International overview and the state of Nursing Sensitive Outcome (NSO) measurement in UK Health Services Professor Peter Griffiths January 2014
Outline Brief overview of the state of the art Why it is important to measure NSO? What is important to measure? NSO measurement in England: The safety thermometer What could be the impact of NSO measuring on health service policy and strategies? 2
Nurse Sensitive Outcomes. reflect patient outcomes that are determined to be nursingsensitive because they depend on the quantity or quality of nursing care therefore can be used as quality indicators 3
State of the art 2008 2008 review, commissioned by the Department of Health (England) 87 different nurse sensitive outcomes identified There are probably more Little consistency between different indicator sets Feasibility and significance variable Griffiths, P., Jones, S., Maben, J., Murrells, T., 2008. State of the Art Metrics for Nursing: a rapid appraisal. King's College London, London. 4
Nursing Minimum datasets 5
Nurse Sensitive Outcomes. 6
So what makes a good (nursing) indicator? Evidence of substantial variability associated with nursing. There must be sufficient knowledge to inform remedial action. Nurses must have responsibility for actions that lead to the outcome. The indicator must be recognised as important (by the public, managers and nurses). Evidence must support links between process or structure measures and important outcomes. Measurable, with data available at reasonable cost. Other considerations include: The risk of gaming where improving performance on the indicators detracts from overall performance. risk adjustment / stratification to ensure comparability across settings Pencheon, D., 2008. The Good Indicator Guide. Association of Public Health Observatories. National Quality Forum. A Comprehensive Framework for Hospital Care Performance Evaluation: A consensus report. Washington: National Quality Forum, 2003. 7
Most consistently identified indicators failure to rescue falls health care associated infection pressure ulcers staffing levels. 8
USA: National Database of Nursing Quality Indicators (NDNQI ) 1400 hospitals Fall/Injury Fall Rates Hospital-/Unit-Acquired Pressure Ulcer Rates Physical Restraint Prevalence Ventilator-Associated Pneumonia Rate Central Line Associated Bloodstream Infection Rate Catheter-Associated Urinary Tract Infection Rate Pain Assessment/Intervention/Rea ssessment Cycles Completed Assault/Injury Assault Rates Nursing Hours per Patient Day Nursing Skill Mix RN Education/Certification Nurse Turnover Rate Peripheral IV Infiltration Rate 9
England: The safety thermometer Venous Thromboembolism 10
Use of the safety thermometer All NHS providers must supply data Providers are incentivised to improve data quality Providers are incentivised to reduce harm Commissioning for Quality Improvement (CQUIN) All data is publically available 11
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Potential impacts of NSO measurement National Regional Local Co-production at all levels of the system Key purposes Improvement against national priorities Accountability to taxpayers International benchmarking Improvement in quality within the region and progress against the regional targets Enable benchmarking Service improvement Board accountability Provider benchmarking Example product (NHS England) National Quality Board Quality Report Regional quality measures Services from Quality Observatory Provider quality account Team Local clinical ownership of indicators Service improvement Team benchmarking for improvement Clinical Team quality measure and dashboards 18
Safety thermometer success Provides a focus on some important nursing issues for those running health services Link to commissioning and incentives is important Improvement is incentivised There appears to have been improvement Not clear if the safety thermometer has caused it Degree of local (ward team) engagement is unclear At best variable 19
Caution Costs vs benefits Collecting data can be expensive and labour intensive No benefit if data is not used Need to properly understand the data 20
And finally: choose your indicators carefully Don t try to measure the un-measurable Make sure your indicator indicates what you think it means All road signs must be bilingual (English / Welsh) Nurses to be rated on how compassionate and smiley they are (Guardian June 16 th 2008) 21
Thank you.!