Measuring Capacity to Care Using Nursing Data

Book Preface

The Need for a Better Understanding of Contributions Made by the Nursing and Midwifery Professions to the Health of any Nation.

This book seeks to meet the need for a better understanding of the many and varied very significant contributions made by the nurses and midwives within any country’s health system. The nursing and midwifery workforce is three times as large as that of any other health professional group. It is viewed by many as the largest health cost burden rather than for being responsible for the most significant cost savings to the health industry by enabling many individuals to continue to contribute productively to the nation’s overall economic status.

We are passionate advocates for the nursing, midwifery and informatics professions and have spent a lifetime endeavoring to make our profession more visible to decision makers. We have fought many battles and encountered many barriers. Despite the many solutions developed over the years, we continue to witness a very poor understanding of the nursing and midwifery human resources’ needs relative to meeting health service demands. Nurses and midwives deserve to be provided with the capacity to care for our fellow human beings during their most intimate and often traumatic life events. That represents a highly valued investment for the population at large. Nurses and midwives, most of whom are women, continue to be compelled to fight and engage in industrial action to get a fair deal. This needs to change.
This book is addressed to a wide readership, including policy makers, health service executives, managers in healthcare settings, nurses and midwives, health IT, health information and ICT professional, researchers and educators. It is intended to contribute knowledge and provide an argument for why nursing and midwifery data need to be a focal point for identifying evidence of practice and facilitating health care service planning and resource management at all levels within any organization, region, nation and the global health ecosystem.

The book’s content is based on extensive literary scoping reviews plus the authors’ real life past and current local, national and international work and research experiences. The many complexities associated with nursing and midwifery work and their human resource management are decomposed. Many tried and tested solutions to address identified issues are provided together with detailed descriptions of the underpinning research and development activities we have undertaken. This includes some case studies from public and private sector, acute, sub-acute and long term care healthcare organizations. Our findings have an unequalled large evidence base.

We provide detailed insights into the complexities associated with any health system to improve future decision making by using digital transformation. It is our desire to influence our readers so that they will be in a better position to negotiate, innovate and find suitable solutions to issues they encounter in the healthcare environment. We have identified numerous impacts of past high-level decisions made and associated lessons learned, so that those in highly influential positions will be able to improve their future decision making.

Attaining the capacity to care requires the inclusion of nursing data and the effective use of routine operational data collected at any point of care. Readers are exposed to evidence provided from numerous systematic reviews and real-world case studies from multiple countries to provide them with new knowledge. Our analysis of the many issues identified has shown a need for improvements in clinical data management, digital transformation implementation strategies, greater collaboration and a stronger focus on working effectively using multidisciplinary teams, and to make use of small teams for direct care delivery in the acute sector.

We have provided evidence based solutions for the adoption of safe nurse staffing principles and optimum use of operational data enabling the implementation of health service delivery strategies that will result in improved patient and organizational outcomes. Our recommended solutions provide organizational transparency enabling every health worker to view information that enables them to effectively contribute as a team member to achieve optimal patient and organizational outcomes. Readers can learn to make better use of informatics to collect, share, link and process data collected at the source for the purpose of providing real time information to decision makers at every level of the organization, enabling optimum use of available human and other resources required to meet health service demands at any point in time and place.

Organization of the book

The first two chapters provide context and a big picture view by describing current dynamic health care environments and explaining the concept of the capacity to care. This is presented within the context of any national health system’s framework and its primary building blocks that determine goals and outcomes. Our focus is on achieving efficient operational processes in order to optimize our capacity to care. This requires us to examine and decompose input, process and output factors together with the metadata needs for measuring operational efficiency and effectiveness.
The next four chapters provide an overview of current data use to determine nursing workloads and analyses four different nurse staffing methodologies. This reveals significant variations and limitations leading to the need to identify the multitude of variables known to influence service demand and to develop an agreed standard nursing metadata set that is well suited to maximizing desired outcomes from any digital transformation. This is followed by an analysis of nursing work measurement methods and an assessment of their construct validity and use for benchmarking. As nurses and midwives constitute the largest group of health professionals delivering care it is important to consider how best to match not only numbers but also skills, knowledge and competencies within this workforce with service demands. This analysis identifies the many difficulties encountered in our attempts to make this happen.

Whilst acknowledging the global shortages of nurses and midwives, we provide suggestions for the re-engineering of clinical service delivery methods by implementing the appropriate use of non-nursing support staff. This section ends with an examination of nursing/midwifery professional models of care, including care plans and organizational models that focus on work allocation and distribution. Possible linkages between nursing documentation, electronic care plans and electronic patient records are explored to identify how best to improve data collection and data use efficiencies whilst supporting the effectiveness of services delivered.

After achieving a better understanding of how to measure service demand, there is a need to explore how to manage human resources to meet these demands in a manner that enables the provision of quality care, facilitates the best possible use of the available skill mix at any time in any location and be cost effective. Rostering staff to cover a 24 hour service is challenging. Detailed instructions for roster development and re-engineering are provided. This is followed by an examination of workforce planning to ensure the supply continues to meet service demand needs over time. We again found many shortcomings in current practice. We provide suggestions for meeting future service demands.

Throughout the book we identify numerous data collection, data use, information and communication flow limitations. These are best resolved by making better use of available digital technologies. Despite an extensive body of work associated with health (medical, clinical and nursing) informatics, we were able to identify only relatively small pockets of success. We understood the need for system connectivity many years ago and have been working as participants in multidisciplinary teams to ensure that interoperability schema adopted were able to accurately meet functional needs. Chapter 9 explains the need to understand the relationships between data characteristics and attributes, and how these are technically processed whilst retaining meaning and accuracy.

Health care is global. Clinical trials and medical advances are shared globally. There is a need to consider how healthcare providers are best able to share, link, aggregate and compare data, to attain reliable and accurate big data sources and facilitate data analytics to benefit global health. Doing so ensures that local needs are met in a timely and sustainable manner. Key technical features required to optimize the results of local and national digital transformation strategies, including system connectivity, interoperability, health data exchanges and secondary data use are provided.

The chapter that follows focuses on how best to manage local digital transformations in a manner that ensures the nursing data are incorporated and able to be used to suit multiple purposes. Considerable detail is provided about how to overcome change management barriers and how to go about designing new work processes. This includes a generic example of a nursing acuity system implementation process. This chapter ends with guidelines for a system implementation evaluation and the provision of an evaluation framework. This leads in to methods of measuring the quality of services provided and the need for adopting meaningful measurements, trend analysis, continuous monitoring and evidence-based practice. The benefits of including nursing data is explained and outcomes research methods currently in use are explored.
Chapter 12 applies all topics discussed in previous chapters to the residential long-term care and community care sectors to identify significant differences. This is of paramount importance given the growing ageing population and an expected growing increase in service demand. Patient acuity is also valid in this sector and needs to incorporate lifestyle support needs. The primary differences between acute and residential long-term care are the funding mechanisms which in turn determine data collection and reporting requirements, without a focus of supporting the capacity to provide holistic day to day care.

The final chapter summarizes findings and recommendations by looking to the future highlighting the unique contributions made by nurses and midwives and initiatives underway to provide greater public visibility. A detailed list of benefits to be obtained from using nursing data is provided along with descriptions of cutting-edge digital transformation activities as examples for others to follow. Two case studies detailing the authors patient acuity research studies are provided as appendices.

Evelyn J.S. Hovenga Cherrie Lowe