Most of the public are unhappy with the NHS, according to latest findings of the British Social Attitudes Survey (Nuffield Trust, 2023). However, at the same time, nursing has topped an independent poll of the country's most trusted professions, with 89% of British people saying that they trusted nurses to tell the truth (Royal College of Nursing (RCN), 2023).
Nursing came top out of 30 professions in the annual Ipsos Veracity Index, which has been running since 1983. Nurses were only added to the list in 2016 and have topped the poll ever since. This, I feel, is one of the reasons that our profession is in a strong position to regain public trust and confidence in health care and drive many of the changes required.
Almost weekly, we hear about another service or organisation that falls short, with the publication of reports detailing poor patient and family experiences, and inadequate, unsafe care. Such findings also have a significant impact on staff. Typically, what then follows is either a local or national report making recommendations for the sector that we all need to consider.
The reflections that I have been having with colleagues more recently, given all that we know in respect of the risks when poor staff and patient experience has occurred, is about how we could learn more openly from the wards, departments and organisations where care either continues to be consistently good or where improvement has taken place and the evidence of improved outcomes are being seen.
An online search of how best to learn nationally from excellence, starting with our health and social care regulator, the Care Quality Commission (CQC) in England, is a little disappointing, in that, while there are several publications, including its annual ‘state of care’ report, this does focus on what the health and care challenges are, and where things have gone wrong.
Locally, there are several initiatives that can be deployed to learn form and celebrate excellence. In my own experience, using a ward or departmental accreditation system has served as a useful tool to support a whole-team approach to excellence and quality improvement.
Celebrating excellence
NHS England recognises the benefits of such systems as stated in its 2019 publication (NHS Improvement, 2019), namely that these programmes:
- Reduce unwarranted variation
- Increase staff engagement
- Help nurses, midwives and care staff understand what the expected standards are at ward and unit
- Provide ward-to-board assurance on the quality of care
- Create a platform for continuous improvement
- Improve accountability and encourages shared governance
- Provide a platform for shared learning
- Create a culture of pride and accomplishment and support collective leadership, personal and professional development.
Crossigham (2022) wrote a blog about the implementation of an initiative called ‘Learning from Excellence’. The scheme's purpose is to capture and study positive feedback from patients to inform quality improvement. Learning from Excellence allows people to say ‘thank you’ in a way that changes behaviour and acts as a tool for cultural change.
Crossingham (2023) also considered the NHS England improvement framework Always Events, first published in 2021, which defined such events as ‘those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the health care delivery system’ (NHS England, 2023).
Learning from others
All of these interventions, it could be argued, have been evaluated and show examples of excellence and culture change at a local level. However, where I feel there is a huge opportunity gap, is in the transparent bringing together of soft and hard intelligence that hears both the patient, the staff and the learner voice, alongside key sensitive indicators, set in the context within which teams operate to enable us to see which services are thriving and enable wider learning to take place.
As I take up post with the Nursing and Midwifery Council (NMC), it will be critical to use these types of tools, and the NMC will play a part in supporting colleagues who wish to shift their positions at pace by taking learning from others in the sector.