Improving the patient experience

through nursing and midwifery KPIs

Professor Tanya McCance
Mona Grey Professor for Nursing R&D, University of Ulster
Co-Director Nursing R&D, Belfast HSC Trust
University of Ulster
Project Team
Project Leads
Professor Tanya McCance, Mona Grey Professor for
Nursing R&D, Belfast Trust/University of Ulster
Mrs Lorna Telford, Assistant Director: Safe and Effective
Care, South Eastern Trust (now retired)
Phase 1
Mrs Olive MacLeod, Co-Director - Standards, Governance
and Performance, Belfast Trust
Dr Julie Wilson, Lecturer in Nursing R&D, Belfast
Trust/University of Ulster
Ms Audrey Dowd, Senior Manager Nursing - Performance
Management & Quality Assurance, Belfast Trust
Phase 2
Mr Jack Hastings, Project Co-ordinator
Ms Christine Boomer, Research Fellow, South Eastern
Trust/University of Ulster
University of Ulster
KPI Project: placing the work in
context
University of Ulster
Global context
Drive for effectiveness and efficiency with a focus
on performance
Reform and modernisation
Emphasis on patient safety
Refocus on the fundamentals and a desire to
improve the patient experience
Encouraging patient and public involvement
University of Ulster
Challenge of complexity
Measuring the quality of
nursing care is not easy. That
is one of the main reasons
why so little work has been
done in this area to date
this is a complex area and
many confounding factors
exist that make it difficult to
isolate and clearly identify the
impact made by nurses.
(NHS Quality Improvement
Scotland, 2005, p.8)
University of Ulster
Most frequently cited indicators....
Pressure ulcer incidence
Failure to rescue
Rates of health care associated infections (of varying
types)
Incidence of falls
Medication errors
Hand hygiene
Nutritional status
Incidence of complaints
(National Research Unit 2008)
University of Ulster
The gap?
A lack of focus on indicators that measure the broader
impact of nursing and midwifery care and which
contribute to the quality of the patient experience
Patient experience of compassionate care is an
important outcome in its own right and may provide the
best measure of the nursing contributions to shared
outcomes and evaluation of processes that are otherwise
elusive (p.24),
(National Research Unit 2008)
University of Ulster
Aim of the study
To develop a framework for the identification,
measurement and implementation of key
performance indicators (KPIs) for nursing and
midwifery
University of Ulster
For this study a key performance
indicator
must focus on the patient
could be applied across the specialities i.e. core
does not necessarily have to be outcome related
should be specific and not broad e.g. a standard
University of Ulster
The KPI Project
Phase 1: Identification of KPIs and development
of a measurement methodology
Phase 2: Testing a framework for implementation
of KPIs
University of Ulster
Developing KPIs through consensus
University of Ulster
Developing KPIs through consensus
Regional Consensus Conference (25 June 08)
Half day workshop (29 May 08)
Further refinement and testing of KPIs against the
criteria
38 KPIs
Top 8 ranked KPIs
Stage 1
Stage 2
University of Ulster
The approach
Starting with a blank sheet
Involving nurses and midwives at all levels across the
region
Securing the voice of services users and carers
Being systematic and trusting the process
Being open minded and staying open minded
Ref: McCance et al. (2012) Identifying key performance indicators for
nursing and midwifery care using a consensus approach. Journal of Clinical
Nursing, 21(7 & 8): 1145-1154.
University of Ulster
Final 8 top ranked KPIs
Key Performance Indicator
1. Consistent delivery of nursing/midwifery care against identified need
2. Patients confidence in the knowledge and skills of the nurse/midwife
3. Patients sense of safety whilst under the care of the nurse/midwife
4. Patient involvement in decisions made about his/her nursing/midwifery
care
5. Time spent by nurses/midwives with the patient
6. Respect from the nurse/midwife for patients preference and choice
7 Nurse/midwifes support for patients to care for themselves, where
appropriate
8 Nurse/midwifes understanding of what is important to the patient
University of Ulster
The key findings
The top 8 ranked KPIs.
