Improving the Patient Experience through
Nursing & Midwifery KPIs
Rosie Kelly
Clinical Manager, Acute Children’s
Services
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)
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)
Final 8 top ranked KPIs
Key Performance Indicator
1. Consistent delivery of nursing/midwifery care against identified need
2. Patient’s confidence in the knowledge and skills of the nurse/midwife
3. Patient’s 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 patient’s preference and choice
7 Nurse/midwife’s support for patients to care for themselves, where appropriate
8 Nurse/midwife’s understanding of what is important to the patient
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
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
Our Experience
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Very positive
Staff engagement from beginning was key
Support from Project Team
Triangulation added weight to findings
Claims, concerns, issues kept everyone engaged
Observations of Practice – timings & activity
Organisational Context
Organisational
Indicators
EXAMPLES
•Reported
number of falls
•Pressure ulcer
incidence
•Nurse facilitated
discharge rates
•Compliance with
hand hygiene
Patient/
Client
EXAMPLES
•Patient’s confidence in the knowledge & skills of the nurse
•Nurse’s understanding of what is important to the patient
•Time spent by nurses with the patient
•Involvement of patients in decisions about their nursing care
EXAMPLES
•Performance against
supervision standard
•Attendance –
management rates
•Management of
salaries & wages
budget incl Bank,
Agency & overtime
Paediatric International Nursing
Study (PINS)
European sites
Craig Ward, Ulster Hospital
Royal Belfast Hospital for Sick Children
Temple Street Children’s University Hospital, Dublin
Worthing Hospital, East Sussex
Great Ormond Street Hospital
East Kent NHS Trust
Hans Christian Anderson Hospital, Denmark
Australian sites
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Princess Margaret Hospital for Children, Perth
Northern Sydney Local Health District
Nepean Blue Mountains Local Health District
The Women's and Children's Hospital, Adelaide
The Sydney Children’s Hospital’s Network (Orthopaedic, Middleton &
Edgar Stephens)
Stages
The project will be delivered through six stages.
• Stage 1: Develop the framework for measurement
• Stage 2: Implementation of the KPIs and measurement
framework
• Stage 3: Supporting practice change and innovation
• Stage 4: Implementation of the measurement framework (repeat
stage 2 & 3)
• Stage 5: Evaluation of the implementation process
• Stage 6: Hypothesis generation and preparation of final
research report
Data Collection & Analysis Timeframe
1
2
3
4
5
6
7
8
9
10
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Observation
Analysis
Feedback
Stories
Stories
Transcribe
Analysis
Document
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Survey – distributed to all patients on discharge (over 7 weeks)
Stories – 3 family stories over 1 week and 3 patient stories over 1 week
Document – review patient record in conjunction with asking staff about patient
goals (10 reviews over 1 week)
Observation – of nursing presence in a specified bay over a 30 minute time
period (3 over 1 week)
Challenges
• Time out for staff
• Using new data collection tools
• Recognising action plans as positive tools
Using the KPIs to change and improve practice
Diagnostics
(& evaluation)
Changing practice
Interventions
underpinned by
participatory
collaborative
approaches
In conclusion ....