are we measuring what matters? how the patient voice can
TRANSCRIPT
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Are we measuring what matters?
How the patient voice can influence
improvements in person-centred practice
Val Wilson Professor of Nursing (ISLHD & UOW)
Denise Edgar Nurse Manager (ISLHD & UOW)
Professor Tanya McCance, Dr Brighide Lynch, Dr Donna Brown, Christine Boomer,
Andrew Ennis, Matias Garcia-Constantino (Ulster University) & Emma Radbron PhDc UOW
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Today’s Workshop
Give an overview of what data we use to measure nursing & midwifery practice
Outline the development of the nursing and midwifery person-centred KPIs
Share evidence from an International study to test the KPIs
Detail the inception of an App for collecting and managing data about the patient experience
Demonstrate the app
Provide an opportunity for participants to work with the app and share their feedback about using the app
Discuss some preliminary results from cycle 1 of the iMPAKT study
Share where to from here and address any questions arsing from the workshop
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How can we demonstrate the impact of nursing and midwifery practice
on quality care and the patient experience?
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What measures do we currently use?
Key Performance Indicators
e.g. infection rates
Incident Reporting
e.g. medication errors, falls
Access and throughput
e.g. waitlist targets
Length of stay
e.g. within target for DRG
Staff recruitment and retention
e.g. vacancy rates
Leave
e.g. sick leave
Complaints
e.g. from patients/families/staff
Patient and staff surveys
Patient stories
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Evidence about measures
There is an argument that data collected on these outcome measures provide limited evidence of the added value of nurses/midwives to the care experience
There is a recognised absence in the evidence base of indicators that measure the broader impact of nursing and midwifery care and that contribute to the quality of the patient experience (Griffiths et al., 2008; Collins, 2014).
Collins, A. (2014) Measuring What Really Matters: Towards a Coherent Measurement System to Support Person-centred Care. London: The Health Foundation.
Griffiths, P., Jones, S., Maben, J. and Murrells, T. (2008) State of the Art Metrics for Nursing: A Rapid Appraisal. London: National Nursing Research Unit, King’s College London.
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Development of the person-centred KPIs
A core set of eight KPIs focusing on the unique
contribution of nursing to the patient
experience was developed from primary
research undertaken by McCance et al.
(2012).
The KPIs provide a different perspective on
the measurement of the nursing and
midwifery contribution at practice,
organisation level and policy level.
McCance, T., Telford, L., Wilson, J., MacLeod, O. and Dowd, A. (2012) Identifying key performance indicators for nursing and midwifery care using a consensus approach. Journal of Clinical Nursing. Vol. 21. Nos. 7-8. pp 1145-1154.
Professor Tanya McCance
& Dr Donna Brown
tanya and donna.MP4
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KPIs for Nursing/Midwifery
KPI 1: Consistent delivery of nursing care against identified need
KPI 2: Patient’s confidence in the knowledge and skills of the nurse
KPI 3: Patient’s sense of safety whilst under the care of the nurse
KPI 4: Patient involvement in decisions made about his/her nursing care
KPI 5: Time spent by nurses with the patient
KPI 6: Respect from the nurse for patient’s preference and choice
KPI 7: Nurse’s support for patients to care for themselves where appropriate
KPI 8: Nurse’s understanding of what is important to the patient
(McCance et al 2012)
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Working with patient’s beliefs and valuesKPI 6: Respect for patient’s preference and choiceKPI 8: Knowing what is important to the patient
Engaging authenticallyKPI 5: Time spent with the patient
Shared decision makingKPI 4: Patient involvement in decisions made about his/her care
Providing holistic careKPI 1: Consistent delivery of nursing care against identified needKPI 7: Support of patients to care for themselves, where appropriate
Professionally competentKPI 2: Patient’s confidence in the knowledge and skills of the nurse
Feeling of well-beingKPI 3: Patient’s sense of safety
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Nature of the KPIs
The 8 KPIs:
do not conform to the majority of other nursing
metrics generally reported in the literature
are strategically aligned to aspects integral to the
patient experience
have the potential to be integrated with other
organisational agendas
are person-centred in their orientation
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PINS
Project Aim
To explore the utility of a set of unique nursing KPIs and related measurement framework in supporting the development of person-centred
practice across a range of services provided to sick children.Europe
Hans Christian Andersen Children's Hospital,
Odense, Denmark
Temple Street Children's University Hospital,
Dublin, Ireland
Great Ormond Street Hospital, London, UK
East Kent, England, UK
Royal Belfast Hospital for Sick Children, Belfast,
Northern Ireland UK
South Eastern Trust, Northern Ireland UK
Australia
Princess Margaret Hospital for Children, Perth
Royal North Shore Hospital, NSW
Hornsby Hospital, NSW
Nepean Blue Mountains Local Health District, NSW
The Women's and Children's Hospital, Adelaide
The Sydney Children’s Hospital’s Network
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Overview of PINS
Cycle 1 data
collection
• Informing practice change
Cycle 2 data
collection
• Informing practice change
Cycle 3 data
collection
• Informing practice change
Program evaluation
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The measurement framework
1. Obtaining user feedback Patient survey comprising 8 questions – 1 per KPI
In 10 languages
Patient/family stories
2. Observations of practice 30 min observation of practice recording visibility of
nursing staff in patient areas
3. Reviewing the patient records and speaking with staff Recording consistency between what is recorded in
the patient record and what is reported by nursing staff
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KPI 5: Time spent by nurses with the patientPatient Satisfaction Survey“Did you feel that the nurses had enough time to give the care which your child needed?”
0%
10%
20%
30%
40%
50%
60%
70%
80%
Always Most of the Time Sometimes Never
Cycle 1 (n=58)
Cycle 2 (n=54)
Cycle 3 (n=67)
Cycle 1mean 3.62
Cycle 2 mean 3.72
Cycle 3mean 3.48
Unfortunately nurses have got lots of kids to look after on the ward …it is just a bit hard if they are all so busy doing their other stuff that they have to do. (parent)
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Improving practice – measuring what matters
Over 60 improvement initiatives
• Bedside handover
• Communication between staff and families
• Orientating families to the ward environment
• Documentation
• Parent education tanya and donna.MP4
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Program Evaluation
What works for whom in what circumstance and why?
Interviews and focus groups Executive sponsors (n=12)
Clinical leaders and their staff (n=56)
Service managers & project leads/co-ordinators (n=40)
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iMPAKTInternational Study – testing the effectiveness of the App in measuring person centredness across a range of care settings
• Northern Ireland & Australia• Recruited sites in two health
districts– Southern Health (6)– ISLHD (6)
• Staff engagement • Data collected and managed
on an iPAD• Undertake 2 data cycles with
intervening QI projects• Unit based reports, plus
benchmarking data • Evaluation of the processes
and the outcomesDr Brighide Lynch
E:\IMPAKT\Brighide.MP4
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The Use of Apps in Healthcare
E:\IMPAKT\EMMA.mp4
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Demonstration of the App
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Cycle 1 of iMPAKT completed
Engagement
The Internet
Data Collection & Analysis
The stories
Timeframes
Reports
Areas for improvementChristine Boomer
E:\IMPAKT\christine.mp4
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Example of a results report
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Where to from here?
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‘Pooh’Wisdom!“Knowledge and cleverness tend to concern themselves with the wrong sorts of things, and a mind confused by knowledge and cleverness, and abstract ideas tends to go chasing off after things that don’t matter, or that don’t even exist, instead of seeing, appreciating, and making use of what is right in front of it”.
(The Tao of Pooh and the Te of Piglet, 2002)
Questions
?