Improving the Patient Experience through Nursing & Midwifery KPIs

1. Improving the Patient Experience through Nursing & Midwifery KPIs Rosie Kelly Clinical Manager, Acute Children’s Services

2. 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)

3. 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)

4. Final 8 top ranked KPIs

5. Measurement framework

6. 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

7. Our Experience • 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

8. Organisational Context Organisational Indicators • EXAMPLES • Reported number of falls • Pressure ulcer incidence • Nurse facilitated discharge rates • Compliance with hand hygiene Indicators for Safe & Effective Care • EXAMPLES • Performance against supervision standard • Attendance – management rates • Management of salaries & wages budget incl Bank, Agency & overtime Patient Experience KPIs 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

9. Paediatric International Nursing Study (PINS)

10. 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

11. 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 (Orthopaedic, Middleton & Edgar Stephens)

12. 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

13. Data Collection & Analysis Timeframe • 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)

14. Challenges • Time out for staff • Using new data collection tools • Recognising action plans as positive tools

15. Using the KPIs to change and improve practice

16. In conclusion ....