Leading Better Care Vicky Thompson National Programme Leader – Senior Charge Nurse Role, Clinical Quality Indicators & Releasing Time to Care NHS Scotland

Role Framework Links Releasing Time to Care Activity Analysis SCN ROLE Exemplar Job Description & KSF Outline Releasing Time to Care SCN ROLE Activity Analysis CQIs Workforce Planning SCN role is pivotal to LBC Educational Framework Development Needs Analysis

Policy Context Audit Scotland 2002 Planning ward nursing: Unable to establish correlation between organisational processes and patient outcomes Identifies inconsistency in quality measures across Health Board areas Need to focus on continuous quality improvement & identify and review quality indicators. Need to demonstrate that quality of care is being provided. Work was undertaken : across NHS boards & in 2005 the impact of nursing on patient outcomes was published. Audit Scotland 2007: Health Boards monitor quality of nursing care in a variety of ways Need to identify and share best practice Need to ensure safe and effective care Requirement for Clinical Leaders but challenges remain in working towards a national system of quality indicators A number of documents, that you are all familiar with have highlighted the need for clinical leadership, to focus on one the most recent Delivering Care, Enabling health highlights that: Culture and Context – Within the policy context of Delivering for Health defines the underlining principles of NMAHP practice Capability –Highlighting the need for effective clinical leadership, the need to use information to develop practice to improve patients’ experience of health services and improve health outcomes. Capacity – Describing the need for an adequate and flexible workforce educated to the right level, with the skills to perform the roles required to deliver the services anticipated in Delivering for Health. This links to work being undertaken across the 4 nations in the uk looking at Modernising nursing careers.

By the end of 2010… Senior Charge Nurses in hospital settings will be working in the context of the revised role The majority of in-patient areas to have Clinical Quality Indicators in place The SCN will be the visible embodiment of clinical leadership in NHS settings, coordinating patient care, and inspiring the nursing/midwifery team

Improving Patient Care at the Bedside Interconnectedness of this project with a variety of strategic national workstreams currently ongoing within the Scottish Government 5

Clearly define this key role and ensure that SCNs are visible and accessible to patients and their carers. LBC establishes a national framework for SCNs working in hospital settings across NHS Scotland. Empowers Senior Charge Nurses to be clinical leaders and guardians of safety and quality in their area. Developed through extensive stakeholder involvement including patient / client input.

Four key dimensions for the Senior Charge Nurse role: Ensuring safe and effective clinical practice Enhancing the patient experience Managing and developing their teams Contributing to the delivery of organisational objectives Supported by Clinical Quality Indicators (Falls, Pressure Ulcer Prevention & Food, Fluid & Nutrition) The revised SCN role is applicable to nurses and midwives working in hospitals in all clinical specialities, and is supported by the NES Education and Development framework, a National Programme Leader and a Board-level facilitator network.  Significant and essential links to the Releasing Time to Care initiative

The vision from Leading Better Care ‘We will have strong clinical leadership delivered by empowered Senior Charge Nurses who are the guardians of quality and clinical standards for the patients under their care.’ Paul Martin Chief Nursing Officer

Why Change? ‘If you always do what you’ve always done, you will always get what you always had’ Albert Einstein Need for modernising nursing roles to meet the changing face of Healthcare over time. Evidence and Mechanisms to measure the impact of a modern Charge Nurse role Frontline Clinical Leaders Clinical Effectiveness Safe and Effective Care Cause and Effect Succession planning 10

Do we all see the same thing? Key message Sometimes we can’t see what is obvious to others! Message to deliver Just a bit of fun. What do you see? Hands up if you see a cow Hands up if you see a map of the world. Notes

Supporting Framework and Tools for Implementation

Framework for Implementation Implementation of Senior Charge Nurse Role Educational Framework Safe and Effective Clinical Practice Enhance Patient Experience Manage and Develop Performance of the Team Effective contribution To Organisational Objectives Workload and Workforce Planning Tools e QIPS CQIs Release Time to Care Productive Ward

SCN Role Framework To Ensure Safe and Effective Practice Clinical Leadership & Teamwork Evidence Based, Clinically Effective Practice Continuous Quality Improvement Patient Safety To Enhance the Patients Experience Clinical Expertise Co-ordination of Patients Journey Promote Culture of Patient Centred Care To Manage and Develop the Performance of the Team Role Model Facilitate Learning & Development Managing the Practice Setting To Contribute to Organisations Objectives Networking Service Development Political & Strategic Awareness

Supporting Framework Competencies and KSF outlined Working Document For current SCNs and their managers ‘Talent Spotting’ – use as framework for development An education framework provides a robust overarching structure which gives shape and support to the elements of contemporary educational provision It includes knowledge, skills and capabilities required for SCN role It articulates links with KSF, SCQF and advanced practice framework It can be used by individual and organisations to assess and plan personal, professional and service development Education providers can use the framework to design curricula

