1. Leading Better Care Vicky Thompson National Programme Leader – Senior Charge Nurse Role, Clinical Quality Indicators & Releasing Time to Care NHS Scotland

2. Role Framework Links Releasing Time to Care Activity Analysis SCN ROLE
Exemplar Job Description & KSF Outline
Releasing Time to Care
SCN ROLE
Activity Analysis
CQIs
Workforce Planning
SCN role is pivotal to LBC
Educational Framework
Development Needs Analysis

3. Policy Context
Audit Scotland 2002 Planning ward nursing: Unable to establish correlation between organisational processes and patient outcomes
Identifies inconsistency in quality measures across Health Board areas
Need to focus on continuous quality improvement & identify and review quality indicators.
Need to demonstrate that quality of care is being provided.
Work was undertaken : across NHS boards & in 2005 the impact of nursing on patient outcomes was published.
Audit Scotland 2007: Health Boards monitor quality of nursing care in a variety of ways
Need to identify and share best practice
Need to ensure safe and effective care
Requirement for Clinical Leaders but challenges remain in working towards a national system of quality indicators
A number of documents, that you are all familiar with have highlighted the need for clinical leadership, to focus on one the most recent Delivering Care, Enabling health highlights that:
Culture and Context – Within the policy context of Delivering for Health defines the underlining principles of NMAHP practice
Capability –Highlighting the need for effective clinical leadership, the need to use information to develop practice to improve patients’ experience of health services and improve health outcomes.
Capacity – Describing the need for an adequate and flexible workforce educated to the right level, with the skills to perform the roles required to deliver the services anticipated in Delivering for Health.
This links to work being undertaken across the 4 nations in the uk looking at Modernising nursing careers.

4. By the end of 2010…
Senior Charge Nurses in hospital settings will be working in the context of the revised role
The majority of in-patient areas to have Clinical Quality Indicators in place
The SCN will be the visible embodiment of clinical leadership in NHS settings, coordinating patient care, and inspiring the nursing/midwifery team

5. Improving Patient Care at the Bedside
Interconnectedness of this project with a variety of strategic national workstreams currently ongoing within the Scottish Government 5

7. Clearly define this key role and ensure that SCNs are visible and accessible to patients and their carers.
LBC establishes a national framework for SCNs working in hospital settings across NHS Scotland.
Empowers Senior Charge Nurses to be clinical leaders and guardians of safety and quality in their area.
Developed through extensive stakeholder involvement including patient / client input.

8. Four key dimensions for the Senior Charge Nurse role:
Ensuring safe and effective clinical practice
Enhancing the patient experience
Managing and developing their teams
Contributing to the delivery of organisational objectives
Supported by Clinical Quality Indicators (Falls, Pressure Ulcer Prevention & Food, Fluid & Nutrition)
The revised SCN role is applicable to nurses and midwives working in hospitals in all clinical specialities, and is supported by the NES Education and Development framework, a National Programme Leader and a Board-level facilitator network. 
Significant and essential links to the Releasing Time to Care initiative

9. The vision from Leading Better Care
‘We will have strong clinical leadership delivered by empowered Senior Charge Nurses who are the guardians of quality and clinical standards for the patients under their care.’
Paul Martin
Chief Nursing Officer

10. Why Change?
‘If you always do what you’ve always done, you will always get what you always had’
Albert Einstein
Need for modernising nursing roles to meet the changing face of Healthcare over time.
Evidence and Mechanisms to measure the impact of a modern Charge Nurse role
Frontline Clinical Leaders
Clinical Effectiveness
Safe and Effective Care
Cause and Effect
Succession planning 10

11. Do we all see the same thing?
Key message
Sometimes we can’t see what is obvious to others!
Message to deliver
Just a bit of fun. What do you see?
Hands up if you see a cow
Hands up if you see a map of the world.
Notes

12. Supporting Framework and Tools for Implementation

13. Framework for Implementation
Implementation of Senior Charge Nurse Role
Educational Framework
Safe and Effective
Clinical Practice
Enhance Patient
Experience
Manage and Develop
Performance of the Team
Effective contribution To
Organisational Objectives
Workload and Workforce
Planning Tools
e QIPS
CQIs
Release Time to Care
Productive Ward

14. SCN Role Framework To Ensure Safe and Effective Practice
Clinical Leadership & Teamwork
Evidence Based, Clinically Effective Practice
Continuous Quality Improvement
Patient Safety
To Enhance the Patients Experience
Clinical Expertise
Co-ordination of Patients Journey
Promote Culture of Patient Centred Care
To Manage and Develop the Performance of the Team
Role Model
Facilitate Learning & Development
Managing the Practice Setting
To Contribute to Organisations Objectives
Networking
Service Development
Political & Strategic Awareness

