On this page
- The aims of Essentials of Care
- How will patients benefit?
- What is essential care?
- Program structure
- Transformational Practice Development
- Reporting and evaluation
- Resources and support
- The role of the facilitator
The Essentials of Care (EOC) program is a framework to support the development and ongoing evaluation of nursing and midwifery practice and patient care. It is underpinned by the principles of transformational practice development. This approach to practice requires that all stakeholders – patients, carers, staff and families – have opportunities to participate and are included in decisions about effective care using approaches that respect individual and collective values. Nurses and midwives have been enthused by this opportunity to refocus on the basic values of caring and the reason why many of us came into the profession.
Implementation across NSW Health commenced in February 2008 and all local health districts (LHD) are now at various stages of implementation. The implementation of EOC is enabling nurses, midwives, allied health and other clinicians to focus on the development of clinical environments that enhance patient care, teamwork and individual/team work satisfaction.
Additional information can be found in the Essentials of Care Program Overview.
The aims of Essentials of Care
The EOC Program aims to enhance the experiences of patients, families, carers and the staff involved in the delivery of care through the ongoing evaluation and development of safe, effective and compassionate clinical care workplace cultures.
This aim is achieved by engaging healthcare teams in collaborative processes that utilise evidence from patients and their families, workplace data and research to inform improvements that impact on patient quality and safety at the point where care is experienced.
The work is done through:
- evaluating the quality of essential care delivery
- identifying opportunities for the development of practice
- activating locally developed plans to improve practice
- developing a culture of critical inquiry
- celebrating excellence in practice
How will patients benefit?
The program will enhance person-centred care and result in better patient outcomes through the establishment of more effective clinical environments. It aims to:
- focus on patients’ needs and their experiences of care provided
- value the contributions from all involved in care
- encourage patient participation in decisions about their care
- support the ongoing review and development of practice
- use relevant research and evidence that is generated from practice and care settings
What is essential care?
Essential care is a term used in this context to help health care professionals identify and articulate the aspects of care that are fundamental to patients’ health and wellbeing. Effective essential care can only be achieved when patients and their carers are included in discussions and decisions, so the health care team understands their individual needs and works together in a person-centred way to achieve them. For the purposes of helping us to understand how, when and where aspects of care occur in day-to-day practice, they have been categorised into ten care domains:
- Documentation and communication
- Promoting self-management
- Medications/IV products
- Privacy and dignity
- Clinical interventions
- Clinical monitoring and management
- Preventing risk and promoting safety
- Learning and development culture
- Personal care
- Organisation of care
Care outcomes and benchmarks have been established for each domain as a basis for measurement.
These domains have been sensitised for use in Mental Health, Maternity, Pediatrics, Community Health and Women’s Health.
EOC is an ongoing process with a two-year evaluation cycle; there are six phases to the program.
The education and engagement of the staff in the informed decision to implement EOC using transformational processes, articulation of staff shared values, ways of working together, and exploring all claims, concerns and issues around implementing the program.
The time period where the observation, auditing and patient/carer stories are collected by a team of internal and external staff. This data is used in conjunction with other available data, as a baseline assessment of clinical practice, care delivery and the care environment.
Feedback - critically reflecting and identifying themes
A facilitated process whereby the data that has been collected is collated and feedback to the clinical staff, enabling them to draw out the themes that are arising and prioritise the themes that need to be actioned in the short and long term.
Action planning - prioritising and actioning themes
A facilitated process whereby the themes are discussed and action plans are devised identifying actions, timelines, responsibilities and how their impact will be evaluated.
Implementation - implementing and evaluating actions
The period during which the action plans are implemented by staff on the ward/unit. During this time there is ongoing evaluation of the action plans and their impact on care and the care environment.
At approximately the two-year stage, the ward/unit staff undertake a review of the work that has been done by repeating the assessment phase. Any outcomes from the action plans implemented are collected, reported and celebrated. Opportunities for further improvements are identified by the clinical staff and the program continues through the cycle of phases outlined here with the intention of it becoming embedded in the way care is planned, delivered, evaluated and developed.
Transformational practice development
Transformational practice development underpins the work of EOC, the principles of which include:
- The use of collaborative, inclusive and participatory approaches
- Being person-centred: Respecting and valuing individuals, and engaging with them in a way that promotes their dignity, sense of worth and independence
- Values-based: Individuals and teams identify their values and beliefs around their clinical practice and themselves
- Enabling facilitation: challenging teams to consider how the behaviours, systems and processes used in practice are consistent with the person centred values they have identified and to identify ways to achieve these in their everyday practice
- High challenge in a supportive environment to enable staff to engage together in sometimes difficult conversations about difficult issues and achieve the goals set out by EOC
- Critical reflection: to critique, evaluate and support ongoing development.
