Measuring the effectiveness of a nurse-led or nurse-run clinic should be an integral part of the service. It encompasses the areas of audit (often known within healthcare as ‘clinical’ audit) and evaluation.
There may be a number of reasons to measure the effectiveness of a nurse-led/nurse-run clinic:
To demonstrate that the clinic is or is not meeting its aim(s) and objectives. NB: These should have been discussed and decided upon when the clinic was set up.
To ensure that the clinic is meeting the needs of patients or clients – related to the service that you are offering.
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To identify deficits in the effectivenss of the clinic, which can then be corrected and reassessed through a further audit.
To compare the clinic against national or local standards of service delivery and/or to compare to a service offered through a different approach, such as by a doctor.
Measuring effectiveness therefore needs to be at least periodic to ensure that you are improving and maintaining a good service.
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Clinical audit has been defined in the United Kingdom as ‘a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change’ (NICE 2002).
Evaluation is a part of any audit process but focuses more on the merit or worth of something. You may note the activities that you are undertaking in the clinic, but do they singularly or as part of the service make a difference to your patients or clients?
It’s important to decide what you are going to measure and what you are going to benchmark this against. For example, you may use a patient satisfaction survey to audit what your patients think about a variety of aspects of the service – waiting times, the chance to discuss issues, whether they have a greater understanding of their condition and so forth – but what are you comparing this against? Essentially, it’s about comparing actual practice to some standard. You may compare to the aims and objectives of the service, national or local criteria or, as highlighted, a similar service offered by a different method.
Measuring effectiveness for beginners
If you have not undertaken an audit of a service before, do refer to the many texts and papers now available and importantly discuss this with your team. There may be some mandatory auditing which needs to be carried out anyway. Many big organisations, such as hospitals and educational institutions, have staff and departments who focus on auditing. Can someone advise and mentor you?
There are many ways to measure effectiveness. Quantitative approaches focus upon numerical data such as readmission rates, physiological parameters, waiting times and importantly cost-effectiveness.
Qualitative approaches focus upon words as the data source and the lived experience of people. Although quality of life measures appear to fall under the latter approach, many questionnaires are more quantitative in nature.
Do read around the advantages and disadvantages of various approaches. Pennery (2003) for example, offers a useful review of the value and limitations of patient satisfaction surveys. Remember that new tools such as questionnaires are notoriously difficult to construct and can be confusing and ambiguous to the patient. Always pilot them first and if you can use pre-existing tools that are reliable then do. However, check that they answer the required questions – that they are valid.
National Institute for Health and Clinical Excellence (2002) Principles for Best Practice in Clinical Audit. Abingdon: Radcliffe Medical Press Ltd.
Pennery E (2003) Effectiveness and Evaluation of the Nurse-led Clinic. In Hatchett R (ed) Nurse-led Clinics: Practice Issues. London: Routledge, pp. 69-86.
Ashmore S, Ruthven T (2008) Clinical Audit: A Guide. Nursing Management 15(1): 18-22.
Cooper J, Benjamin M (2004) Clinical Audit in Practice. Nursing Standard 18(28): 47-53
Skills – Clinical Audit. Nursing Times (2003) 99(13): 31.