Download Engaging patients and their families in Practice Change

Professor Tanya McCance & Ms Rosie Kelly
Background Information
 The project is a collaboration
between UTS (lead researcher
Professor Val Wilson co-joint
appointment with Sydney
Children’s Hospitals Network) &
University of Ulster (lead
researcher Professor Tanya
McCance)
 This study is being conducted in
collaboration with children’s
hospitals and children’s units in
general hospitals across a number
of countries in Europe and
Australia with 12 organisations
involved (across 20 wards/units)
 A core set of 8 KPIs have been
developed from primary research
undertaken by Tanya McCance at
the University of Ulster
Participants
from the
Australian sites
Workshop
29/30th Jan 2013
KPIs for Nursing and Midwifery
KPI 1: Consistent delivery of nursing/midwifery care against identified need
KPI 2: Patient’s confidence in the knowledge and skills of the nurse/midwife
KPI 3: Patient’s sense of safety whilst under the care of the nurse/midwife
KPI 4: Patient involvement in decisions made about their nursing/midwifery care
KPI 5: Time spent by nurses/midwives with the patient
KPI 6: Respect from the nurse/midwife for patient’s preference and choice
KPI 7: Nurse’s/midwife’s support for patients to care for themselves where appropriate
KPI 8: Nurse’s/midwife’s understanding of what is important to the patient
(McCance et al 2012)
ATTRIBUTES OF THE NURSE
Professionally competent
Patient’s confidence in the knowledge and
skills of the nurse/midwife
PERSON-CENTRED PROCESSES
Consistent delivery of nursing/midwifery care
against identified need
Time spent by nurses/midwives with the
patient
Working with patient’s beliefs and values
Knowing what is important to the patient
Respect for patient’s preference and choice
Sharing decision making
Patient involvement in decisions made about
his/her care
Person-centred Nursing
Framework
(McCormack & McCance 2010)
Providing holistic care
Support of patients to care for themselves,
where appropriate
Patient’s sense of safety whilst under the
care of the nurse/midwife
Measurement Framework
 The framework for measurement utilises a range of data
collection methods
 The measurement framework comprises three key data
sources
i.
obtaining user feedback (patient survey &
patient/family stories)
ii. observations of practice
iii. reviewing the patient records against identified goals
iv. Speaking with staff
Project Aim
To explore the utility of these KPIs and related
measurement framework in supporting the
development of person-centred practice across a
range of services provided to sick children.
European Sites
 Hans Christian Andersen Children's Hospital, Odense,
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
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Denmark
Temple Street Children's University Hospital, Dublin,
Ireland
Great Ormond Street Hospital, London, England, UK
East Kent, England, UK
Royal Belfast Hospital for Sick Children, Belfast, Northern
Ireland UK
South Eastern Trust, Northern Ireland UK
Australian Sites
 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
Project Plan
Tailoring KPIs and
measurement
framework for use
within a paediatric
setting
3 cycles of
implementing the
KPIs and
measurement
framework,
followed by
supporting practice
change and
innovation
Evaluation of the
implementation
process
Hypothesis
generation and
preparation of final
research report
Stage 2: Implementation of the KPIs and
measurement framework
1
2
3
4
5
6
7
8
9
Survey
Survey
Survey
Survey
Survey
Survey
Survey
Observation
Analysis Feedback
Stories
Stories
Transcribe
Analysis
Document
• Survey: distributed to all patients on discharge (over 7 weeks)
• Stories: 3 family stories over 1 week and 3 patient stories over 1 week
• Documentation: review patient record in conjunction with asking staff
about patient goals (10 reviews over 1 week)
• Observation: monitoring nursing presence in a specified bay over a 30
minute time period (3 over 1 week)
10
Outcomes for SE Trust (1)
KPI 8: Did you feel the nurses understood the things that were important to your
child during their time in hospital?
Parent’s comment:
Maybe they could have told the parents a wee bit more about the arrangements for staying
overnight. Because you’re sitting there you don’t really know whether to get into your jammies
or not or is there a bathroom for the mummies that we can use. Nobody really said anything to
us so we weren’t sure, so maybe that was the only thing .
Outcomes for SE Trust (2)
KPI 5: Did you feel that the nurses had enough time to give the care which your
child needed?
Patient Satisfaction survey
Parent’s comments:
They had time for them, you know, they spent time with them and got them
whatever they needed. And if the buzzer went they were there.
Outcomes for SE Trust (3)
KPI 4 : Did you feel the nurses involved you in the decisions made about your/your
child’s care?
Child’s comments:
I felt really included in every decision that there was to make, because they made
me fell like I was the adolescent and they treated me like I was the person going
through, like I was able to make the decisions and it gives you a sense of
independence and I really like that.
Action Plan
Issue
Current documentation
does not:
1.Facilitate easy
identification of parent
daily priorities of care to
their hopes/wishes.
Relationship to KPI
KPI 4 patient’s
involvement in decision
making
KPI 8 understanding of
what is important to the
patient
Action Required
Review of current
nursing documentation
is already underway
Person Responsible &
Date for Completion
Rosie Kelly and pediatric
ward sisters/deputy sisters
2.Clearly identify area for
nurses to record daily
patient
priorities
There is no agreed standard
written information leaflet/
welcome to booklet for the
children’s unit.
KPI 6 Respect for
patient preference and
choice
KPI 8 understanding of
what is important to the
patient
The development of
‘Welcome to the children and
young person’s unit at the Ulster
Hospital’ booklet
Craig Ward staff
Our experience
 Staff engagement through regular feedback is key
 Time consuming to embed in practice
 Learning new skills around data collection and analysis
made us a bit anxious to start with
 Action planning is a bonus because it gave us focus
 Publicising our results for parents and kids to see is
important
Outcomes
Example 2: Comparison of six wards in one organisation
KPI 1: Consistent delivery of nursing
care against identified need
KPI 5: Time spent by nurses with the
patient
Patient Satisfaction Survey
“Did you feel that the care your child
needed was delivered each day regardless of
which nurses were on duty?”
Observations of Practice: Based on
observations carried out at differing times of
the day
Outcomes
Example 4: Benchmarking across all participating sites
KPI 1: Consistent delivery of nursing care against identified need
Chart Review
4.00
3.50
3.00
2.50
2.00
Chart review
1.50
Mean
1.00
Paediatric hospital mean
0.50
General hospital mean
General 6
General 5
General 4
Paediatric 13
Paediatric 12
Paediatric 11
General 3
General 2
General 1
Paediatric 10
Paediatric 9
Paediatric 8
Paediatric 7
Paediatric 6
Paediatric 5
Paediatric 4
Paediatric 3
Paediatric 2
Paediatric 1
0.00
Novelty of the project
 Measuring the impact of nursing on the experience of
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
patients and their families
Involving nurses in evaluating and making changes to their
own practice as a result of engaging with the research
process
Implementing processes that support the use of evidence
to inform practice and knowledge translation in action
Developing capacity in research through engagement of
local facilitators
Creating active research collaborations that can influence
the local, national and international healthcare agenda.
Further Information
Professor Tanya McCance
Institute of Nursing and Health Research
University of Ulster
E: [email protected]
Ms Rosie Kelly
Paediatric Unit
South Eastern Trust
E: [email protected]
Patricia Coulter
BHSCT
E: [email protected]