Impact case study database

The purpose of this programme of work was to evaluate the impact of implementing the KPIs on the experience of care for patients, families and staff across different clinical contexts. Impacts I1 and I2 are interconnected within the implementation studies and are described simultaneously.

Enhancement of the health care experience for patients and families and for nurses

Through the Paediatric International Nursing Study (PINS), the eight KPIs were implemented across a range of sick children’s services (2013-2015) (R3). It involved 6 organisations in Australia (Princess Margaret Hospital for Children, Perth; Royal North Shore Hospital, NSW; Hornsby Hospital, NSW; Nepean Blue Mountains Local Health District, NSW; Women's and Children's Hospital, Adelaide; and the Sydney Children’s Hospitals Network) and 6 in Europe (Hans Christian Andersen Children's Hospital, Odense, Denmark; Temple Street Children's University Hospital, Dublin; Great Ormond Street Hospital, London, England; East Kent, England; Royal Belfast Hospital for Sick Children, Northern Ireland; and South Eastern Trust, Northern Ireland). Participating sites confirmed the value of the data captured by the KPIs as a means of highlighting “ the positive and excellent care that is provided and is recognised and appreciated by families”, whilst at the same time being able to act on “ immediate negative feedback that identifies people or interdisciplinary services and requires attention i.e. is unsafe or disrespectful” (I1, C1). It was this that drove practice change by providing meaningful information, permitting nurses to pinpoint directly what specific areas of practice needed improved (I1, C1, C2). Improvements focused on areas such as nursing documentation, bedside handovers (I1, C3) and supporting information for families (I1, C2). Similarly, there was evidence that using the KPIs embraced the value of nursing, impacting on staff morale and providing opportunities to celebrate good practice (I2, C1, C2).

As a result of PINS (R3), there was organisational roll out by the Women’s and Children’s Health Network in South Australia across 4 divisions, covering 8 nursing and midwifery teams (I1, C1). The KPI data collected from 2013-2020 had significant reach involving approximately 1,285 patients and families completing surveys or stories, resulting in approximately 80 action cycles (I1, C1). Examples include: allocation guidelines of patients to staff to improve consistency in care, and development of patient profiles for complex care so families don’t have to repeat their stories (I1, C1). Staff engagement in this process “ raise[d] awareness of the impact of care, what person-centred care looks like and what works and doesn’t work” (I2, C1).

Development of the iMPAKT App (Implementing and Measuring Person-centredness using an APP for Knowledge Transfer) offered a technological solution for collecting the KPI data and was evaluated as an effective method to measure the patient experience in real time (R4). Nurses (n=22) participated from a range of clinical contexts (5 sites in South Eastern Health & Social Care Trust, Northern Ireland and 6 sites in Illawarra Shoalhaven Local Health District, Australia). Illawarra Shoalhaven Local Health District has continued to use the iMPAKT app, engaging a total of 177 nursing and midwifery staff across a range of clinical settings. The number of beneficiaries totalled 677 patients and carers (C5). The impact on nursing practice included: an improved team focus approach to care delivery; changes to staffing allocations and rostering to enhance consistent care; development of person-centred nursing documentation; and improvement in visibility of nurses for patients (I1, C5). The positive impact on staff of using the KPI data to improve practice was also emphasised, with the introduction of regular staff celebrations. One unit also developed an employee of the month programme. Other staff benefits included: provision of clinical supervision and reflection; and increased opportunities to de-brief following challenging situations (I2, C5).

The KPIs have also been implemented by NHS Lothian, Scotland, as part of an organisational care assurance programme between 2017 and 2019. Across 3 hospital sites, 31 acute wards used the KPIs, with 7,940 patients completing the survey and 253 patients providing stories (C6). Clinical teams were considered the main beneficiaries, with the reporting of improved staff morale (I2, C6). Patient story feedback was also key in improving practice, such as changing ways of working and addressing long standing environment issues (I1, C6). Use of the KPIs within NHS Lothian led to further collaboration with South Eastern Health & Social Care Trust in Northern Ireland to test the implementation of the KPIs within a community nursing context (R5).

The significance of the original research (R1, R2) resulted in the implementation of the KPIs within chemotherapy units (n=5), across the entire region of Northern Ireland from 2018 to 2019 (R6). A key impact was nurses’ ability to truly involve patients in decisions about their care and the things that really mattered to them in their daily lives (I1, C7). This influenced a significant regional change in the electronic documentation system used in chemotherapy environments. There was no area in the documentation where nursing staff could capture what was currently important to the patient and their family, leading to significant inconsistency between what the nurse said was important to the patient and a review of the patient documentation. Consequently, the restrictive dropdown menu to record what was important to the patient was expanded with a free text option to ensure what is important to the patient was accurately captured and evidenced as an ongoing dialogue (I1, C8). The impact was also significant for chemotherapy nurses and influenced their ability to clearly articulate their role and enhance their contribution to the patient experience (I2, C7). Nursing teams felt disempowered to reduce waiting times for patients, but the KPI data encouraged them to think differently about this issue and as a result developed person-centred interventions. It was “ small simple changes that can play a big part of a patient’s experience and journey”, with examples including: offering complimentary therapies to reduce stress and anxiety and to facilitate relaxation; working with the catering department to install a fridge in the unit to provide patients with fresh cool bottled water; and developing a post-discharge pack to provide a range of information to enhance experience of patients after they have finished their chemotherapy treatment. These interventions led to an enhanced patient experience (I1, C7).

Influencing strategy and policy

Finally, there is evidence of the programme of work influencing strategy and policy. NHS Lothian, Scotland, illustrated this through the impact of the work on the Board’s Patient Experience Strategy (I3, C6). Similarly, within Illawarra Shoalhaven, Australia, the KPIs aligned with the Nursing and Midwifery Workforce Plan and “ provided a link between policy and practice” (I3, C5). Within Northern Ireland the KPIs are being used to inform policy for nursing through the Northern Ireland Cancer Strategy and the Nursing and Midwifery Task Group (I3, C9). Further implementation of the KPIs on an international stage is evidenced by the establishment of a Chief Nursing Officers’ Collaborative between Australia and Northern Ireland to further develop the iMPAKT app for large scale use (I3, C10).