Essence of Care – From Director of Nursing Perspective

Margaret Gordon

Director Nursing, Quality & Elder Care

Causeway Health & Social Services Trust

10 May 2005

Essence of Care in CHSST

• Why important to Director of Nursing & Organisation.

• What have we achieved.

• How have we made it happen.

• What next ………. only a beginning.

EoC – Why?

• Duty of Quality:– Not just professional requirement but public mandate.– Need to know what is happening near patients.– Influence from a distance.

• Corporate Issue - Fundamental Care.

• Focus to Date– Management systems.– Targets - performance management.– Modernisation, reform - role redesign.

EoC – Why?

• Relevant all Health & Social Care setting. Director of Elder Care.Transprofessional – Nurse Led.

• Framework with patients, clients and carers experiences at the heart of the process – qualitative approach to identify, measure and reflect on quality of service provided.

Why EoC Approach? - 3 Key Messages

• Quality assures fundamental care.– Stepping stones for improvement.

• Delivers care as patient and clients want it.

• Creating organisations where:– Front-line staff responsible and accountable for delivery of right

care to right person at right level.

– Executive team have evidence that care delivered at optimal level.

– Benchmarked standard integral to Clinical Governance process.

Bedrock of Clinical & Social Care Governance

• Consultation - Patient Centredness.

• Patient Centredness.– Consultation on quality of care.– Power.– Knowledge.– Dignity.– Self-efficacy skills.– Respect for diversity.– Freedom of Action. Chasim Report (2001)

Institute of Medicine

• Clinical Risk Management.– Illuminates front-line activity, capacity and capability.

• Staffing & Staffing Management.

• Clinical Audit.– Mainstream fundamental care into audit activity.

• Research.– Assists integration of research into practice.

• Eoc Can Make a Difference From Point of Care Using Range of Evidence.– Research.– Patient.– Expert opinion.

Bedrock of Clinical & Social Care Governance

• Use of Information About Patients, Carers Experiences.

“Patient Stories”- “How it is”

• Analysing Complaints.

• Continuous Professional Development.

• Education, CPD – Non-traditional learning.

• Integrated Into Healthcare Education at Every Level.

• It is as important to build a future as heal the present.– “Professionals emerging ill prepared to Care”

• Standards and Guidelines.– Beyond unit costs.– Standards to shape and change direct Patient Care.

EoC - Challenges• Support staff to treat everyday practice as a learning opportunity with

focus on service improvement.

• Accept the unacceptable?– Quantity v Quality.– Beds on wheels in Accident & Emergency - Trolleys!– Hospital acquired infections.– Outputs v Outcomes.

• Public opinions matters.– Must be committed to actions that carry on nurses reputation regarding

public trust worthiness.– Partnership underpinned by Trust.

As I see it:

• We create knowledge through research.• We derive learning through education.• We provide service through Practice.• We provide leadership through social

responsibility.• We build communities through relationships.• We transform lives through caring.

Linking EoC to Nursing Principles• Live and breath clear values and standards.

• Build real patient engagement.

• Focus on frontline staff.

• Do not assume goodwill - nurture it.

• Care for each other.

“What we do as leaders is even more

important than what we say”

• Conscience at the corporate table - who?We must be the change we seek in the world Ghandi

How - Making EoC Happen

• Project Managed.

“If nothing changes, nothing changes”

“You need to disturb the present to improve the future”

• Organisational Readiness.

Top down + Bottom Up approach.

• Staff Capacity to Change.

Apathy - Resisters - Champions.

– Nursing Times Poll.

46% Aware of Essence of Care & Making a Difference.

20% Didn’t Understand What Was Involved.

9% Unaware of Initiative Themselves.

25% Saw it Purely as a Management Initiative.

• Start Small - Think Big.

Starter pack - 3 projects.

– Design small wins for feedback and learning.

• Care for Care Givers - Listen to Messages.

• Inclusive Process.

– Local ownership.

– Transprofessional +

• Profile Activity - Celebrate Successes.

What Next?• Sustainability.

– Learn From UK Experience.– Quality Standards for Health & Social Care - Regional Recognition.– RMAG - Funding Secured 2005/06.– Clinical & Social Care Action Plan.

• Demonstrate it Makes the Difference.– Link to Organisational Objectives.– Information Processing.– Trust Delivery Plan - Benchmarking.

• Corporate Governance - Beyond CSCG.– Share Best Practice Outside Organisation.– Showcase Success.– Need Patients to Notice the Difference.

• Recognition that EoC is Benchmarking Tool – Must Not Become Self-limiting.

Leveraging Small Wins

‘Do not be fettered by too many rules at first. Try different things and see what answers best. Look

for the ideal, but put it into the actual. Everything which succeeds is not the production

of a scheme of rules and regulations, made beforehand, but of a mind observing and adapting

itself to

wants and events’.

Florence Nightingale.

Caring Matters

‘Most don’t just want soup, they want contact where they are appreciated, loved, feel

wanted and find some place in their hearts. It’s the personal touch that matters’

Sr Deloras

‘We can do great things, only small things with great love’

Mother Teresa