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

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

How can we demonstrate the impact of nursing and midwifery practice

on quality care and the patient experience?

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

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.

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

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)

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

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

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

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

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

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)

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

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)

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

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The Use of Apps in Healthcare

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Demonstration of the App

Cycle 1 of iMPAKT completed

Engagement

The Internet

Data Collection & Analysis

The stories

Timeframes

Reports

Areas for improvementChristine Boomer

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Example of a results report

Where to from here?

‘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

?