Evidence standards and safety

Healthcare systems across the world are dedicated to delivering care that is informed by evidence rather than historically based traditions and dogma (34). Evidence-based practice is defined by the International Council of Nurses as, 'a problem solving approach to clinical decision making that incorporated a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring (35).' The UK, and Scotland more specifically, have several dedicated bodies to evaluating scientific research and establishing best practices such as: the National Institute for Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN). EiC works in tandem with these organisations, whilst simultaneously commissioning our own research and collaborating with clinical and academic colleagues, to determine what indications of care quality should be considered and promoted by NHS Scotland. This approach combines positivist, research-based data with the expert knowledge of clinical staff contributes to robust evidence that is used to inform EiC’s objectives and priorities (36).

To ensure EiC is an informed, evidence-based programme, there is an established academic advisory group whose role is to ensure the programme is informed by the latest evidence and best practice standards. EiC will work in partnership with our quality assurance and evidence directorates to share learning and intelligence to inform and influence priorities for improvement and standardisation of evidence-based care.

Safety is paramount in conceptualisations of quality care and is identified as the first step in ensuring EiC (37). Patient safety can be defined as the reduction of risk of unnecessary harm, simultaneously maximising the successful implementation of care (38). Despite efforts by healthcare professionals, evidence suggests that approximately 10 % of those admitted into NHS Scotland hospitals experienced some degree of unintentional harm–with researchers estimating that roughly half of these adverse events were avoidable (39). In response to concerns over patient safety, NHS Scotland became the first health service in the world to create a nationwide, systematic approach to improving patient safety: the SPSP. Early results have indicated that as of the implementation of this programme, all health boards have reported some improvements in patient safety (40). Informed by SPSP, several of the measures included in the CAIR dashboard are explicitly related to the safety of patients, such as falls rates and pressure ulcers, whilst other indicators of care quality are indirectly associated with patient safety and experience of the healthcare system more broadly.

As well as the co-development of measures, it is the aspiration of EiC to work with the SPSP to drive improvement through the use of the CAIR dashboard to influence, prioritise and reduce risk within the health and care system in Scotland. This collegial approach will increase quality improvement capacity through joint working and reduce systemic waste by decreasing duplication.