Reflections on the implementation and evaluation of a system‐wide improvement programme based on the fundamentals of care: Lessons learned

Abstract

Aim To demonstrate how implementing a system‐wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice. Design Discussion paper. Data Sources A retrospective evaluation of the experience of implementing a system‐wide peer review programme using the Promoting Action on Research Implementation in Health Services framework. Implications for Nursing Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care. Conclusion The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change. Impact This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Leadership for fundamental care: The whole is greater than the sum of the parts

“…Unless fundamental care is embedded in our professional practice frameworks and measurement processes (Aspinall et al, 2022;Merkley et al, 2022), then the likelihood of neglecting fundamental care is increased.…”

“…We continue to have a dearth of evidence to help us argue for and embed better fundamental care practices in our acute care systems, whether that's trying to reduce delirium in older people in acute hospital settings (Cahill et al, 2022) or understanding why fundamental care is ‘missed’ (Blackman & Mudd, 2022; Grealish et al, 2022). Unless fundamental care is embedded in our professional practice frameworks and measurement processes (Aspinall et al, 2022; Merkley et al, 2022), then the likelihood of neglecting fundamental care is increased.…”

“…We have great examples from several health systems internationally where nursing leaders have raised awareness to the value and central importance of fundamental care (Merkley et al, 2022). They have operationalized fundamental care through their professional practice frameworks, routine quality and safety measures and clinical indicators (Aspinall et al, 2022; Mainz et al, 2022; Merkley et al, 2022). These initiatives need to be replicated across all our health and care jurisdictions so that our actions around fundamental care lead to demonstrable improvements in health and care outcomes as well as create greater efficiencies.…”

InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses’ competence and achieve person-centred fundamental care—A research protocol describing an action research approach

“…FoC is described as a point of care nursing theory [ 14 ] helping nurses and leaders navigate the practical aspects of nursing. Bedside nurses across several countries, address that the framework can be applied in clinical practice to reinforce leadership [ 17 ] and successful initiatives were leaders raised the awareness to the value of fundamental care in different collaborations are available [ 18 – 20 ]. Within the framework the term person-centered care is often used but not included in the definition [ 15 ].…”

Leadership for Fundamental Care: The whole is greater than the sum of the parts

“…We continue to have a dearth of evidence to help us argue for and embed better fundamental care practices in our acute care systems, whether that is trying to reduce delirium in older people in acute hospital settings (Cahill et al, 2022) or understanding why fundamental care is ‘missed’ (Blackman & Mudd, 2022; Grealish et al, 2022). Unless fundamental care is embedded in our professional practice frameworks and measurement processes (Aspinall et al, 2022; Merkley et al, 2022), then the likelihood of neglecting fundamental care is increased.…”