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Essence of Care – patient-focused benchmarking for health care practitioners Time to celebrate and share best practice (Part 1) Jane Stokes Abstract: the first of a series of articles that will appear in Nursing Progress exploring the clinical benchmarking process. The Department of Health published the 'Essence of Care - patient-focused benchmarking for health care practitioners' in February 2001. This articles outlines the eight fundamental aspects of care and the process of sharing best practice across the Trust, and ultimately throughout the NHS. Contents Return to Nursing Progress contents list The Department of Health published the 'Essence of Care - patient-focused benchmarking for health care practitioners' in February 2001.(1) The eight fundamental aspects of care and the process of sharing best practice across the Trust, and ultimately throughout the NHS are outlined. These are presented in the context of on-going practice development work within Barts and London NHS Trust. If you would like to know what makes a difference to a patient's time in hospital, ask the patient. Last year, across the UK, over 2000 patients, carers, health care professionals and patient-representative groups were asked to identify the important aspects of care that they valued. Eight fundamental aspects of care were recognised as high priority for improvement. The challenge is 'to stimulate professional consideration of how useful benchmarking activity may be in escaping from your ghetto's of good and bad practice, providing an approach to help you appreciate, share and utilise all levels of evidence, to attain patient-focused best practice'. (2) The opportunity now exists for nurses to be able to celebrate and share their evidence of best practice in these areas. Barts and London NHS Trust (BLT) certainly has a wealth of best practice to celebrate, but it is more important to take this opportunity to share this practice across the Trust. The priorities have been established as a UK wide quality initiative, BLT is ahead in establishing what patients value about the care they receive, and providing suggestions for improvement. The Shared Governance nursing teams collaborated last year to write the nursing philosophy The process became as inclusive as possible and sought the views of many people who were eager to contribute their values and beliefs about nursing. The Clinical Practice Nursing Team provided a forum to share and discuss the emerging issues from the feedback about the value nurses placed on delivering direct patient care. The Essence of Nursing group was established as a result, and then merged with the Philosophy Group as it became evident from patient audit that the themes identified were similar, if not the same. Collaboration and partnership in care emerged as the way to take forward projects aimed at enhancing the patient's experience. Many people had the opportunity to share and celebrate some of the projects of the Nursing Teams during the 2nd Nurses Symposium, held at the end of last year. The Symposium "Here is our Evidence", concluded with the jury (the audience) reaching a guilty verdict. The Trust was guilty of providing the evidence for our nursing practice. In February the Department of Health launched the 'Essence of Care' tool kit to be utilised by Hospital Trusts and Primary Care Trusts (PCT's) across the UK. The 'tool' provides the benchmark standards set as part of the clinical governance agenda and is aimed at quality improvement across the NHS (see Table 1). The tool is to be used as a resource for practitioners to explore the value of benchmarking activity. Benchmarking is 'a process through which best practice is identified and continuous improvement pursued through comparision and sharing'. (3) The eight benchmarks are:
Barts and The London Strategy for Benchmarking Aim To implement 'Essence of Care' - Patient-focused benchmarking for health care practitioners' Trust-wide. 1. To raise awareness of the 'Essence of Care' across the Trust. 2. To develop 8 'resource groups' representing each of the benchmarks. 3. To devise a communication strategy to disseminate knowledge and understanding of the benchmarking process. 4. To create an audit tool which will provide both qualitative and quantitative data allowing the identification of benchmarking priorities for Wards and Departments. 5. To create the opportunity for individual Wards and Departments to identify one or two benchmarks that represent a priority area for practice development. 6. To provide a forum to share best practice across the Trust facilitated by the Practice Development Nurses. 7. To establish systems of support to Practice Development Nurses, Clinical Leaders and Resource Group Members. 8. To create a comprehensive website on the intranet for networking, identifying resources and sharing best practice across the Trust. 9. To develop a framework to ensure that patient's views and participation, are sought at all stages of the benchmarking process. The 'Essence of care - patient-focused benchmarking for health care practitioners' be introduced throughout the Trust The Nursing Policy Board agreed that the Trust will commence work on all eight of the fundamental aspects of care. This affords the opportunity for individual wards and departments to be able choose one or possibly two benchmarks that reflect an area of best practice that they would like to celebrate. This will support the sharing of best practice across the Trust. It will allow a diversity of activity to occur throughout the Trust that reflect a commitment to establish priorities based on local needs assessment. It will be the clinical leaders and their teams, supported by their practice development nurse/s that identify a patient-focused aspect of care to benchmark. Having established agreement, the team may then access the 'expert' members of that identified benchmark resource group. The creation of an innovative and dynamic website will provide an excellent communication route to support the wards and departments to get started, and more importantly, the opportunity to surf 'across, and into the waves of activity' throughout the Trust. Wards and departments will become 'live' on the site as soon as they identify their choice and commence the process of benchmarking. The launch and introduction of benchmarking will require saturation training of all staff but particularly the nursing teams and the practice development nurses Roadshows, open to all, will held on all hospital sites to present - the 'Essence of Care' and provide an opportunity for discussion of the