Introducing evidence-based guidelines through a best practice accreditation programme to improve care quality in Spain
- Variability in nursing practices across Spanish health care organizations and concerns regarding the quality and safety of services provided.
- Lack of comparable indicators across institutions with which to systematically monitor or evaluate nursing practices.
- The Best Practice Spotlight Organization accreditation model (developed by the Registered Nurses’ Association of Ontario in Canada) was rolled out in Spain to encourage care organizations to improve adherence to best practice guidelines.
- While the initiative activated a well-established and structured programme model, flexibility in implementation supported the tailoring of new practices to local needs.
- Providers were given lead roles in implementing the accreditation programme within their respective organizations, providing them with ownership over the initiative and increasing their acceptance of new practices.
- A focus on generating and comparing data, as well as strengthening the evaluation of care practices, motivated performance improvements.
In 2010, inconsistencies in nursing practices across the Spanish health care system contributed to quality and safety concerns. Comparable indicators with which to draw comparisons across health care organizations were lacking and limited recordkeeping or evaluation of nurses’ clinical practices resulted in a failure to systematically measure and monitor the standard of care being delivered.
Seeing the potential to improve service quality, the Nursing and Healthcare Research Unit of the Spanish Institute of Health Carlos III (Investén-isciii) partnered with the Registered Nurses’ Association of Ontario (RNAO) to bring RNAO’s best practice nursing guidelines to Spain. As a result, 40 or so RNAO guidelines supporting evidence-based nursing, care quality improvements and better health outcomes for patients have been translated into Spanish. Furthering this relationship, Investén-isciii also became a Best Practice Spotlight Organization Host, responsible for overseeing implementation of RNAO’s prestigious Best Practice Spotlight Organization (BPSO) accreditation programme in Spain. In 2011, the first cohort of Spanish health care organizations was selected to participate in the three-year BPSO Programme. Only eight organizations were chosen to ensure each could receive enough personalized support during the accreditation process. The BPSO Programme aims to provide a guiding structure to incentivize, facilitate and monitor utilization of best practice guidelines. BPSO candidates are required to introduce at least three best practice guidelines based on the needs of their organization; examples of guidelines chosen included breastfeeding promotion, fall prevention and ostomy care. BPSOs are also required to collect and report data on standardized nursing quality indicators using an online portal. Each BPSO has access to their own data to enable strategic planning and inform improvements; participating organizations can also view aggregate data of other BPSOs. In 2015, all eight BPSO candidates achieved two-year accreditation status and the BPSO Programme has since recruited an additional 10 candidates.
Fully implemented and scaled up
Close collaboration between RNAO and Investén-isciii brought the BPSO Programme to Spain. Investén-isciii, a national Spanish health research organization with experience collaborating with other international centres, serves as the BPSO Host and has full responsibility for the BPSO Programme in Spain. RNAO has overall oversight and provides Investén-isciii with free guidance and support in the form of trainings, educational resources and mentorship. While accreditation through the BPSO Programme is voluntary, it has proved to be competitive and there is a surplus of organizations wishing to participate. All senior management within selected organizations must sign a contract with Investén-isciii to demonstrate widespread managerial support for the BPSO Programme. Selected BPSO candidates then lead the necessary changes within their organizations to meet the standards of the BPSO Programme. Each BPSO is required to designate an overall project leader, as well as a leader for each guideline being implemented. In addition, a group of health providers are selected to become guideline champions who are responsible for leading peer-trainings within their organization and promoting the initiative.
Several research projects on the impact of the BPSO guidelines in Canada have demonstrated positive outcomes for patients. While research relating to the implementation of BPSO guidelines in Spain is not yet available, it is expected the success of Canadian BPSOs will be mirrored in the Spanish context.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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Nursing and Healthcare Research Unit of the Institute of Health Carlos III Spain (Investén-isciii) and the Registered Nurses’ Association of Ontario