Implementation of the new role Crucial in leading and delivering the high quality care that our patients and the public expect. Transition of SCNs to the revised role is a phased process that has Executive level support from NHS Board Nurse Directors across Scotland and is overseen by a national steering group. The work of NHS Boards is supported by a funding package provided by Scottish Government Health Directorates. Board-level Clinical Facilitation, plus the delivery of education and development packages and one to one facilitation for Senior Charge Nurses will provide additional support

Many Boards are also offering action learning for their SCNs Many Boards are also offering action learning for their SCNs. In addition, educational and developmental initiatives are supported by the NHS Education for Scotland (NES) Educational Framework and resources. Cohorts of SCNs are already developing into these roles across NHS Scotland and the initiative targets the implementation of this role for all SCNs working in hospitals by the end of 2010. From recent information provided by NHS Boards we know that there are around 2000 SCNs in Scotland. Of them, around 1545 will be included in the revised role and around 700 are already undergoing development or working to the outline.

Clinical Quality Indicators - CQIs

Why did we need Clinical Quality Indicators? Audit Scotland (2002) reported on limited availability of information on impact of nursing on quality Audit Scotland (2007) – acknowledged progress but challenges for national quality indicators Identify nurse specific measures that have impact on quality of care and patient experience

CQI Progress Three CQIs developed: Falls Food, Fluid and Nutrition Pressure Area Care Prevention Data capture and reporting systems being developed locally & nationally Further CQIs in discussion for specialist areas, eg midwifery, mental health, etc

Clinical Quality Indicators Change of culture Data collection and analysis skills Quality improvement skills

Data, data and more data… Expect poor results initially Use it as a tool to engage staff and improve care If it’s not documented where is the evidence of care delivered?

Impact on Quality Implemented revised SCN Role

CQI Compliance trends

Synergies with other national programmes

Supporting Development

Supporting Development National Programme Leader Network of Clinical Facilitators Steering group chaired by Executive Nurse Director Commitment from Scottish Government, QIS and NES

Leading Better Care Implementation Group Scotland’s Executive Nurse Director’s Group (SEND) Leading Better Care Implementation Group Releasing Time to Care Facilitator Network eQIPS / CQI Development Group Leading Better Care Clinical Facilitator Network

Leading Better Care Facilitators 8. NHS Highland Jenny Lobban Project Manager / Facilitator, 01463 704715 1. NHS Ayrshire & Arran Susan Hannah Practice Development Lead, 01294 323457 11 9. NHS Lanarkshire Margot Russell, Practice Development Specialist Clinical Leadership and Quality, 01698 723205 2. NHS Borders Kim Smith Practice Development Leadership coordinator, 01896 827651 3. NHS Dumfries & Galloway Maureen McCrae Unit manager, specialist palliative care, 01387 241986 12 10. NHS Lothian Fiona Bonnar & Linda Conway Lead Clinical Facilitators, 01506 434274 / 07813 579660 4. NHS Fife Lynn Barker Programme Lead Leading Better Care, 01592 743505 14 11. NHS Shetland Andrea Ridealgh, Senior Charge Nurse, 01595 743357 5. NHS Forth Valley May Fallon Senior Nurse, Practice Development, 01324 678528 12. NHS Orkney Moira Sinclair, Charge Nurse, 01856 888244 8 6 13. NHS Tayside Debbie Baldie, Senior Practice Development Nurse, 01382 660111 6. NHS Grampian Fiona Gray, Programme Manager / Facilitator, 01224 555064 13 14. NHS western isles Mary McElligot, Professional Practice Development Manager , 01851 708057 4 5 7. NHS Greater Glasgow & Clyde Kate Cocozza, Lead Nurse Practice Development, 0141 201 1695 7 10 9 2 1 National Programme Leader – Leading Better Care Vicky Thompson, 07920 765343 Special Health Boards Golden Jubilee National Hospital – Irene McGachy, Clinical Facilitator, 0141 951 5050 The State Hospital - Sandra Steele 3 N Please note that this diagram is for internal use only and should NOT be used in any publications

How do we know if we’ve succeeded in implementation?

By the end of 2010… Clinical Quality Indicators will provide us with: Data used for quality improvement as part of day-to-day work Quality improvement methodology known and used regularly by all nurses

By the end of 2010… Senior Charge Nurses will be: Empowered clinical leaders Guardians of quality and clinical standards Visible, approachable and authoritative

Contact Details Vicky Thompson National Programme Leader – Senior Charge Nurse, Clinical Quality Indicators & Releasing Time to Care 07920 765343 v.thompson@nhs.net