2. NIPEC Organisational Guide to Practice & Quality Improvement Tanya McCance, Director of Nursing Research & Practice Development (UCHT) & Reader (UU) Brendan McGrath, Assistant Director of Nursing, Altnagelvin Hospitals Trust

3. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Presentation Structure Development of practice – context and background A mapping exercise involving Trust Nurse Directors Developing the organisational guide

4. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Vision Statement for Development of Practice (April 2004) Development of practice described as the range of activities with the shared aim of improving the quality of care provided to patients and clients A vision statement that reflects the important elements for effective development of practice 8 statements of strategic intent

5. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Implementing the Vision Statement Strategic Area 1: Supporting Clinical and Social Care Governance through promoting the Development of Practice Strategic Area 2: Contributing to an infrastructure that supports Development of Practice Strategic Area 3: Developing strategic collaborative relationships

6. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Strategic Area 1: Workplan A Mapping Exercise with Trust Nurse Directors in the 18 HPSS Trusts. A comprehensive review of the literature Development of a ‘Best Practice Guide’ aimed at helping organisations think more strategic about development of practice

7. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel The Mapping Exercise The process –One-to-one informal meetings, conducted by two SPOs –May – July 2005 Areas discussed –Awareness of NIPEC’s Vision Statement –NIPEC interpretation of development of practice –The range of activities within organisations –The enablers and barriers –Available resources –Perceived value of activities –Client involvement –Impact on staff development –Links with C&SCG structures

8. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Views on the Vision Statement Widespread agreement on the broad content The need to engage with staff on the ground to ensure a shared understanding Clear consensus on NIPEC’s interpretation of development of practice The challenges that might impact on the implementation of the vision

9. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Current Activity Practice Development Clinical Audit Benchmarking Quality Improvement Integrated Care Pathways Service improvement Reflective practice Analysis of Critical Incident Leadership Development Programme Research

10. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Supporting development of practice Leadership Organisational culture Infrastructure Communication Multi-professional involvement Attainment of knowledge and skills Policy/strategic context Resources

11. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Impact on staff Supports the practitioner in managing risk Promotes staff empowerment Enhances awareness of professional issues Promotes readiness for change Contributes to recruitment and retention Contributes to career development

12. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Links with C&SCG The influence of development of practice within C&SCG structures was variable Committees identified within structures covered the breadth of activity Influence of evidence and outcomes arising from this activity was not always clear The value of this activity for both the patient and the organisation was clearly articulated.

13. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Organisational Guide Aim: To help create organisational environments that enable staff undertake practice and quality development activities to support safe and effective care Potential Uses Self-assess organisational readiness for P&Q improvement Support implementation of RQIA recommendations A multi-professional tool

14. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Organisational Guide – Development Process 3 Stages Stage 1 – Vision Statement Development of Practice Stage 2 – Mapping Exercise with Directors of Nursing Stage 3 – Literature analysis EBP, PD, C&SCG Partnership with Expert Working Group

15. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Organisational Guide - Overview 3 key requirements of organisational readiness for practice and quality improvement Infrastructure Systems People

16. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel People 4 Key Factors Leadership – at all levels Culture – of improvement Communication and Engagement User Involvement People

17. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Culture A culture of… Person-centredness Learning Inquiry Openness and transparency Fair blame Performance Management People

18. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Communication and Engagement Essential at all levels in the organisation. People Evidence of P&Q Improvement Activities Evidence of sharing good practice Evidence of partnership working Recognition of good practice Recognised through involving staff in decision making

19. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Patient/Public Involvement - PPI People Corporate level The inclusion of patients and public in service planning and commissioning Capacity for PPI in service planning/delivery Patient and public representation in quality improvement activity Individual Patient and Practitioner level Visible leadership for PPI PPI integral to the work of all involved in the HPSS Patient stories/satisfaction surveys to inform practice and quality improvement activity Evidence of learning from complaints Patient/client involvement in care and treatment the norm.

20. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Infrastructure 3 Factors Human Technological Financial People Infrastructure

21. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Human Infrastructure All professional staff should have practice and quality improvement skills… Infrastructure People Develop specific expertise within key roles… Examples of key roles  Ward Sisters/Charge Nurses/Team Leaders  Practice Educators  Quality Managers/Practice Facilitators  Nurses Consultants/Specialist Nurses  Services Managers/Programme Managers  Directors/Assistant Directors  Governance Leads

22. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Human Infrastructure The specific expertise relates to skills such as; Infrastructure People Facilitation skills Audit Skills Research skills Analytical skills Interpretive skills Change management skills Political skills Interpersonal skills Evaluation and Performance Improvement skills Project Management Skills

23. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Technological Infrastructure Access to relevant information systems to inform practice, Facilities to support evaluations of practice that address performance improvement targets. Indicators of an effective Technological Infrastructure include: People Infrastructure  Access to the Internet at work…  Access to systems and personnel that support data collection, analysis and presentation  Access to e-mail at work to enable communication and networking

24. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Financial Infrastructure Need for identified ‘ring-fenced’ funding to support successful practice and quality improvement People Infrastructure Examples include:  Funded establishments  Ring fenced budgets for staff learning  Facilities conducive to learning and improvement  Funding for practice and quality improvement activities

25. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Systems 9 Factors Effective practice and quality improvement requires clearly articulated and understood systems that inform, guide and monitor the practice of staff… Examples People Infrastructure Systems  Risk Management System  Complaints Management System  Incident Reporting Systems  Appraisal Systems  Professional Supervision System  Performance Improvement System  Controls Assurance System  Equality/Human Rights System  Health and Safety Management System

26. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Organisational Guide Self Assessment People Infrastructure Systems Level Descriptor No evidence Not achieved Some evidence Work commenced Well evidenced Fully evidenced Good progress Well established

27. Improving Patient Experience and Care through Practice and Quality Improvement NIPEC Conference, 27 th March 2007 Hilton Templepatrick Hotel Consultation Feedback Document has real value Provides clear direction on how to ensure effective practice and quality improvement A useful resource for organisations to measure their readiness and progress A useful framework for developing a strategy for practice and quality improvement Self Assessment approach useful given RQIA Assessments format Support implementation of RQIA recommendations Consider multiprofessional value of guide People Infrastructure Systems