15. Supporting Framework Competencies and KSF outlined Working Document
For current SCNs and their managers
‘Talent Spotting’ – use as framework for development
An education framework provides a robust overarching structure which gives shape and support to the elements of contemporary educational provision
It includes knowledge, skills and capabilities required for SCN role
It articulates links with KSF, SCQF and advanced practice framework
It can be used by individual and organisations to assess and plan personal, professional and service development
Education providers can use the framework to design curricula

17. Implementation of the new role
Crucial in leading and delivering the high quality care that our patients and the public expect.
Transition of SCNs to the revised role is a phased process that has Executive level support from NHS Board Nurse Directors across Scotland and is overseen by a national steering group.
The work of NHS Boards is supported by a funding package provided by Scottish Government Health Directorates. Board-level Clinical Facilitation, plus the delivery of education and development packages and one to one facilitation for Senior Charge Nurses will provide additional support

18. Many Boards are also offering action learning for their SCNs
Many Boards are also offering action learning for their SCNs. In addition, educational and developmental initiatives are supported by the NHS Education for Scotland (NES) Educational Framework and resources.
Cohorts of SCNs are already developing into these roles across NHS Scotland and the initiative targets the implementation of this role for all SCNs working in hospitals by the end of 2010.
From recent information provided by NHS Boards we know that there are around 2000 SCNs in Scotland. Of them, around 1545 will be included in the revised role and around 700 are already undergoing development or working to the outline.

19. Clinical Quality Indicators - CQIs

20. Why did we need Clinical Quality Indicators?
Audit Scotland (2002) reported on limited availability of information on impact of nursing on quality
Audit Scotland (2007) – acknowledged progress but challenges for national quality indicators
Identify nurse specific measures that have impact on quality of care and patient experience

21. CQI Progress Three CQIs developed:
Falls
Food, Fluid and Nutrition
Pressure Area Care Prevention
Data capture and reporting systems being developed locally & nationally
Further CQIs in discussion for specialist areas, eg midwifery, mental health, etc

22. Clinical Quality Indicators
Change of culture
Data collection and analysis skills
Quality improvement skills

23. Data, data and more data…
Expect poor results initially
Use it as a tool to engage staff and improve care
If it’s not documented where is the evidence of care delivered?

27. Impact on Quality
Implemented revised
SCN Role

28. CQI Compliance trends

29. Synergies with other national programmes

31. Supporting Development

32. Supporting Development
National Programme Leader
Network of Clinical Facilitators
Steering group chaired by Executive Nurse Director
Commitment from Scottish Government, QIS and NES

33. Leading Better Care Implementation Group
Scotland’s Executive Nurse Director’s Group (SEND)
Leading Better Care Implementation Group
Releasing Time to Care Facilitator Network
eQIPS / CQI Development
Group
Leading Better Care Clinical Facilitator Network

34. Leading Better Care Facilitators
8. NHS Highland
Jenny Lobban
Project Manager / Facilitator,
1. NHS Ayrshire & Arran
Susan Hannah
Practice Development Lead, 11
9. NHS Lanarkshire
Margot Russell, Practice Development
Specialist Clinical Leadership and Quality,
2. NHS Borders
Kim Smith
Practice Development Leadership coordinator,
3. NHS Dumfries & Galloway
Maureen McCrae
Unit manager, specialist palliative care, 12
10. NHS Lothian
Fiona Bonnar & Linda Conway
Lead Clinical Facilitators, /
4. NHS Fife
Lynn Barker
Programme Lead Leading Better Care, 14
11. NHS Shetland
Andrea Ridealgh, Senior Charge Nurse,
5. NHS Forth Valley
May Fallon
Senior Nurse, Practice Development,
12. NHS Orkney
Moira Sinclair, Charge Nurse, 8 6
13. NHS Tayside
Debbie Baldie, Senior Practice Development Nurse,
6. NHS Grampian
Fiona Gray, Programme Manager / Facilitator, 13
14. NHS western isles
Mary McElligot, Professional Practice
Development Manager , 4 5
7. NHS Greater Glasgow & Clyde
Kate Cocozza, Lead Nurse Practice Development, 7 10 9 2 1
National Programme Leader –
Leading Better Care
Vicky Thompson,
Special Health Boards
Golden Jubilee National Hospital – Irene McGachy,
Clinical Facilitator,
The State Hospital - Sandra Steele 3 N
Please note that this diagram is for internal use only and should NOT be used in any publications

35. How do we know if we’ve succeeded in implementation?

36. By the end of 2010… Clinical Quality Indicators will provide us with:
Data used for quality improvement as part of day-to-day work
Quality improvement methodology known and used regularly by all nurses

37. By the end of 2010… Senior Charge Nurses will be:
Empowered clinical leaders
Guardians of quality and clinical standards
Visible, approachable and authoritative

38. Contact Details Vicky Thompson National Programme Leader –
Senior Charge Nurse, Clinical
Quality Indicators & Releasing
Time to Care