Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.

Morrell, Clare; Harvey, Gill; Kitson, Alison

doi:10.1136/qshc.6.1.29

Cited by 19 publications

(22 citation statements)

References 4 publications

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“…Most of these audits were initiated by doctors who tended to dominate audit groups. Morrell et al 17 have reviewed the use of the Royal College of Nursing dynamic standard setting system. Although it was used as a model for collaborative audit in some study sites, misunderstandings and "tribal" boundaries hindered the process.…”

Section: Introductionmentioning

confidence: 99%

Nurses' participation in audit: a regional study

Cheater¹,

Keane²

1998

Quality and Safety in Health Care

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Objectives-To find out to what extent nurses were perceived to be participating in audit, to identify factors thought to impede their involvement, and to assess progress towards multidisciplinary audit. Research design-Qualitative. Methods-Focus groups and interviews. Participants-Chairs of audit groups and audit support staV in hospital, community and primary health care and audit leads in health authorities in the North West Region. Results-In total 99 audit leads/support staV in the region participated representing 89% of the primary health care audit groups, 80% of acute hospitals, 73% of community health services, and 59% of purchasers. Many audit groups remain medically dominated despite recent changes to their structure and organisation. The quality of interprofessional relations, the leadership style of the audit chair, and nurses' level of seniority, audit knowledge, and experience influenced whether groups reflected a multidisciplinary, rather than a doctor centred approach. Nurses were perceived to be enthusiastic supporters of audit, although their active participation in the process was considered substantially less than for doctors in acute and community health services . Practice nurses were increasingly being seen as the local audit enthusiasts in primary health care. Reported obstacles to nurses' participation in audit included hierarchical nurse and doctor relationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work load pressures and lack of protected time, availability of practical support, and lack of knowledge and skills. Progress towards multidisciplinary audit was highly variable. The unidisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary audit was more successfully established in areas already predisposed towards teamworking or where nurses had high involvement in decision making. Audit support staV were viewed as having a key role in helping teams to adopt a collaborative approach to audit. Conclusion-Although nurses were undertaking audit, and some were leading developments in their settings, a range of structural and organisational, interprofessional and intraprofessional factors was still impeding progress. If the ultimate goal of audit is to improve patient care, the obstacles that make it diYcult for nurses to contribute actively to the process must be acknowledged and considered.

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Section: Introductionmentioning

confidence: 99%

Nurses' participation in audit: a regional study

Cheater¹,

Keane²

1998

Quality and Safety in Health Care

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“…Employing practitioners -nurses, occupational therapists, social workers -already engaged with the setting, rather than outsiders, was particularly successful, thanks to pre-existing local knowledge, contacts and credibility. 20 Facilitator pairs worked well since they could discuss issues and problems, support one another, and make reduced demands upon busy local practitioners. Not only were insiders and facilitator pairs more objectively successful, they identified greater rewards and fewer frustrations, suggesting they enjoyed the process more.…”

Section: Discussionmentioning

confidence: 99%

Establishing and facilitating practice-based interprofessional learning: experiences from the TUILIP project

2012

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The Trent Universities Interprofessional Learning in Practice (TUILIP) project aimed to establish interprofessional learning (IPL) for healthcare students in clinical practice settings. Ten IPL facilitators were employed in eight varied practice setting pilot sites for up to a year to research, develop and run locally appropriate, sustainable IPL initiatives. Following the pilot phase, a qualitative evaluation was conducted in each site by means of interviews or focus groups with all key stakeholders (facilitators, clinical managers, practitioners, students, service users, carers). Data collection was guided by Kirkpatrick's evaluation framework (1996), which focuses upon participant reactions, and their perceptions of learning, behaviour change and sustainable impact. In keeping with this framework, participants were asked to discuss their experiences of TUILIP in their placement setting (including its facilitation), and their opinions about its impact and success in terms of learning, behaviour change and sustainability. We report a subset of evaluation results relating to the roles of the facilitator, facilitation processes, experiences and challenges, personal and professional impact upon facilitators, and implications for IPL projects in practice. Facilitation tasks included preparing the ground, earning credibility, gathering ideas, researching feasibility, developing initiatives, involving service users, trialling and embedding initiatives. Facilitators were faced with challenges such as getting a focus, time limitations and dealing with logistics. They reported highs (being a fly on the wall, protected time, their educational role, and a sense of satisfaction) and lows (loneliness, frustration and fear of failure), but considered they had developed personally and professionally as a result of their experiences. Results demonstrated the complexity and demands of establishing and facilitating IPL initiatives in practice settings. Facilitation was time-consuming and effortful and did not always achieve its aims, but was a source of satisfaction and personal development. These findings suggest higher education institutions and practice settings should consider carefully the selection, preparation and support for facilitators of practice-based IPL, as well as how to engage local practitioners and service users, and embed changes in the clinical setting.

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“…This has resulted in a range of approaches to the management of quality being adopted in UK health care. These include standard setting (Mead 1989, Harvey & Kitson 1996, Morrell et al. 1997, Williamson 2000), medical audit (Packwood 1991, Packwood et al.…”

Section: The Continuing Challenge Of Health Care Qualitymentioning

confidence: 99%

Service improvement in health care

Hewison¹

2010

Journal of Nursing Management

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Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.

Cited by 19 publications

References 4 publications

Nurses' participation in audit: a regional study

Nurses' participation in audit: a regional study

Establishing and facilitating practice-based interprofessional learning: experiences from the TUILIP project

Service improvement in health care

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