Measurement Plan
We’ve created a Culture of Care dashboard where each ward and organisation can see their own data, together with the national data for the Culture of Care Programme.
Our dashboard contains three sections which aim to determine whether there is improvement in care being safe, therapeutic and equitable, and the overall experience of patients, staff and carers. These are:
- Proxy outcome measures
- Patient, staff and carer experience
- Staff measure
Our approach to data collection has been designed to place minimal burden on ward staff by making use of data already collected by organisations for the outcome measures and electronic survey responses being sent directly to the National Collaborating Centre for Mental Health (NCCMH), the lead delivery partner for the Culture of Care Programme. The only exception to this is when patients or carers complete paper copies of the surveys and staff may assist in returning the surveys to the NCCMH via freepost.
These are a set of 4 measures which tell us something about what a ward is like and are proxy indicators of culture on the ward. All four measures are submitted to the NCCMH monthly and are displayed using statistical process control charts on the Culture of Care dashboard. We have requested a 12-month baseline from each organisation so improvement over time can be measured.
The four outcome measures, the data we’ll request from organisations, and the reason for selecting it are below:
| Outcome measure | Data required | Rationale |
|---|---|---|
| 1) The number of episodes of restrictive practice (restraint, seclusion, rapid tranquilisation) on the ward | Number of restraints, rapid tranquilisation and uses of seclusion. | Avoiding harm is one of the CofC standards, and the use of restrictive practice is harmful to patients and causes moral injury for staff. It is a widely recognised indicator and there is near universal agreement that it should be used only as a last resort. Data is usually good quality, and our own comparison of safety cross data vs Trust data in our RRP collaborative showed low levels of difference.
|
| 2) The number of instances of sexual harm | Number of sexual harm incidents. | Safety is one of the CofC standards and within that sexual safety has been a big concern for a number of years, highlighted by the CQC, then our own standards and collaborative, and more recently is a focus on a number of different areas in NHSE. Data is likely to be patchy but the focus on it may improve data quality, which in itself is a good outcome.
|
| 3) The number of days since the last incident of AWOL from the ward | Dates of any instances of someone being AWOL from the ward | Most inpatient suicide happens off the ward, either on agreed leave or AWOL. Patients being AWOL also tells us something about the culture of a ward – I.e. whether patients want to be there (accepting there are factors other than the culture of the ward that will affect this). Data should be good quality. AWOL is a relatively rare event on most wards, so using ‘days since’ as a measure will be more meaningful than a count of instances of AWOL.
|
| 4) Percentage of shifts filled by bank and agency staff | Number of total shifts on the ward. Number of shifts filled by bank and agency staff | Low turnover of staff is identified as one of NCISH’s 10 steps to safety, and high use of bank and agency staff can be a barrier to providing relational care, which is one of the CofC standards. |
To find out what patients and carers think about the ward, and how much their experience and care, or that of their loved one, aligns with the Culture of Care standards, we are collecting two anonymous surveys from patients:
- We use an adapted version of the validated Consultation and Relational Empathy (CARE) measure, which we invite patients to complete after every interaction with staff. This can be completed whenever the patient chooses and consists of ten questions.
- We have developed a survey which focuses on overall patient experience. There are 12questions, with each one relating to one of the Culture of Care standards. We invite patients to complete this survey once during their admission.
- We have developed a questionnaire for carers, families and friends. This is a survey containing 13 questions, with each question relating to one of the Culture of Care standards.
A QR code is available for patients and carers to complete the surveys at any time (posters have been sent to each ward to display). This process ensures feedback goes directly to the NCCMH, without requiring staff involvement on the ward. Where phone access is limited or an alternative format is preferred, wards are asked to provide an iPad or paper versions of the questionnaire, which can be returned directly to the NCCMH using supplied freepost envelopes.
As an overall measure for staff, the extent to which they feel burned out is a measure of how they feel about working on the ward, and high levels of burnout directly impact their ability to be present alongside people in their distress (one of the Culture of Care standards).
We are inviting staff to complete the anonymous Mini-Z burnout survey, adapted to reflect a ward environment, once per quarter. This is the only data collection we ask of ward staff across the whole measurement plan.
All surveys are anonymous, but we do collect the person’s demographics so we can aggregate the data and look at the differential experiences by demographic(s) nationally.
The patient experience and patient CARE surveys are available in English, Arabic, Chinese, French, Polish, Russian, Slovak, Swahili and Urdu.
We have also developed an easy read survey for the patient CARE and experience measures.