Nursing & Midwifery Quality Care-Metrics

The Irish Experience

National Lead: Anne Gallen

Health Service Executive, Ireland

Presentation

– Data measurement in Nursing & Midwifery– Quality Care-Metrics– Quality of patient care in Ireland – feedback

from staff and the media’s perspective– Defining quality and clinical governance– National roll out of Quality Care-Metrics– Governance and academic rigor– Next steps– Evaluation

Measuring Nursing Care – 1850

Measuring Nursing Care – Embracing the digital era

Measuring Care – a new language for

Nursing & Midwifery

Key Performance Indicator

…is a quantifiable measure of an organisation’s critical success factors or outputs

Metric

…is a quantifiable measure of an organisation’s activities or processes

WHAT are Quality Care-Metrics?

..are measures of the quality of Nursing and Midwifery

clinical care processes in healthcare settings in Ireland, aligned to

evidenced-based standards and agreed through national consensus

HSE (2015)

WHY introduce Quality Care-Metrics?

Quality & Patient Safety is the most contemporary issue in healthcare world wide

• To drive improvements in the fundamentals of nursing and midwifery care delivery

• To demonstrate the contribution of Nurses & Midwives to safe, effective, efficient, patient-centred care

What do staff say about the quality of patient care

‘HSE staff fear for care of sick loved ones’

(16/04/15 - Irish Independent Newspaper)

• HSE Staff Survey – 8627 responded – 7%

• 1 in 3 staff not happy with the standard of care

• Almost half of respondents stated in the last month they saw errors that could hurt or harm patients or clients

What does the media say about the quality of patient care

Health System Failures:

• HSE (2013) Galway University Hospital - Savita Halapannaver

• HSE (2014) Sligo Regional Hospital – Sally Rowelette

• DoH (2014) Midland Hospital Portlaoise Baby Deaths

• HIQA (2015) Unit 3 Aras Attracta

• HSE Cregg House Services

• HSE St Patrick’s Community Hospital

All highlighted deficiencies in patient care&

Professional concerns re: Nursing & Midwifery Practice

Media Findings from Irish Health System Failures

• General lack of provision of basic, fundamental care

• Failure to recognise, act or escalate concerns to an appropriately qualified clinician when the patient was showing signs of clinical deterioration

• Families and patients were treated in a poor (appalling) manner with limited respect, kindness, courtesy and consideration

• Disabled children left in bed until 1pm due to understaffing

• Residents had not received a bath or shower for a month or more

• Excessive use of chemical restraint

• A rise in ‘never events’ and serious adverse events

• Preventable, poor outcomes identified for patients

How do we define quality in healthcare

HIQA – Quality…Safe Care, Effective Care, Person Centred Care

HSE - Quality…is the delivery of effective care in an environment that is safe for patients, staff and the public

(Quality & Patient Safety Directorate, 2013)

Clinical Governance?

• • •

• “….is described as the system through which healthcare teams are accountable for the quality, safety and experience of patients in the care they have delivered. For health care staff this means: specifying the clinical standards you are going to deliver and showing everyone the measurements you have made to demonstrate that you have done what you set out to do”.

(HSE, 2014)

Implementing Clinical Governance in Nursing/Midwifery

• No awareness of nurses/midwives knowledge of clinical standards

• No mechanism to measure the quality and safety of care delivery

• No mechanism to ASSURE the quality and safety of care

• CHALLENGE for NMPDs - Establish national approach and infrastructure

ChallengeChallenge• Wealth of information Wealth of information

already in usealready in use - - How can How can we ensure consistency in we ensure consistency in data collection and analysis data collection and analysis across the region – across the region –

• How do we make it How do we make it meaningful and available meaningful and available to frontline staffto frontline staff

• How do we ensure it is How do we ensure it is not a not a burden to staffburden to staff and that we and that we avoid staff drowning in a avoid staff drowning in a sea of datasea of data??

The SolutionThe Solution • Chief Nursing Officer Chief Nursing Officer

– Mandie Sunderland Heart of England Mandie Sunderland Heart of England NHS Foundation TrustNHS Foundation Trust

• 2010 - Irish Association of 2010 - Irish Association of Directors of Nursing & Midwifery Directors of Nursing & Midwifery meetingmeeting

• 2011 2011 Test Your CareTest Your Care was was introduced across 3 regions of the introduced across 3 regions of the HSEHSE– North WestNorth West– North EastNorth East– DublinDublin

How does Test Your Care Work?

• Data entered monthly through a web-based online system

• Results are displayed in real-time and available immediately to each CNM /DON

• Results show areas of good practice and areas that require improvement

• Action plans are drawn up where improvement to meet the standard is required

Quality Care-Metrics Report

2014 – ONMSD Quality Care-Metrics

National Roll Out• Acute Hospital Services

• Midwifery Services

• Children’s Hospital Services

• Mental Health Services

• Intellectual Disability Services

• Older Person’s Services

• Public Health /Community Nursing

Government to Government

www.testyourcare.com

Enabled through NMPD support

• West/Midwest : Gillian Conway• Midlands : Mary Nolan• North West : Paula Kavanagh• North East : Margaret Nadin• Dublin South : Ciara White• Dublin North : Martina Giltenane• South : Aoife Lane• South East : Leonie Finnegan

NMPD Project Officers

• Providing information sessions and establishing demand

• Setting up locations on TYC, passwords and usernames

• Delivering training and providing support

• Currently 1944 locations established on TYC

• Quality Care-Metrics in use in 82% of acute hospitals and has penetrated into all CHO areas

Standardised Approach-May 2015

http://www.hse.ie/eng/about/Who/ONMSD/news/QCM Launch.html

Developing new national metrics - consensus

Academic Rigor

• Prof Declan Devane: NUIG• Prof Fiona Murphy: UL• Prof Laserina O’Connor: UCD• Prof Ailish McAuliffe: UCD

• Dr Maria Brenner UCD – Children’s Work-stream

• Dr McDonald-Naughton AIT – Intellectual Disability Work-stream

Next Steps• PHN / Midwifery / Children’s / Older Person Work-

stream established – ID / Acute / Mental Q4

• Hand-held technology – ICT tablets

• Further develop reporting functionality

• Clinical Dashboards

• Podcast – undergrad and post grad

• HSEland

Evaluating the Irish Experience

1. HSE (2013) Nursing & Midwifery Medication Management Metrics Research Evaluation Report

2. HSE (2014) An Evaluation of the Development and Implementation of Nursing & Midwifery Metrics in Dublin North

• ‘Previously we reacted to incidents as they occurred but metrics helped to improve the system so that incidents didn’t occur’ (SN)

• ‘when HIQA came… they noted that nurses on the wards had a real awareness of implementing standards and had quality improvement plans in place and felt the displaying of these results were really positive’ (DON)

• “It has improved practice and it has made nursing staff more aware of their responsibilities in relation to medication management overall” (DON)

• “Beneficial? Oh definitely. People are more aware of the standards” (DON)

•

Benefits of Nursing/Midwifery Quality Care-Metrics?

• Provides the evidence that identifies the areas of good practice and also the areas where improvement is required.

• Assists managers to manage - by using QC-M to– Enable continuous improvement in nursing/midwifery care

– Embed awareness of evidenced based clinical standards

– Place Safety & Quality of Care at the heart of service provision and delivery

– Demonstrate the contribution of nurses and midwives to safe and effective care

Metrics our acronymMetrics our acronym