It just didn't work: the realities of quality assessment in the English health care context.
OBJECTIVE
Assessment of care quality is integral to health and palliative care provision and there is a need to develop and implement outcome measures to assess quality. This study aimed to: (1) describe the implementation of a palliative care outcome measure in non-specialist palliative care settings and (2) to understand the implementation of the measure.


METHODS
Twenty-five non-specialist palliative care settings were purposely sampled and invited to implement a palliative care outcome measure. Fifteen settings agreed to take part. The research team provided training and support in the use of the measure. Data were collected on actual use of the measure and, via interviews with patients and nurses, on their experiences.


RESULTS
The number of assessments was low (21 patients assessed against an anticipated minimum of 240). The analysis of nurses' accounts identified important considerations in understanding the low response. Although nurses saw the implementation of the outcome measure as bringing opportunities for themselves, including their own professional development, and for the organisations they represent, including raising organisational profiles, there were a number of factors that acted as impediments. These include: perceived time to administer the paperwork; competence and confidence in recruiting patients and proceeding with informed consent; concerns about the effects of completing the measure with very ill patients; and the effects of nurses raising palliative care issues on their relationships with patients.


CONCLUSIONS
It is difficult to integrate outcome measures into routine clinical practice. Future interventions should consider how to tailor the implementation of outcome measures within existing working structures and provide education and training to enable nurses to deal with potentially sensitive palliative care issues.
School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. rhidian.hughes@ukonline.co.uk
Rhidian
R
Hughes
Fiona
F
Aspinal
Julia M
JM
Addington-Hall
Maria
M
Dunckley
Christina
C
Faull
Irene
I
Higginson
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards; D004509:Education, Nursing, Continuing / Q000592:standards; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007258:Informed Consent; D007318:Inservice Training / Q000592:standards; D008131:London; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010166:Palliative Care / Q000523:psychology / Q000592:standards*; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires; D017748:Time Management; D016526:Workload