Nursing and midwifery metrics
Metrics are, essentially, any set of data. A Performance Indicator is a particular type of metric which identifies issues which may be worthy of further investigation. In practical terms, nursing and midwifery metrics can provide a broad indication of the value and effectiveness of the nursing and midwifery contributions to patient care. Whilst audit can measure the more tangible aspects of care, metrics can measure some of the softer, less tangible, aspects such as compassion and kindness.
Indicators, by definition, can only provide an indication; they will never be able to capture the entire richness and complexity of care. They provide information related to how, and how effectively, systems work.
The quality of nursing and midwifery care has been notoriously difficult to measure as many of the indicators used are very subjective and focus on patients' perceptions of care received, for example, 'were the nurses kind?' Nursing and midwifery metrics can assist in measuring both the quantity and quality of care and serve to act as performance indicators i.e. a measured indication of the quality of care being delivered.
Local development of the metrics
At Noble's Hospital, Metrics have been developed to reflect care in in-patient and out-patient settings, for adults and children, in critical care areas and conventional ward locations. As a result of this approach, there is an opportunity to benchmark between clinical areas in a division or across divisions; there is even the potential to benchmark outside the organisation. The Nursing and Midwifery Metrics which have been developed seek to enquire about the following three domains: patient safety and governance; the patient experience; and, the nursing/midwifery infrastructure underpinning the delivery of patient care. In order to do this, the metrics measure indicators such as: the presence of relevant risk assessments; identification and monitoring of risks to patients (including failure to rescue); patients knowing the names of the nursing and/or midwifery staff delivering care; patients feeling comfortable and safe in hospital; patients being able to access food and beverages; nursing/midwifery staffing; staff professionalism; and, staff performance monitoring.
Local process
On alternate months, each division's senior nurse/midwife undertakes the measurement of the metrics related to 5 patients on each ward/department. All of the results are processed, compiled and returned to the relevant senior nurse/midwife to share with her/his team. Any areas for improvement can then be action planned by ward/department teams, and those areas which are compliant can share their examples of best practice with their colleagues.
Established for over 18 months, the metrics have provided some excellent information regarding patients' experiences in our hospital.
Reporting mechanisms
Divisional results showing the compliance, or degree of non-compliance, are submitted to the Noble's Hospital Executive Team and the Clinical Governance Committee as part of their respective quality monitoring processes. The metrics are also discussed at the regular Senior Nurse/Midwife meeting providing an opportunity for staff to share examples of best practice and innovation.
Some examples of the information gathered are shown on the following pages. Further information is available from Shelagh Leonard, Senior Nurse, Professional Development at Noble's Hospital on telephone: +44 1624 650116 or email: shelagh.leonard@gov.im