process of implementation. The four nursing teams have had a presentation at their meetings during April. Practice development nurses from all directorates have been exploring the benchmarking-process during their workshops. They will act as a local resource for raising awareness of the fundamental aspects of care within their directorates. A resource group for each of the benchmarks to be established Trustwide groups will be established that will provide a valuable resource to support Wards and Departments in introducing their chosen benchmark. Each group will represent one of the fundamental aspects of care and become the 'expert' resource. There are existing and established multi-disciplinary groups within the Trust that directly relate to the themes of two of the fundamental aspects of care; Nutrition and Tissue Viability. Both groups have agreed to facilitate the 'resource group' activity They provide an excellent model to utilise for the remaining six groups that will be new to the Trust. Recruitment to these groups will be underway soon, and anyone with an interest in a particular benchmark will be encouraged to join. Membership of the groups will be open to all and the role and responsibilities will be outlined and discussed during the roadshows. The Clinical Practice Nursing Team (CPNT) to be the project's steering group The 'Essence of Care' represents fundamental aspects of patient-focused care. It also represents the on-going agenda for practice development in the Trust that was identified through the audit of the Nursing Philosophy. The CPNT is leading this work. The CPNT will function in two main ways. As the Steering Group for the project, and secondly the team members will provide a link with each resource group. The CPNT will be able to capture the Trust-wide perspective on activity and progress. The team will report, to the Nursing Policy Board, on the progress of the project every B months. Members of the CPNT to be represented in each 'Resource Group' There are 16 members in this team and together; agreement has been reached, as to the contribution the team will make in facilitating the project. Each resource group will have, as part of their team, two members from the CPNT Their role is to actively participate in the defined group activities and provide a communication link from the group to the team. This demonstrates the commitment that members have to the project and is a welcomed opportunity to influence and support clinical practice. Practice Development Nurses to facilitate and support the introduction and on-going development of benchmarking at directorate level, in partnership with the clinical leaders Practice development nurses are viewed as pivotal to the success of the project. They have the opportunity of setting the agenda for the corporate vision for practice development as well as supporting the identification of areas of best practice within their directorates. They are ideally placed to work in partnership with clinical leaders and their teams at a local level. Each practice development nurse has an 'Essence of Care toolkit' and will facilitate local education and training on the benchmarking process. This will enhance the cascade of awareness, information and knowledge of the project throughout the Trust. The benchmarking process fits into the quality framework along with the National Service Frameworks (NSF), the guidance from the National Institute of Clinical Excellence (NICE) and will be monitored through the Commission for Health Improvement (CHI). The benchmarks set standards for aspects of patient care and clearly articulate what patients want from the health service. For Barts & The London this project will enhance our patient's experience of care. The work will contribute to the creation of a culture of effectiveness across the Trust that involves the valuing of all nurses involved in the delivery of direct patient care. Clinical benchmarking is a nurse-led initiative. It will involve nurses the co-ordinators of patient care, in working in partnership with their patients and other members of the multi-professional team to develop best practice. For many it may be an opportunity to explore news ways of working, and to celebrate the impact nurses have on the patient's experience. It is time to put the value back on the delivery of the fundamental aspects of direct patient care Our goal? - if you want to know what is the best experience of nursing care, ask a patient from Barts & The London. 1. Department of Health. Essence of Care - patient-focused benchmarking for health care practitioners. London, DoH 2001. 2. Ellis J. Benchmarking: A way of universalising the best?' NT Research 2001: 6.2; 566-7. 3. Department of Health. Making a Difference: strengthening the nursing. midwifery and health visiting contribution to health and healthcare. London, DoH 1999; 49. Nursing Progress: Issue 10 : June 2001. Copyright: Nursing Progress, Royal Hospitals NHS Trust
Back to Nursing Progress contents Table 1 For each of these fundamental aspects of care 'The Essence of Care benchmarking toolkit contains: 1. An overall statement, which expresses what patients/clients/consumers want from care (Patient-focused outcome). 2. Suggested indicators or information that is currently gathered which may indicate action is required to improve poor practice or that good practice exists which should be shared with others. 3. Elements of practice that support the attainment of the patient-focused outcome (Factors). 4. Key sources: Policy documents, references, the evidence base used in compilation. 5. Patient-focused best practice in each of the factors, the benchmark - which is placed at the extreme right of a series of statements and allotted an A score. 6. A scoring continuum for each factor. These statements guide practitioners in awarding their own practice a score, and provide stepping stones for practitioners to consider in order to achieving best practice. Diagrammatic representation of benchmarking statements Factor 1
7. Finally, there is a space for the identification of evidence that comparison group members, agree would justify an A score in their particular area of practice 8. Statements around best practice were identified by patients/clients, consumers and professionals and are included to help stimulate comparison group discussions (DoH, 2001, p.9) Back to Top Part 2 of the series Nursing Progress: Issue 10: June 2001.Copyright: Nursing Progress, Royal Hospitals NHS Trust Back to Nursing Progress contentsBack to Issue 10 contents list Page last revised by DEB on 18/10/03 |
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