Abstract
EXECUTIVE SUMMARY
The Context
Following a successful Macmillan pilot project at the Chemotherapy Unit at the Ulster Hospital, Macmillan hosted an engagement workshop in October 2017 to explore the potential of co-producing a person-centred cancer nursing implementation study across chemotherapy units in Northern Ireland. This workshop included people affected by cancer, nurses from chemotherapy units in each of the five Health and Social Care Trusts, lead cancer nurses/managers and cancer service improvement leads. It inspired a shared vision and enthusiasm for a regional study across the chemotherapy units, focused on developing person-centred practice within the field of cancer nursing. In March 2018 Macmillan funded the recruitment of a project coordinator to work alongside Professor Tanya McCance to undertake a large scale implementation study known as the CIP-CAN Project (Co-producing and Implementing Person-centred Key Performance Indicators in CAncer Nursing), The project ran from March 2018 until the end December 2019.
Background Evidence
Globally, healthcare systems for people living with cancer are moving toward a more person-centred approach. This approach is reflected in current policies and strategic frameworks that focus on the needs, values and preferences of the patient. Research has shown that when patients have positive experiences of nursing care, nurses also experience a good and healthy work environment (Aiken et al., 2012; Kieft et al., 2014). Whilst many studies analyse what patients consider being essential for a positive experience in healthcare (Damman et al., 2009; Bridges et al., 2010), there are fewer studies that explore the significant contribution nurses make in determining a positive patient experience. Whilst nurses and patients alike recognise that a good care experience cannot be measured solely by clinical outcomes, the difficulty in finding indicators that measure the delivery of effective person-centred care remains a challenge.
McCance et al (2012) developed eight nursing key performance indicators that were sensitive to the unique contribution of nursing and focused on improving patient’s experience of care. These 8 person-centred nursing key performance indicators, implemented within a model of co-production, offer an opportunity to improve the experience of patients undergoing chemotherapy through the promotion of person-centred practice.
Study Aim
To explore the impact of a co-produced implementation project using the person-centered nursing KPIs to support the development of person-centred care across ambulatory chemotherapy units.
Project Approach
Six chemotherapy units (n=6), in the five Health and Social Care Trusts across Northern Ireland participated in the study. The underpinning philosophy of CIP-CAN is grounded in collaborative and engaged ways of working, reflected in the use of a model for co-production. The Macmillan investment included support for each Trust to recruit a local nurse champion who worked closely with the project team and purchase of hand-held devises for data collection. The main role of the champion was to actively promote the project and ensure that all nurse colleagues in their chemotherapy unit were engaged. People affected by cancer (peer facilitators) were also recruited as part of the local project team and took part in all aspects of the project, but particularly a lead role in data collection using the iMPAKT app. The peer facilitators focused on collecting patient stories and were supported by the local champions in each of the six sites.
Three cycles of data collection using the eight key performance indicators and associated measurement tools were undertaken using the iMPAKT App. Results from each cycle were reviewed by the team in each chemotherapy unit and action plans were generated to celebrate achievements and improve practice. In order to maximise sustainability, the development of knowledge and skills within the chemotherapy team was paramount. The project included several workshops to support practice development knowledge, covering topics such as working with different sources of evidence, clarifying values and beliefs and gaining knowledge of self and critical reflection. The study was underpinned by the Person-centred Nursing Framework (McCormack and McCance, 2010). As part of a programme of research, an evaluation approach derived from the work of the Medical Research Council was used as the research methodology.
Findings
Four main themes emerged from analysis of the data
• Building relationships that nurture the care experience focuses on the relational aspects of care that impact on patient experience
• Inspiring nursing staff to flourish focuses on the evidence that demonstrates the impact of the person-centred KPIs on staff experience in the chemotherapy units.
• Shaping practice and service changes through the nature of the conversations focuses on how the nature of conversations, within the model of co-production, challenged custom and practice leading to the development of practice improvement initiatives and the shaping of service changes. One example is a regional change in the electronic record developed for use within chemotherapy units to improve nurses’ understanding of what is important to patients and families (KPI 8).
• Becoming person-centred through co-production focuses on the impact of using the person-centered nursing KPIs within the model of co-production to support the development of person-centred care in the chemotherapy units.
These themes reflect the relational aspects of care that impact both patient and staff experience in the chemotherapy units and reveal the impact of using the KPIs within a model of co-production to support the development of person-centred cultures within ambulatory chemotherapy units.
Impact on Practice
This study demonstrated evidence of impact on nursing practice through the following outcomes:
•a heightened awareness of the importance of the relational aspects of person-centeredness.