do not conform to the majority of other nursing
metrics generally reported in the literature
are strategically aligned to recent work on the
patient experience
have the potential to be integrated with other
metrics
are person-centred in their orientation
University of Ulster
Developing a framework for
measurement
University of Ulster
Developing the a Framework for
Measurement
Establishment of a regional Expert Group
Expertise in a range of areas
Quality and audit
Research
Performance management
Clinical management
User and carer representation
Guiding principle - the strongest source of
evidence
The nature of evidence
Evidence = research
Hierarchy of evidence
RCTs and meta-analyses
Non-experimental and
descriptive studies
Broader evidence base
Multiple types of evidence
to include:
research
clinician's experience
patient experience
local information/data
University of Ulster
Measurement framework
Strongest Source
of Evidence
Data Collection Methods
Asking patient Survey
Patient Stories
Observing practice Observations of practice
Asking nurses/midwives Interview
Reviewing
documentation/data
Reviewing the patient
record
University of Ulster
Testing the KPIs and framework for
measurement
University of Ulster
Methodology: 4
th
Generation Evaluation
Fourth generation evaluation is described as a
form of evaluation in which the claims, concerns
and issues of stakeholders serve as
organisational foci
(Guba & Lincoln 1989, p.50).
University of Ulster
Study participants
Belfast HSC Trust, NI
1. District Nursing Team
2. Speciality ward
dermatology
3. Acute general surgical ward
colorectal surgery
South Eastern HSC Trust, NI
1. Mental Health Inpatient
Unit
2. Maternity Inpatient Unit
3. Paediatric Ward
Stakeholder groups are defined as those who
have something at stake in the evaluand
(Guba & Lincoln 1989, p.51).
Mater Univeristy Hospital, Dublin, RoI
1. Cancer inpatient unit
2. Orthopaedic Inpatient ward
3. Medical/Respiratory Inpatient ward
University of Ulster
Implemented through 2 cycles of data
collection comprising ....
3 patient stories per cycle
3 Observation of Practice per cycle
10 Patient Records / Staff Interviews per cycle
Patient Satisfaction Survey administered on discharge
and continuous throughout project
Retrospective review of compliments and complaints
University of Ulster
Illustrative example drawn from the
data
KPI 5: Time spent by nurses/midwives with the
patient
Strongest Source
of Evidence
Data Collection Methods
Asking patient Survey
Patient Stories
Observing practice Observations of practice
Asking nurses/midwives Interview
Reviewing
documentation/data
Reviewing the patient
record
Patient Satisfaction Survey
Q: Did you feel the nurses had enough time to give you the
care which you needed?
Observations of Practice
KPI 5: Time Spent...
Positive Comments (n=34) Negative Comments (n=7)
Examples of comments
It doesnt matter how long theyre there
as long as theyre
doing what you need
Theyre always there if you need them,
never a problem
There are people who are worse off
than me, but they spend time with me
and look after me
Ive been in and out of hospital half
a dozen times in the past year but
you see very little of the nurses on
the ward
Its when they say Ill be back in a
wee minute when they know damn
well they wont be back for half an
hour
I think they could spend more [time]
with some people, but I dont think its
their fault, its just that there isnt
enough of them to do everything for
everybody
Feedback from Patient Stories
Themes from CCI
Giving patients a voice
The value of the project in highlighting the
contribution of nursing and midwifery
A methodology that is fit for purpose
Providing evidence for gut instinct
Engagement from staff and patients
Providing a benchmark for the future
Moving forward
Setting the KPIs in a broader menu of
metrics
Patient/
Client
Organisational
Indicators
Examples
Performance
against supervision
standard
Attendance
Management rates
Management of
Salaries and
Wages budget
including Bank,
Agency and
overtime
Examples
Reported
number of falls
Pressure Ulcer
incidence
Nurse
facilitated
discharge rates
Compliance
with hand
hygiene
Examples
Patients confidence in the knowledge and skills of the nurse
Nurses understanding of what is important to the patient
Time spent by nurses with the patient
Involvement of patients in decisions made about their
nursing care
Using the KPIs to change and improve
practice
Diagnostics
(& evaluation)
Interventions
underpinned by
participatory
collaborative
approaches
Changing
practice
In conclusion ....
Contact Details
Professor Tanya McCance
Co-Director for Nursing R&D, Belfast Trust
Mona Grey Professor for Nursing R&D, University of Ulster
Admin Building
Knockbracken Healthcare Park
Saintfield Road
Belfast BT8 8BH
Email: tanya.mccance@belfasttrust.hscni.net
Tel: +44 (0) 28 9056 4987
Fax: +44 (0) 28 9056 5813