In the document The Essence of Care (DoH, 2001) the National Health Service (NHS) is encouraged to ensure uniform provision of high quality health care by exploring the benefits of benchmarking. This paper attempts to carry out a critical review and of two research articles and examine their appropriateness as reference sources in the compilation of The Essence of Care (DoH, 2001).
I shall look at the privacy and dignity benchmark focussing on privacy, dignity and modesty factor. Essence of Care shall be looked at briefly and also illustrate how best practice is achieved through process benchmarking. I shall also draw on evidence from other literature reviews relating to attaining best practice. In conclusion I shall relate evidence from my area of practice and also offer evidence based recommendations on best practices from other trusts that can be copied by my trust.
The Essence of Care offers nurses a toolkit for reflecting on, comparing and sharing best practices, to improve continuously the care offered to patients (Davies, 2002). Best clinical practice benchmarking involves reaching a consensus on what constitutes best practice by examining processes by which it is achieved and using them to compare individual practices. The Essence of Care (DoH, 2001) document defines privacy as freedom from intrusion, dignity as being worth of respect and modesty, as not being ashamed. The agreed patient focused outcome of this benchmark is for patients to benefit from care that promotes their privacy and dignity and protects their modesty.
I have chosen this benchmark because of the realisation on my part that respect for patients’ privacy and dignity is important in establishing and maintaining their trust. During my current training I have observed that dignity and privacy are poorly respected on many a ward. By concentrating on this benchmark I believe it teaches me what best practice are in this area, how it has been achieved and gives me guidance on what is expected of me as a nurse and make me a better practitioner. Studies, such as the ones examined in this paper, help practitioners take a structured approach to sharing and comparing practice, enabling them to identify the best practice and to develop action plans to remedy poor practice. Basing government policies on research and evidence based practices helps to deliver quality care that exceeds patient expectations (Lipley, 2001).
Attempts at enhancing the system to this is evident in the recent history of the NHS which shows a proliferation of management inspired approaches – Total Quality Management (TQM), business process re-engineering and ISO 9000. The handicap with these approaches was their emphasis on organisational quality rather than clinical care. By the mid 1990s, the idea that the quality of clinical practice must be based directly and demonstrably on recent, robust research evidence and that common standards could be set had become attractive to the NHS (Davies, 2002). The embracing of benchmarking in setting quality of clinical care practice is evidence of government’s paradigm shift on delivery of care.
Benchmarking is a practical tool for improving performance by learning from best practices and the processes by which they are achieved (http://www.psigroup.co.uk). It involves looking outside your own area of practice to examine how others achieve their performance levels and to understand the processes they use. In this way benchmarking helps explain the processes behind excellent performance. When the lessons learnt from a benchmarking exercise are applied appropriately, they facilitate improved performance in critical functions within an organisation or in key areas of the business environment (Stark, MacHale, Lennon&Shaw, 2000).
Clinical governance is the first policy driver that has paved the way for the production of clinical benchmarks (Chambers &Jolly, 2002). Whilst clinical governance is a quality assurance system, the focus is often on management systems and there is a danger of not paying much attention to quality of services. What the Essence of Care, does, is offer a framework with patients, clients and their carer’s experiences at the heart of the process – a qualitative approach to identifying, measuring and reflecting on quality of services provided (Lunn, 2003). The two articles being reviewed show the patient as the central figure in all these systems and processes.
The patient is now given recognition as the key adviser for healthcare development and improvement. The government strategy on a local and national level is that wards and departments performing well will share how they do this with others, so that patient care can improve equally at all levels. Benchmarking should not be considered a one-off exercise. To be effective, it must become an ongoing, integral part of an ongoing improvement process with the goal of keeping abreast of ever-improving best practice (Ellis, 2000). This marries well with current government strategy to bring in a culture of continuous improvement of evidence based patient care.
The privacy and dignity benchmark addresses the patient’s freedom from intrusion and being worthy of respect. One source for the motivation to improve practice is comparing your own performance against some internal or external reference points (Scalon&Whitfield, 2002). Benchmarking involves measuring quality and evaluating changes in process, provides the opportunity and reference points for that comparison.