•an enhanced nature of conversations that challenge custom and practice
•a co-production approach where each person contributes their own distinct expertise, strengths and assets to the collaboration
•a increased understanding of the value of technology through the use of the iMPAKT App to support development of nursing practice
•recognition of the importance of key facilitators roles within the project and the added value they bring.
Conclusion
The evidence presented in this report demonstrates how the KPIs have explicitly focused on important aspects of person-centred practice in cancer nursing using a model of co-production. The evidence generated by the use of the KPIs offers chemotherapy teams an opportunity to celebrate the delivery of high-quality care. The nature of the data generated reflects the patient voice, and offers valuable feedback to nurses that can inform the development of person-centred cultures in cancer nursing. The project provides evidence of innovation through the process of genuine co-production and collective leadership with people affected by cancer i.e. the peer facilitators, the clinical nursing teams led by the nurse champion, cancer service improvement leads, managers, and academic expertise. As the findings suggest, the key to the success of this project centres on the collaboration of all three facilitator roles, namely the champion, the research facilitator and the peer facilitator. The CIP-CAN study provides strong evidence of the value of implementing these person-centred KPIs within ambulatory cancer care, and provides a firm foundation for wider implementation in future.
Recommendations
1. Consideration should be given to establish Person centred Key Performance Indicators into regular audit of nursing practice within all chemotherapy units using the methodology demonstrated within this study to generate evidence of best practice.
2. The implementation of the person-centred nursing KPIs should be integral to other quality initiatives to facilitate improvements in nursing practice.
3. The facilitated model of co-production exemplified within this study should be further replicated in other areas of practice to establish confidence.
4. This study further demonstrates the transferability of these KPI’s across specialist fields of nursing care. Further opportunity should be explored to test how these indicators could be incorporated as measures to demonstrate the positive impact of clinical nurse specialists
5. The development of the Northern Ireland Cancer Strategy should recognise the value and implementation of KPIs that determine a positive patient experience at various times throughout their treatment and care.
6. Confidence in the use of technology across patients and professionals provides an opportunity to further develop the use of the iMPAKT App for wider implementation and enhanced co-production opportunities.
The Context
Following a successful Macmillan pilot project at the Chemotherapy Unit at the Ulster Hospital, Macmillan hosted an engagement workshop in October 2017 to explore the potential of co-producing a person-centred cancer nursing implementation study across chemotherapy units in Northern Ireland. This workshop included people affected by cancer, nurses from chemotherapy units in each of the five Health and Social Care Trusts, lead cancer nurses/managers and cancer service improvement leads. It inspired a shared vision and enthusiasm for a regional study across the chemotherapy units, focused on developing person-centred practice within the field of cancer nursing. In March 2018 Macmillan funded the recruitment of a project coordinator to work alongside Professor Tanya McCance to undertake a large scale implementation study known as the CIP-CAN Project (Co-producing and Implementing Person-centred Key Performance Indicators in CAncer Nursing), The project ran from March 2018 until the end December 2019.
Background Evidence
Globally, healthcare systems for people living with cancer are moving toward a more person-centred approach. This approach is reflected in current policies and strategic frameworks that focus on the needs, values and preferences of the patient. Research has shown that when patients have positive experiences of nursing care, nurses also experience a good and healthy work environment (Aiken et al., 2012; Kieft et al., 2014). Whilst many studies analyse what patients consider being essential for a positive experience in healthcare (Damman et al., 2009; Bridges et al., 2010), there are fewer studies that explore the significant contribution nurses make in determining a positive patient experience. Whilst nurses and patients alike recognise that a good care experience cannot be measured solely by clinical outcomes, the difficulty in finding indicators that measure the delivery of effective person-centred care remains a challenge.
McCance et al (2012) developed eight nursing key performance indicators that were sensitive to the unique contribution of nursing and focused on improving patient’s experience of care. These 8 person-centred nursing key performance indicators, implemented within a model of co-production, offer an opportunity to improve the experience of patients undergoing chemotherapy through the promotion of person-centred practice.
Study Aim
To explore the impact of a co-produced implementation project using the person-centered nursing KPIs to support the development of person-centred care across ambulatory chemotherapy units.
