nipec organisational guide to practice & quality improvement tanya mccance, director of nursing...
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NIPEC Organisational Guide to Practice & Quality Improvement
Tanya McCance, Director of Nursing Research & Practice Development
(UCHT) & Reader (UU)
Brendan McGrath, Assistant Director of Nursing, Altnagelvin Hospitals
Trust
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Presentation Structure
• Development of practice – context and background
• A mapping exercise involving Trust Nurse Directors
• Developing the organisational guide
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Vision Statement for Development of Practice (April 2004)
• Development of practice described as the range of activities with the shared aim of improving the quality of care provided to patients and clients
• A vision statement that reflects the important elements for effective development of practice
• 8 statements of strategic intent
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Implementing the Vision Statement• Strategic Area 1: Supporting Clinical and
Social Care Governance through promoting the Development of Practice
• Strategic Area 2: Contributing to an infrastructure that supports Development of Practice
• Strategic Area 3: Developing strategic collaborative relationships
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Strategic Area 1: Workplan
• A Mapping Exercise with Trust Nurse Directors in the 18 HPSS Trusts.
• A comprehensive review of the literature
• Development of a ‘Best Practice Guide’ aimed at helping organisations think more strategic about development of practice
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
The Mapping Exercise • The process
– One-to-one informal meetings, conducted by two SPOs – May – July 2005
• Areas discussed – Awareness of NIPEC’s Vision Statement– NIPEC interpretation of development of practice – The range of activities within organisations– The enablers and barriers – Available resources – Perceived value of activities – Client involvement – Impact on staff development – Links with C&SCG structures
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Views on the Vision Statement
• Widespread agreement on the broad content
• The need to engage with staff on the ground to ensure a shared understanding
• Clear consensus on NIPEC’s interpretation of development of practice
• The challenges that might impact on the implementation of the vision
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Current Activity
Practice Development
Clinical Audit
Benchmarking
Quality Improvement
Integrated Care Pathways
Service improvement
Reflective practice
Analysis of Critical Incident
Leadership Development Programme
Research
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Supporting development of practice
• Leadership
• Organisational culture
• Infrastructure
• Communication
• Multi-professional involvement
• Attainment of knowledge and skills
• Policy/strategic context
• Resources
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Impact on staff
• Supports the practitioner in managing risk
• Promotes staff empowerment
• Enhances awareness of professional issues
• Promotes readiness for change
• Contributes to recruitment and retention
• Contributes to career development
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Links with C&SCG
• The influence of development of practice within C&SCG structures was variable
• Committees identified within structures covered the breadth of activity
• Influence of evidence and outcomes arising from this activity was not always clear
• The value of this activity for both the patient and the organisation was clearly articulated.
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Organisational Guide
Aim:To help create organisational environments that enable staff undertake practice and quality development activities to support safe and effective care
Potential Uses• Self-assess organisational readiness for P&Q
improvement• Support implementation of RQIA recommendations• A multi-professional tool
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Organisational Guide – Development Process
3 Stages• Stage 1 – Vision Statement Development of
Practice• Stage 2 – Mapping Exercise with Directors of
Nursing• Stage 3 – Literature analysis EBP, PD,
C&SCG• Partnership with Expert Working Group
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Organisational Guide - Overview
• 3 key requirements of organisational readiness for practice and quality improvement
Infrastructure
Systems
People
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
People
4 Key Factors
• Leadership – at all levels
• Culture – of improvement
• Communication and Engagement
• User Involvement
People
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Culture
A culture of…
• Person-centredness
• Learning
• Inquiry
• Openness and transparency
• Fair blame
• Performance Management
People
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Communication and Engagement
Essential at all levels in the organisation.
People
•Evidence of P&Q Improvement Activities•Evidence of sharing good practice•Evidence of partnership working•Recognition of good practice
Recognised through involving staff in decision making
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Patient/Public Involvement - PPIPeople
Corporate level • The inclusion of patients and public in service planning and
commissioning• Capacity for PPI in service planning/delivery• Patient and public representation in quality improvement
activity
Individual Patient and Practitioner level• Visible leadership for PPI• PPI integral to the work of all involved in the HPSS• Patient stories/satisfaction surveys to inform practice and
quality improvement activity• Evidence of learning from complaints• Patient/client involvement in care and treatment the norm.
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Infrastructure
3 Factors
• Human
• Technological
• Financial
People
Infrastructure
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Human Infrastructure
• All professional staff should have practice and quality improvement skills…
Infrastructure
People
• Develop specific expertise within key roles…
• Examples of key roles
Ward Sisters/Charge Nurses/Team Leaders Practice Educators Quality Managers/Practice Facilitators Nurses Consultants/Specialist Nurses Services Managers/Programme Managers Directors/Assistant Directors Governance Leads
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Human Infrastructure
The specific expertise relates to skills such as;
Infrastructure
People
• Facilitation skills• Audit Skills • Research skills• Analytical skills• Interpretive skills• Change management skills• Political skills• Interpersonal skills• Evaluation and Performance Improvement skills• Project Management Skills
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Technological Infrastructure
• Access to relevant information systems to inform practice,
• Facilities to support evaluations of practice that address performance improvement targets.
• Indicators of an effective Technological Infrastructure include:
People
Infrastructure
Access to the Internet at work… Access to systems and personnel that support
data collection, analysis and presentation Access to e-mail at work to enable
communication and networking
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Financial Infrastructure
• Need for identified ‘ring-fenced’ funding to support successful practice and quality improvement
People
Infrastructure
• Examples include: Funded establishments
Ring fenced budgets for staff learning
Facilities conducive to learning and improvement
Funding for practice and quality improvement activities
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Systems• 9 Factors
Effective practice and quality improvement requires clearly articulated and understood systems that inform, guide and monitor the practice of staff…
• Examples
People
Infrastructure
Systems
Risk Management System Complaints Management System Incident Reporting Systems Appraisal Systems Professional Supervision System Performance Improvement System Controls Assurance System Equality/Human Rights System Health and Safety Management System
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Organisational Guide
Self Assessment
People
Infrastructure
Systems
Level DescriptorNo evidence Not achieved
Some evidence Work commenced
Well evidenced
Fully evidenced
Good progress
Well established
Improving Patient Experience and Care through Practice and Quality ImprovementNIPEC Conference, 27th March 2007Hilton Templepatrick Hotel
Consultation Feedback
• Document has real value• Provides clear direction on how to ensure effective
practice and quality improvement• A useful resource for organisations to measure
their readiness and progress • A useful framework for developing a strategy for
practice and quality improvement• Self Assessment approach useful given RQIA
Assessments format• Support implementation of RQIA recommendations• Consider multiprofessional value of guide
People
Infrastructure
Systems