Ms Suzanne O

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Ms Suzanne OBoyle

• Project Manager
• NI Essence of Care Project

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Essence of Care Where has it come From?

• English Nursing Strategy
• Making a Difference (1999)
• The NHS Plan (2000) reinforced importance of
  improving the patient experience
• Benchmark standards tested, refined and endorsed.
• Version 1 (2001) / Version 2 (2003)

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Update

• 16 Trusts
• 6 Nursing Homes
• Prison Service Nursing
• Marie Curie

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Clinical Governance

• Consultation and patient involvement
• Clinical Risk Management
• Clinical Audit
• Research and effectiveness
• Use of information about the patients and or
  carers experience
• Staffing and staff management
• Education, training and CPD
• Strategic capacity

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Essence of Care ??

• A Tool to help practitioners

To take a patient focused
And
Structured approach to sharing and comparing best
Practice
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Benchmarking

• Acts as a standard
• Enables practitioners / organisations compare
  practice and share difficulties.
• Several approaches can be used
• wards / directorates / primary care teams /
  organisations can compare processes and
  structures
• There must be a willingness to share practice

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Fundamental Aspects of Care

• Published 2001, revised format 2003
• All benchmarks are interrelated relevant to all
  health social care settings
• National framework-local approach!

Communication
seeing things through the patients eyes
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The Toolkit - Whats in it?

• An overall agreed patient-focused outcome that
  expresses what patients or carers want from care
  in a particular area of practice
• factors that need to be considered to achieve the
  overall patient outcome

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The Toolkit - Whats in it?

• A benchmark of best practice for each factor on a
  continuum
• Indicators for best practice identified by the
  patients, carers and professionals!

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The Benchmark Process
Agree best practice

• STAGE 1

Assess clinical area against best practice
STAGE 2
Produce Implement action plans aimed at
achieving best practice
STAGE 3
Review achievement towards best practice
STAGE 4
Disseminate improvements or review action plans
STAGE 5
Agree best practice
STAGE 6/1
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Benchmarks for Food Nutrition

• Agreed patient-focused outcome-
• patients are enabled to consume food which meets
  their individual need
• The benchmark comprises of 10 factors- each
  with its own benchmark of best practice

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The Factors

• The Environment
• conducive to eating- acceptable sights, smells
• activities
• cultural/ ethnic considerations
• Assistance
• skill, sensitivity patience
• links to oral hygiene
• cultural/ ethnic consideration

• Screening Assessment
• essential to identify nutritional requirements
• identifies at risk
• establish individuals nutritional status

• Planning Implementation
• support ranges from simple
• to high risk invasive interventions
• care planning
• evaluation

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The Factors

• Obtaining Food
• adequate information/ Communication
• cultural, age related, special needs ethnic
  considerations
• Food Provided Availability
• meets the needs of individuals, appetising
• appealing portion sizes
• alternative food/ access
• own food/religious, cultural, issues

• Monitoring Promotion
• accurate recording of
• amounts eaten
• appropriate action taken
• opportunities for health
• promotion
• staff training available
• multi-agency partnerships

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The Continuum
E D C B A
Stepping Stones for Development
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Factor 1- Screening Assessment
Patients nutritional needs are not ascertained
Benchmark of Best Practice Nutritional screening
progresses to further assessment for all patients
identified as at risk
A
E
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The Benchmark Process

• Stage 1 Agree best practice
• Stage 2 Assess clinical area against best
  practice
• Stage 3 Produce Implement action plans aimed
  at achieving best practice
• Stage 4 Review achievement towards best
  practice
• Stage 5 Disseminate improvements or review
  action plans
• Stage 6/1 Agree best practice

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Using the Benchmarks How?

• Stage 1 Agree best practice
• - consider patients carers experiences and how
  
• current care is delivered.1, 2
• - agree which benchmarks to take forward
• - set up your comparison group with ground
  rules4
• - using general indicators and specific
  indicators
• agree evidence needed to provide best
  practice

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Assess Clinical Area Against Best Practice
Stage 2

• Obtain baseline information
• Consider the indicators and provide evidence that
  shows current achievement towards best practice3
• Consider barriers which prevent achievement of
  best practice3
• Compare and share best practice so that good
  practice is not wasted. The E A scoring can be
  used to stimulate discussion

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Producing and Implementing Action Plan Stage 3

• Action plan to include5
• Changes to be made to improve practice
• Who is responsible
• Timescale
• Actions should be realistic, achievable and
  measurable
• Aim for quick wins

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Review Achievement Towards Best Practice Stage 4

• Evaluation of action plan 6
• did the patient / carers experience improve
• If no improvement review activities in action
  plan does it need refocusing on?

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Disseminate Improvements / Review Action Plan
/Stage 5

• Disseminate good practice by all available
  resources throughout the organization/(s)
• Build into organizational business plan, clinical
  and social care governance plan, and quality
  reports1,7

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Agree Best Practice Stage 6/1

• The whole cycle continues again!!

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Success Factors

• Steering group
• Driven from the top but grow from the grass
  roots.
• Embedded into practice creating time,
  ownership, integration
• Recognition - Celebrate success

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Success Factors

• Champions
• Timing
• Cultural fit
• Support
• Facilitation
• Teamwork

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Service Users

• Very important!
• Patient Support Officer
• Forums / Groups
• Partnerships

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Role of Project Officer

• Facilitate at organizational level those wishing
  to implement the Essence of Care Toolkit
• Co-ordinating benchmarking across organizations
• Assess the need for tailoring of the benchmarks
  to fit the Northern Ireland context
• Ultimately ensure that the project links to the
  development of the overall Clinical and social
  Care Governance Structures as they take shape
  within northern Ireland.

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Facilitators Role

• Set up Essence of Care
• Lead
• Inform / Raising awareness
• Maintain momentum
• Produce reports for project officer

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Team Leaders Role

• Direct facilitation of the benchmark
• Co-ordinate all activity in relation to benchmark
  selected
• Produce reports to the facilitator regularly
• Produce timely minutes of each group meeting
• Represent group at higher level meetings /
  presentations etc

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Summary

• Working to achieve best practice in fundamental
  care
• Its about what matters to patients, carers and
  health care personnel
• It is integral to good clinical governance
  management.

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Finally

• Benchmarking through The Essence of care
  challenges us to think outside the box and own
  our decisions.
• The process is evolutionary not revolutionary
  aim for quick wins!
• Its the wee things that count!

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Essence of Care

• The authority to engage in the Humanity of Care

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Contact Information
Address Suzanne OBoyle Essence of Care
Manager NIPEC, Centre House 79 Chichester
Street BELFAST, BT1 4JE Tel [phone] Fax
028 9033 3298 Suzanne.oboyle_at_nipec.n-i.nhs.uk