Limitations
As Donabedian (1988) cautions, measuring quality of clinical
care is neither precise nor complete. Whilst a larger
sample of all participants may have revealed additional
information about the safety and quality of nurse practitioner
service in the study sites, the Donabedian framework
proved to be an appropriate audit methodology to investigate
this new service provider. Our findings adequately validated
the Donabedian framework and provided important
baseline information for ongoing audit of nurse practitioner
service in these sites.
Conclusions
Nurse practitioners are a new level of healthcare provider,
and the service is well established in most countries.
However, evaluation of the role in terms of quality
and safety of the service in a SPO framework has not to
date been reported in the literature. This audit has demonstrated
that implementing an innovative service intervention
requires detailed preparation in the field of
service.
Clarity around roles and responsibilities is essential for
optimum functioning of the existing MDT. Detailed preparation
and education with all clinicians on the scope of practice,
service goals and internal collaborations are essential.
Structural elements of the service and the goals of service
reform need to be established and communicated. Notwithstanding
the Structure and Process issues related to the implementation
of nurse practitioner service, in this study the
clinical service was considered safe and effective. Furthermore,
patients were overwhelmingly positive about the clinical
and interpersonal quality of nurse practitioner service.
The Donabedian framework provides a useful model to
guide planning, preparation and evaluation of a health service
innovation. This audit has demonstrated that nurse
practitioner services in this sample lacked the level of organisational
and Process support required for the effective implementation
of a service innovation. It also demonstrated that
nurse practitioner service was valued by patients, deemed
safe and effective by the MDT and judged to meet all indicators
of quality and safety by the expert auditor.
Acknowledgements
We gratefully acknowledge the Queensland Health nurse
practitioners, their medical and allied health colleagues and
the patients who participated in the study and Ms Anna
Doubrovsky MPH for technical support, assistance with
data collection and data entry. The study was funded by
consultancy funds from the Office of the Chief Nurse,
Queensland Health.
Limitations
As Donabedian (1988) cautions, measuring quality of clinical
care is neither precise nor complete. Whilst a larger
sample of all participants may have revealed additional
information about the safety and quality of nurse practitioner
service in the study sites, the Donabedian framework
proved to be an appropriate audit methodology to investigate
this new service provider. Our findings adequately validated
the Donabedian framework and provided important
baseline information for ongoing audit of nurse practitioner
service in these sites.
Conclusions
Nurse practitioners are a new level of healthcare provider,
and the service is well established in most countries.
However, evaluation of the role in terms of quality
and safety of the service in a SPO framework has not to
date been reported in the literature. This audit has demonstrated
that implementing an innovative service intervention
requires detailed preparation in the field of
service.
Clarity around roles and responsibilities is essential for
optimum functioning of the existing MDT. Detailed preparation
and education with all clinicians on the scope of practice,
service goals and internal collaborations are essential.
Structural elements of the service and the goals of service
reform need to be established and communicated. Notwithstanding
the Structure and Process issues related to the implementation
of nurse practitioner service, in this study the
clinical service was considered safe and effective. Furthermore,
patients were overwhelmingly positive about the clinical
and interpersonal quality of nurse practitioner service.
The Donabedian framework provides a useful model to
guide planning, preparation and evaluation of a health service
innovation. This audit has demonstrated that nurse
practitioner services in this sample lacked the level of organisational
and Process support required for the effective implementation
of a service innovation. It also demonstrated that
nurse practitioner service was valued by patients, deemed
safe and effective by the MDT and judged to meet all indicators
of quality and safety by the expert auditor.
Acknowledgements
We gratefully acknowledge the Queensland Health nurse
practitioners, their medical and allied health colleagues and
the patients who participated in the study and Ms Anna
Doubrovsky MPH for technical support, assistance with
data collection and data entry. The study was funded by
consultancy funds from the Office of the Chief Nurse,
Queensland Health.
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