Project Approach
Six chemotherapy units (n=6), in the five Health and Social Care Trusts across Northern Ireland participated in the study. The underpinning philosophy of CIP-CAN is grounded in collaborative and engaged ways of working, reflected in the use of a model for co-production. The Macmillan investment included support for each Trust to recruit a local nurse champion who worked closely with the project team and purchase of hand-held devises for data collection. The main role of the champion was to actively promote the project and ensure that all nurse colleagues in their chemotherapy unit were engaged. People affected by cancer (peer facilitators) were also recruited as part of the local project team and took part in all aspects of the project, but particularly a lead role in data collection using the iMPAKT app. The peer facilitators focused on collecting patient stories and were supported by the local champions in each of the six sites.
Three cycles of data collection using the eight key performance indicators and associated measurement tools were undertaken using the iMPAKT App. Results from each cycle were reviewed by the team in each chemotherapy unit and action plans were generated to celebrate achievements and improve practice. In order to maximise sustainability, the development of knowledge and skills within the chemotherapy team was paramount. The project included several workshops to support practice development knowledge, covering topics such as working with different sources of evidence, clarifying values and beliefs and gaining knowledge of self and critical reflection. The study was underpinned by the Person-centred Nursing Framework (McCormack and McCance, 2010). As part of a programme of research, an evaluation approach derived from the work of the Medical Research Council was used as the research methodology.
Findings
Four main themes emerged from analysis of the data
• Building relationships that nurture the care experience focuses on the relational aspects of care that impact on patient experience
• Inspiring nursing staff to flourish focuses on the evidence that demonstrates the impact of the person-centred KPIs on staff experience in the chemotherapy units.
• Shaping practice and service changes through the nature of the conversations focuses on how the nature of conversations, within the model of co-production, challenged custom and practice leading to the development of practice improvement initiatives and the shaping of service changes. One example is a regional change in the electronic record developed for use within chemotherapy units to improve nurses’ understanding of what is important to patients and families (KPI 8).
• Becoming person-centred through co-production focuses on the impact of using the person-centered nursing KPIs within the model of co-production to support the development of person-centred care in the chemotherapy units.
These themes reflect the relational aspects of care that impact both patient and staff experience in the chemotherapy units and reveal the impact of using the KPIs within a model of co-production to support the development of person-centred cultures within ambulatory chemotherapy units.
Impact on Practice
This study demonstrated evidence of impact on nursing practice through the following outcomes:
•a heightened awareness of the importance of the relational aspects of person-centeredness.
•an enhanced nature of conversations that challenge custom and practice
•a co-production approach where each person contributes their own distinct expertise, strengths and assets to the collaboration
•a increased understanding of the value of technology through the use of the iMPAKT App to support development of nursing practice
•recognition of the importance of key facilitators roles within the project and the added value they bring.
Conclusion
The evidence presented in this report demonstrates how the KPIs have explicitly focused on important aspects of person-centred practice in cancer nursing using a model of co-production. The evidence generated by the use of the KPIs offers chemotherapy teams an opportunity to celebrate the delivery of high-quality care. The nature of the data generated reflects the patient voice, and offers valuable feedback to nurses that can inform the development of person-centred cultures in cancer nursing. The project provides evidence of innovation through the process of genuine co-production and collective leadership with people affected by cancer i.e. the peer facilitators, the clinical nursing teams led by the nurse champion, cancer service improvement leads, managers, and academic expertise. As the findings suggest, the key to the success of this project centres on the collaboration of all three facilitator roles, namely the champion, the research facilitator and the peer facilitator. The CIP-CAN study provides strong evidence of the value of implementing these person-centred KPIs within ambulatory cancer care, and provides a firm foundation for wider implementation in future.
Recommendations
1. Consideration should be given to establish Person centred Key Performance Indicators into regular audit of nursing practice within all chemotherapy units using the methodology demonstrated within this study to generate evidence of best practice.
2. The implementation of the person-centred nursing KPIs should be integral to other quality initiatives to facilitate improvements in nursing practice.
3. The facilitated model of co-production exemplified within this study should be further replicated in other areas of practice to establish confidence.
4. This study further demonstrates the transferability of these KPI’s across specialist fields of nursing care. Further opportunity should be explored to test how these indicators could be incorporated as measures to demonstrate the positive impact of clinical nurse specialists
5. The development of the Northern Ireland Cancer Strategy should recognise the value and implementation of KPIs that determine a positive patient experience at various times throughout their treatment and care.
6. Confidence in the use of technology across patients and professionals provides an opportunity to further develop the use of the iMPAKT App for wider implementation and enhanced co-production opportunities.
| Original language | English |
|---|---|
| Type | Unpublished Report |
| Number of pages | 62 |
| Publication status | Published (in print/issue) - Nov 2020 |
