Nurse leadership and the quality agenda

There would be very few nurses working in the NHS and other healthcare organisations today who would not welcome wholeheartedly the announcement by the prime minister, David Cameron, that paperwork and bureaucracy will be reduced in future. The Coalition Government will also establish a nurse review group to address issues of standards across the NHS. The Nurse Quality Forum Group will lead the uptake of good practice and recommend ways of improving care standards, although the terms of reference of the group will not be decided until the first meeting at the end of February. The Nurse Quality Forum is to be led by Sally Brearly, a former nurse and expert on patient involvement and experience and a lay member of the National Quality Board. It will be composed of nurses, nurse leaders and patients and will be charged with taking a national leadership role in promoting excellent care and ensuring good practice is adopted across the NHS. A Number 10 statement said: “The prime focus will be to exhibit national leadership, to stimulate local action by those delivering care to address problems and promote improvements needed across services.” Those readers who keep up with the healthcare news will be aware that this is a response to a variety of damning reports published last year, which did not reflect well on the state of nursing in the acute sector. In October 2011, the Care Quality Commission found that a half of NHS hospitals were not delivering expected standards of nutrition to elderly patients and 40% did not offer dignified care.

Releasing Time to Care

 The Government also announced its aim to have all hospitals implementing the NHS Institute Productive Ward by April 2013. A recent report found that, despite the countless examples of quality improvement and savings incurred, only half the potential wards in England have availed themselves of the programme. The report says this is a ‘huge missed opportunity – and one which needs to be addressed urgently.’ The research team were particularly keen to answer the question about how the spread and sustainability of staff experience of implementing the Productive Ward, can help the spread of other large scale change initiatives.1 The Productive Series aims to empower teams to identify areas for improvement on the ward by giving staff information, skills and the time they need to regain control of their ward and the care they provide. While a successful implementation of the Productive Ward would seem to be an ideal solution for hospitals wishing to tackle the quality agenda and also make savings, it is recognised that implementation of this type of programme uses energy and needs dedication. The report highlights that organisational energy is influenced by levels of visible executive support, resources for programme leadership and facilitation and building resilience to times of pressure and change.2 It is perhaps no wonder that Trusts are failing to devise a spread of the initiative while they are consumed with the cost-saving agenda, which currently applies across the board. It is welcomed, therefore, that ‘targeted support’ to 20 Trusts will be facilitated by the Department of Health. In January last year, the NHS Institute for Innovation and Improvement undertook a Rapid Impact Assessment of the Productive Ward,3 reporting that it delivered an increase of 41% in direct patient care time. By investing that time in higher quality of care, the report demonstrates that the following benefits can be delivered: • Better staff satisfaction. • Better patient experience. • Reduced harm events (such as MRSA, C. difficile, pressure ulcers and falls). • Reduced (same diagnosis) re-admissions. In addition, the productivity, efficiency and financial benefits of the improvements are: • Reduced length of stay (and reduced excess bed day costs per patient). • Reduced staff sickness and absence. • Stock reduction. The assessment reports that the Productive Ward has significant identifiable quality, productivity and efficiency benefits for Trusts. The authors conclude that the programme empowers frontline staff to influence and improve the way they work, which improves morale and enhances the working lives of nurses and other ward based staff. The results of this study, which involved nine Trusts, suggest that, the Productive Series (if extrapolated across the NHS), could provide many of the answers required by the Nurse Quality Forum.