Assume, Reassure or Assure? How can senior nurses sleep at night?

1. Assume, Reassure or Assure?How can senior nurses sleep at night? Mandie Sunderland: Chief Nurse The Pennine Acute Hospitals NHS Trust

2. Challenges for Nursing • Build public confidence in the nursing profession particularly in light of national adverse media coverage • Robust Board Assurance – lots of data not much info • Professional concerns re nursing practice • Nursing largest workforce • Biggest pay bill • Patient contact 24/7 • Nurse staffing now receiving national attention • Efficiency challenge

3. Assume Reassure Assure We can mix it up… Proposition that is taken for granted as if it were known to be true Comfort, faith A declaration to inspire full Confidence, freedom from doubt, based on evidence

4. Old NHS Tribal Response to Dead horse • Fasten three dead • horse together • Visit somewhere • else that has a dead • horse • Stop feeding the • horse due to lower • running costs • Threaten the horse • with the sack • Whip it harder • Buy a bigger whip • Get a new rider • Hire an outside • contractor to ride it • Lower standard to • include dead horses

5. Knowing How We Are Doing • Where did we start? Review of what we had Multiple audit tools reports, shared drives, Evidence base, NICE guidelines, NPSA, RCN…. Implementation of the NW Indicators using an in house developed IT solution, with a back to the floor approach. Falls Assessment Nutrition Pain Management Pressure Area Care Medicine Administration Observations Infection Prevention Added: Continence Diabetes

6. Developments at HoEFT • Development of new metrics • Maternity • Community • Neonates • Paediatrics • Theatres • Outpatients • A&E • Endoscopy

7. General Care Indicators 2013

8. General Care Indicators 2013

9. Progress

10. Reporting

11. Metrics Assurance Framework

12. Metrics Assurance Framework cont...

13. However We recognised that we were measuring process which had its limitations What else could we triangulate? What would we do with all of this information?

14. Nursing & Midwifery Performance Committee • Co-Chair – Deputy Director of Finance and Performance • TOR adapted form Finance and Performance committee • Monthly meet with head nurses • Forward planner for suite of indicators/Triangulated scorecards • Exception reports • Performance notices • Real sense of business like accountability

17. Outcomes • Measuring to improve really does work • Huge benefits with working with performance team • Increased accountability ward to board • Healthy competition • Opportunities to celebrate • Opportunities to share • Shared accountability • Robust proactive assurance both internally and externally

18. What a nightmareAsked ourselves a serious question • How do we know your workforce has the essential knowledge and skills in key areas of fundamental care that ensure safe high quality patient care? • Particularly where the requirement to update face to face learning/training activities are registered as attendance only. • Chances are…………you don’t. We didn’t

21. Return on expectation • VITAL has created a ‘common language’ for fundamental care. • Nurses now understand what they need to know regardless of where they work. • Centralised VITAL completion data for all nurses for reporting against CQUINs, HIA / NHSLA. • Training needs analysis for fundamental care. • Nurse feedback…..”I have worked in outpatients for years and have never seen or used a MEWS chart….having passed VITAL I now know how to assess patients using MEWS”.

22. Future for VITAL VITAL has the potential to be used for: • Appraisal - all nurse complete VITAL as part of appraisal • Recruitment / probation period tool. • Annual self declaration with NMC. • VITAL for Medic’s/AHP’s/Health Care Assistants/Managers. • Signoff Pre Registration nurses. • Longitudinal research. Data set in excess of 10,000.

23. Million Dollar Question! Over 2 million Fundamental care questions have now been answered on VITAL