake - we don't want a box-filling exercise."
- "Focus on systems, not outcomes."
- "Don't reinvent wheels."
- "Integrate patient and staff experience."
- "Remember patient/carer and student feedback."
- "Facilitation and support for staff will be important."
- "We need nationally developed IT solutions."
- "Multidisciplinary record-keeping will be an important part."
- "There is a responsibility on the Scottish Government and Healthcare Improvement Scotland not to ask for huge amounts of data."
- "Openness and transparency is key - any tools should demonstrate to patients and families what quality care is and what to expect."
- "Ward welcome-board displays should include data relevant to the approach."
- "Be brave, stop measuring processes and empower frontline staff, creating the conditions for them to do the right thing."
- "Let staff own the system, changing their expectations of governance in the process."
Next stage …
Comments and ideas generated at the table discussions have been collected and will now inform the next stage of the process, which is drafting principles to underpin the work.
Email: Jan Liddle
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