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, patientcentred 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
•
Challenge
Wealth of information
already in use - How can
we ensure consistency in
data collection and analysis
across the region –
• How do we make it
meaningful and available
to frontline staff
• How do we ensure it is not a
burden to staff and that we
avoid staff drowning in a
sea of data?
The Solution
• Chief Nursing Officer
– Mandie Sunderland Heart of England
NHS Foundation Trust
• 2010 - Irish Association of
Directors of Nursing & Midwifery
meeting
• 2011 Test Your Care was
introduced across 3 regions of the
HSE
– North West
– North East
– Dublin
How does Test Your Care Work?
• Data entered monthly through a webbased 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
Midlands
North West
North East
Dublin South
Dublin North
South
South East
:
:
:
:
:
:
:
:
Gillian Conway
Mary Nolan
Paula Kavanagh
Margaret Nadin
Ciara White
Martina Giltenane
Aoife Lane
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 Workstream 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 CareMetrics?
•
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 acronym