Nursing and midwifery care: event report

Excellence in Care: Group Work

Table Talk

Event participants were asked to discuss the idea of a national approach to assuring nursing and midwifery care, focusing on issues vital to success and potential challenges. The messages from spokespersons for each group appear below, followed by a summary of outputs from the groups on three key issues - why a national approach is necessary, what is needed to put one in place, and what challenges might be anticipated.

Why do we need a National Approach to Assuring Nursing and Midwifery care?

• There are gaps in current reporting systems.
• We need it to ensure there is no disconnect or disengagement from ward to board: the approach will promote ward-to-board communication and support.
• It will define clear standards for all.
• The approach will promote patient and public involvement in services.
• It will ensure nursing and midwifery contributions continue to be driven by the profession.
• A national approach will help to ensure consistency of care across Scotland.
• It will provide sufficient flexibility to allow clinical judgement to guide appropriate assessment to achieve person-centred care - it is not a one-size-fits-all approach.

What is needed to ensure the national approach is successful?

We need to:

• promote enthusiasm and vitality in teams.
• care for our staff, recognising that the workforce is ageing and taking steps to avoid exhaustion and burn-out.
• show our trust in staff and their skills.
• keep the approach simple and meaningful to the user.
• include service users - it cannot simply focus on nurses' opinions.
• clarify the purpose of the system.
• reduce the data burden through using appropriate electronic systems that "speak" to each other.
• ensure indicators are principle-based, not compliance-based.
• capture person-centredness and assure it is at the centre of care delivery.
• ensure alert systems are in place to identify problems early.
• promote the approach as a model of empowerment, not restriction.
• ensure the approach links with other systems, such as those of the Healthcare Environment Inspectorate and Healthcare Improvement Scotland.
• recognise that nurses are not data collectors.

What are the challenges?

• The potential to generate lots of complex data.
• Ensuring IT systems are integrated and support staff are in place.
• Measuring the wrong things for the wrong reasons.
• Getting the balance between assurance and improvement right.
• Making sure a model of empowerment is promoted, not a model of compliance.
• Keeping focused on what is core to patients' needs.
• Ensuring the system remains simple to use.
• Identifying elements of care currently measured that do not need to be measured.
• Getting consensus on the key standards.

Other comments …

• "There is enthusiasm and commitment in the room to find solutions and make this work."
• "This is about assurance, not judgement."
• "Can we stop using words such as 'performance' and 'compliance'? 'Empowerment' and 'ownership' are much more useful."
• "This mustn't be about measurement for measurement's sake - we don't want a box-filling exercise."
• "Focus on systems, not outcomes."
• "Don't reinvent wheels."
• "Integrate patient and staff experience."
• "Remember patient/carer and student feedback."
• "Facilitation and support for staff will be important."
• "We need nationally developed IT solutions."
• "Multidisciplinary record-keeping will be an important part."
• "There is a responsibility on the Scottish Government and Healthcare Improvement Scotland not to ask for huge amounts of data."
• "Openness and transparency is key - any tools should demonstrate to patients and families what quality care is and what to expect."
• "Ward welcome-board displays should include data relevant to the approach."
• "Be brave, stop measuring processes and empower frontline staff, creating the conditions for them to do the right thing."
• "Let staff own the system, changing their expectations of governance in the process."

Next stage …

Comments and ideas generated at the table discussions have been collected and will now inform the next stage of the process, which is drafting principles to underpin the work.