Compassion in practice: measuring quality of care Paula O’Brien (MSc Nursing, 2015) wrote her dissertation on the use of metrics in measuring nursing care. She is a matron at University College London Hospitals NHS Foundation Trust


It’s not easy to measure quality of care but there are indicators that, taken collectively,


can give us some useful insights. These include workforce indicators, such as absenteeism and use of agency staff, so-called processes of care – which include non-technical aspects of care like


educating patients about their condition and discharge planning – and of course patient experience itself.


‘I recently gave a talk at a local community college. The students asked me which of the 6Cs I thought


was most important, and I said “care”. It covers everything: if patients feel cared for, it means they’ve had good communication from competent


‘Success increasingly came to be based


on what could be measured,’ she says. ‘That led to a distortion of priorities, and less attention being given to non-targeted activities. The patient experience got pushed down the agenda. This is very much borne out by the various reports into these hospital scandals, which paint a picture of organisations that were under-funded and under-resourced, with managers under constant pressure to deliver more with less, leading them to make ever more unrealistic demands of frontline staff.’ Indeed, the report into the Mid-Staffs scandal specifically points to a link between an over-reliance on targets and measures


nurses with the courage and commitment to


demonstrate compassion. We need to know more about what “care” actually means to patients, and that means looking beyond the existing “friends and family” test to really understand the factors that influence patient experience and start identifying themes and


trends that we can then use as a basis for action.


‘As a matron, I rely very heavily on what patients tell me about the care


they receive. Each month I read every single free text comment so that I can pick up any recurring themes. For example, we recently changed our admissions process after a number of patients told us they were finding it stressful. We


developed the new approach as a team, and although


‘We need to know more about what “care” actually means to patients, and that means looking beyond the existing “friends and family” test to really understand the factors that influence patient experience’


there was some resistance to change from our medical colleagues we were able to ensure that the patient perspective prevailed. If a patient praises a specific member of staff, I make sure they get a personal “well done” from me.


Caring for staff ‘For me, staff experience is also vital. It’s often viewed separately from patient experience, but I see the two as going hand in hand. Care for staff, and they will care for patients. Organisations can support that, by focusing more explicitly on the patient experience. I would urge them to look at their mission statements and rather than focusing on technical excellence, world-class education and research, think about going back to the heart of what the NHS is about – caring for those in need.’


and a failure to deliver high quality care. According to the executive summary, ‘management thinking… was dominated by financial pressures, to the detriment of quality of care’, and ‘statistics and reports were preferred to patient experience data, with a focus on systems, not outcomes’. It’s not hard to imagine how staff might


come to feel that they had no choice but to compromise on patient care. ‘If a ward is understaffed, you don’t have the resources to be able to deal properly with everyone that’s in need, and your manager is putting pressure on you to discharge three patients in the next 30 minutes to free up beds, you might well choose to focus on what’s


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