News and Comment

Generating impactful economic evidence in practice

Friday 22 March 2013


I am delighted to be convening a symposium at the RCN 2013 International Nursing Research Conference in Belfast today, the final day of this three-day conference. The purpose of this symposium is to trace the journey I have travelled over the past three years with RCN colleagues and those from the frontline nursing workforce. This journey took us from producing the economic evidence underpinning the RCN’s high profile Frontline First campaign, to designing a programme that would empower the nursing workforce to be able to generate such evidence themselves, and eventually to a stage now where trained nurses have started publishing their own evidence on the financial costs and benefits of their services.

This journey has been guided by our belief that those working in public services must be intimately involved in economic assessments of the services they deliver. They know their services better than anyone else does, and therefore play a critical role in mapping the pathways through which costs and benefits can be audited. They routinely generate clinical evidence on patient satisfaction and the effectiveness of their services. In the current climate of austerity, I would argue that they also have a responsibility for knowing how to continuously transform care through understanding how scarce resources should be deployed more effectively and efficiently.

To train frontline practitioners to engage with economic assessments required careful planning. Not only do we have to contend with the cultural assumption prevalent among many public services workers that the ‘economics business’ is ‘best left to the experts’, but we also have to appreciate the considerable demands on their time. We have to make the concepts and procedures accessible and to work with practitioners to co-produce sensible processes and materials.

We started by grounding the programme in authoritative sources of information and guidance, for instance, the HM Treasury’s Green Book. At 118 pages long, this is not the easiest read. We distilled the core requirements and procedures in ways that are easy to understand. We made the material accessible by explaining key terminology and concepts in lay-person’s language and by relating these to actual activities and occurrences that resonate with the practice of the frontline workforce. We crystallised a number of helpful tips and easy-to-remember prompts, and designed tools and templates that help the workforce operationalise key procedures. Instead of presenting economic assessment as a monolithic and scary entity, we broke it down into bit-sized chunks; each backed up by a step-by-step visual process map. Last but not least, we put in place infrastructures to support emergent ‘communities of practice’, as we believe that peer-to-peer support and mentoring approaches can be effective in building confidence and cascading newly acquired skills. Ultimately, this is not about the acquisition of new skills per se; but is about the ability to know how to generate and use economic evidence to continuously transform the quality of care.

It gives me great pleasure to be sharing a speaking platform with Dr Ann McMahon from the RCN who shares my conviction that the workforce can and should play an active role in economic assessments, and with Jill Nicholls, a heart failure specialist nurse from NHS Tayside; who is doing just that.

For those interested in this subject, OPM are hosting a free breakfast seminar next month, in which we’ll formally launch our Valuing Public Services publication and give people the opportunity to hear from service commissioners and providers about their experiences of putting the Public Services Social Value Act into practice. For more information please visit our events page.