Excellence In Care - Scotland's National Apporach to Assuring Nursing and Midwifery Care Event Report

A report of Scotland's first assuring nursing and midwifery event.

Excellence in Care: Group Work

Table Talk

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.

Messages from spokespersons for each group that were asked to discuss the idea of a national approach to assuring nursing and midwifery care

Messages from spokespersons for each group that were asked to discuss the idea of a national approach to assuring nursing and midwifery care

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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