Nursing and midwifery care: event report

Excellence in Care: Moving Forward

Ending, And Beginning

CNO Fiona McQueen looks back on the event and sets out the next steps.

This was a hugely valuable event. It took us some way down the road to developing our understanding of the possibilities that lie before us and clarified our thinking on shared aims. Importantly, it emphasised what care assurance should not be, which means we can focus on what it should be.

The people of Scotland have high expectations of nurses and midwives, and we must provide them with assurance that the care we deliver is safe, effective and person-centred. We need to gather data intelligently and use it for multiple purposes to provide that assurance, using information to improve and encourage staff rather than threaten and frighten them. There will always be an element of scrutiny of performance, but we have a real opportunity now to bring scrutiny together with improvement to make things better for patients, families and staff. Momentum being generated in areas such as electronic data collection methods and patient record systems will support our efforts on this.

Listening to participants, it became clear to me that above all else, this initiative is about excellence in care. In trying to create a national system and create consistency, we must always look at it from the perspective of an individual patient - what will it mean to him or her, and what benefits will it bring? How will it improve his or her experiences and outcomes of care?

No one questions the value of the contribution nurses and midwives make to the delivery of effective care. That contribution has to be maximised. We need to tell and share our stories of excellence - nothing breeds success like success. And we need to remain mindful that patient experience and perceptions of excellence stretch beyond the nursing and midwifery care they receive.

We heard about individual systems being used in NHS boards. These systems share the principles we have identified for care assurance and are unquestioningly bringing benefits. I anticipate, however, that the national work we are taking forward will gain momentum over time, corralling ideas and defining a unified way forward for Scotland.

We are in this for the long haul, so the pace has to be right. Our outputs have to be thought through, meaningful and deliverable. There will be no point coming back to the same event two years down the line and saying, "If only we had not tried to rush this through … ". Getting it right, rather than getting it quick, is our aim.

The event has challenged my own thinking. As CNO, I would quite like a tick box that tells me every patient in Scotland has, for example, been offered a drink. But I've always felt that an approach like that is not sufficient, and the event confirmed it. Ticking a box doesn't mean excellent care has been delivered. I think we all need to examine our thinking, accept the challenges we face and be prepared to move our position to genuinely progress a new way of assuring care in Scotland.

Creating a culture of improvement is never easy, and challenges undoubtedly lie ahead. But the event helped to crystallise what the challenges are. When we recognise them, we can understand them, manage them and work out what we need to do to overcome them.

We have a strong foundation in Scotland through the patient safety movement, which is helping to make once relatively common problems, such as ventilator-acquired pneumonia in intensive care units, now comparatively rare. We should remember this when the road ahead seems dark and unclear, taking confidence from what we have done already and trusting that we will be able to do it again.

The next steps will be developed using collaborative and co-production processes. Members of my team will be visiting a number of NHS boards to get a real insight into what they are doing under the four key deliverables of Excellence in Care:

• a nationally agreed (small) set of clearly defined key measures/indicators of high-quality nursing and midwifery
• design of a local and national infrastructure, including an agreed national framework and dashboard
• a framework document that outlines key principles/guidance to NHS boards and integrated joint boards on development and implementation of local care assurance systems/processes
• a set of NHSScotland record-keeping standards.

We will agree governance and reporting structures for the work, focusing on reducing the need for multiple reporting and action plans and limiting bureaucracy, and develop a communication plan to drive the work forward with multidisciplinary and multiagency teams, patients and the public. We will also build on the feedback from the event to continue developing the core principles for Excellence in Care and work with colleagues from NHS Education for Scotland to ensure alignment with Leading Better Care moving forward.

Initial actions specific to the four deliverables are shown in the text box overleaf.

Above all else, we need to keep the dialogue going to take things to the next level. Our journey will be an easier and more successful one if we stay the course together.

Professor Fiona McQueen, Chief Nursing Officer

Next steps to support key deliverable 1

A nationally agreed (small) set of clearly defined key measures/indicators of high-quality nursing and midwifery.

We will:

• work with stakeholders to start scoping, mapping and developing a nationally agreed (small) set of clearly defined key measures/indicators of high-quality nursing and midwifery care, using the proposed domains and categories identified by the quality of care review: this will bring together national and local measurement under the ethos of "measure once and share widely"
• meet with national and local programmes (including the Scottish Patient Safety Programme and person-centred health and social care work).

Next steps to support key deliverable 2

Design of a local and national infrastructure, including an agreed national framework and dashboard.

We will:

• work with stakeholders, including eHEALTH colleagues, to start scoping and developing a national framework and dashboard (including a national prototype dashboard) using the proposed domains and categories identified by the quality of care review.

Next steps to support key deliverable 3

A framework document that outlines key principles/guidance to NHS boards and integrated joint boards on development and implementation of local care assurance system/processes.

We will:

• commission the development of a review of the evidence base on care assurance.

Next steps to support key deliverable 4

A set of NHSScotland record-keeping standards.

We will:

• work with eHEALTH colleagues on developing and testing options for electronic-based documentation to reduce paperwork and increase consistency across Scotland
• commission the development of record-keeping standards using outputs from the event to support a reduction in paperwork and the data burden.