The use of transformational practice development methodologies allows the identification of values and current practices at the ward/unit level. This provides a basis to challenge practice and workplace cultures, enabling new ways of working that are values and evidence based.
This leads to sustainable practice change while providing an ongoing framework for evaluation.
References for further reading
- Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B & Seers K 2002, 'Getting evidence into practice; the role and function of facilitation', Journal of Advanced Nursing, vol. 37, no. 6, pp. 577–88.
- Larsen J, Maundrill R, Malone J & Mouland L 2005, 'Practice Development facilitation: An integrated strategic and clinical approach', Practice Development in Healthcare, vol. 4, no. 3, pp. 142–9.
- McCormack B & McCance T 2006, 'Development of a framework for person-centred nursing', Journal of Advanced Nursing, vol. 56, no. 5, pp. 472–9.
- McCormack B, Henderson E, Wilson V & Wright J 2009, 'Making practice visible: The Workplace Culture Critical Analysis Tool (WCCAT)', Practice Development in Healthcare, vol. 8, no. 1, pp. 28–43.
- NSW Health Nursing and Midwifery Office 2009, Essentials of Care Resource Guide for Facilitators Introduction.
- Wright J & McCormack B 2001, 'Practice Development: Individualised care', Nursing Standard, vol. 15, no. 36, pp. 37–42.
- Wright S 2006, 'The heart of nursing', Nursing Standard, vol. 20, no. 47, pp. 20–3.
- Youngston R 2008, 'Compassion in healthcare: the missing dimension of healthcare reform?', The NHS Confederation Futures Debate Paper 2.
Reporting and evaluation
Evaluation of the program occurs at several levels within the NSW health care setting.
The outcomes as a result of the changes in clinical practice, care delivery processes and the care environment provide the basis for the evaluation strategy. The reporting of this data provides information about the outcomes of the EOC program.
During the assessment phase the ward/units identify the baseline data to be used in the measurement of the impact of EOC, and at the action planning phase identify the evaluation strategies for the implementation of the improvements that are to be made. The ward/unit also look at strategies to capture the outcomes of the processes used e.g. change in the way staff are communicating, or engaging as a team.
Local health district/service network
The progress and outcomes of the implementation of the program across the LHD/service network are reported quarterly by the EOC Coordinators to the LHD District Director of Nursing.
Nursing and Midwifery Office
The progress and outcomes of the implementation of the program across the state are reported quarterly by the EOC Coordinators to the EOC Program Manager.
There is currently work conducted in developing an EOC Database.
"The Essentials of Care Program has changed the way we work, improving our teamwork, and the communication between staff. It has led to a culture where open questioning and advocating for patients is welcomed."
Resources and support
EOC is sponsored by the Chief Nursing and Midwifery Officer of NSW and supported by the state-wide program manager, along with a state-wide program development and support team.
Each LHD/service network has a team who are managing the implementation of the program. The LHD/service networks EOC teams are involved in organising and running of facilitation development workshops. These workshops are part of the facilitation development program.
Written resources available include the resource guide for facilitators, the evaluation and reporting guidelines and the facilitation development program model and curriculum.
These are available from local coordinators/facilitators along with other resource materials.
EOC Program Manager - Nursing and Midwifery Office
The role of the facilitator
The central role of skilled facilitation is critical to the implementation of EOC using the PD methodologies.
The purpose of the facilitator is to engage and enable staff to work with the EOC program in evaluating their own practice and looking at ways of improving or celebrating that practice. This leads staff to become more empowered to have ownership of the improvements being made and allows them to develop better ways of working together and with patients.
Each individual ward/unit will have an external facilitator and one or more internal facilitators.
These facilitators are members of staff who have expressed an interest in being a champion for the EOC program, and developing their facilitation and practice development knowledge and skills.
The facilitators are involved in supporting staff with the implementation of each of the phases of EOC (see program structure) and engaging with the N/MUM and senior clinical team of the ward/unit to ensure access, rostering and resources are available for the appropriate facilitation of the program.
Once a person volunteers to become a facilitator, they will be involved in a comprehensive and ongoing facilitation development program over a 12–18 month period. The aim of the program is to extend the participants' knowledge and skills in facilitating in practice development methodology and introduce participants to a range of activities and strategies that can be used when working with their clinical units.
"As a facilitator, I have been fortunate to see firsthand the growth and the development of clinical nursing staff, especially as they discover that this process enables them to have some control over their everyday lives and the care that they provide to their patients."