Fundamentals of Care Report

Problem Statement

Fundamentals of care (FOC) is a conceptual framework that involves the establishment of a trusting relationship with the patient to ensure their essential physical, psychological and relational needs are addressed and received.

The delivery of this care often goes unnoticed, in part because it is primarily concerned with meeting everyday basic human needs that are taken for granted. The importance of fundamental care is most evident when this care is suboptimal or missed as evidenced in the 2013 Francis Report.

A lack of evidence supporting the crucial nature of fundamental care to patient outcomes in the CM Health context has not previously been visible.

To ensure we provide high quality consistent patient/whaanau care and health equity for our community. FOC is recognised internationally as best practice and has nine clearly defined standards. The standards are supported within an improvement and assurance framework.

What are we trying to achieve?

Our goals are to:

• reduce variation in the delivery of fundamentals aspects of care
• improve patients’ experience and outcomes
• establish longitudinal quality evidence that measures nine Fundamentals of Care domains from a variety of sources.

What have we done?

Forty-one wards at CM Health participated in a peer review in March 2019, which consisted of four parts: (a) patient interview, (b) ward observations, (c) ward management interview and (d) audit and monitoring results. Previously, 40 (2018) and 34 (2017) wards had participated.

Each ward review took between two and four hours. In addition, 192 patient surveys were completed: 17.7% were from patients who identified as Maaori (19.5% in July 2018), 25.5 as Pacific (23.6% in July 2018), 14.06% as Asian (9.8% in July 2018), and 40% as NZ European (46% in July 2018). Patient participants were equally distributed by gender.

What did we find?

The overall organisational result was 82.2% (compared with 79.3 % in July 2018).

• The highest standard achieved was for ‘Respect, privacy and dignity’, which scored 87.0% (87.1% in July 2018).
• The lowest standard was ‘Clinical monitoring and management’ with 75.3% (67.1% in July 2018).
• The most improved part within the ‘Respect, privacy and dignity’ standard was Part D, reflecting improvement from 71.5% to 78%.
• Sixty-five per cent of the items in ‘Clinical monitoring and management’ refer to objective data (Part D), which scored 71.5% and was a 10% improvement since 2018.
• Part C: Charge Nurse Interview scored 33.3% in the ‘Clinical monitoring and management’ standard and represents the greatest opportunity for improvement.
• European and Pacific Island responses differed significantly from Maaori participant responses (Maaori were lower). Also, Asian responses scored the highest, and were significantly different to Maaori responses.

• Under the ‘Communication’ standard, Asian participant responses were significantly higher than Maaori, Pacific Island and European responses.
• Under the ‘Clinical monitoring and management standard, Maaori participant responses were significantly lower than both Asian and Pacific Island participant responses.
• Under the ‘Care environment’ standard, Maaori participant responses were significantly lower than Asian, Pacific Island and European responses.
• Under the ‘Respect, privacy and dignity’ standard, Maaori participant responses were significantly lower than both Asian and European responses.
• Under the ‘Nutrition and hydration’ standard, Maaori participant responses were significantly lower than both Asian and European responses.

How did we make a difference?

The Fundamentals of Care Programme has produced a comprehensive overview of care at the organisational and ward and unit levels. It allows the organisation to quantify nine standards relevant to patient safety, satisfaction and quality of care.

Fundamentals of Care also gives wards and units information and feedback to identify critical areas for improvement, and design and implement activities for improvement by using the Institute of Healthcare Improvement tool and a plan-do-study-act cycle. Having this information available helped CM Health during its recent certification audit.

The use of post-review panel meetings for eight wards provided an opportunity for charge nurse managers to discuss their results and plans in detail, ensure that their plans are sufficiently specific and identify where further support is required.

Furthermore, the Fundamentals of Care review continues to provide an opportunity for data-informed quality improvement activities and their subsequent measurement, and to support recognition and celebration of good work and the excellent results achieved.

Where to from here?

A fourth peer review is planned for September 2019.