News and Comment

Proactive Data: Developing NMC’s Allegations Code Framework

Wednesday 18 October 2017

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The NMC (Nursing and Midwifery Council) recently published their annual report for 2016-2017. It refers to a project led by OPM Group to design and develop a new allegations code frame to help the NMC to better understand the allegations being brought against nurses and midwives. As the NMC explains:

This will enable us to identify patterns and trends so we can take a more proactive approach with employers to help reduce unnecessary referrals or identify trends which may warrant further exploration.” [1]

OPM Group was commissioned to undertake this research in late 2015 with this ‘exam question’: What kinds of allegations lead to nurses and midwives being brought before their regulator? Within the NMC and more widely there was interest in gaining greater insight into the nature of allegations against nurses and midwives and how they change throughout the Fitness to Practise process. Our job was to develop a new code frame which provided much more detail than the previous version, and which would allow the NMC to understand – and respond to – allegations data more effectively.

We analysed 900 recent case documents from the Fitness to Practise process, and including cases which closed at the initial screening phase, those which closed following investigation and those which reached adjudication. Throughout, we followed several guiding principles:

  • Iterative: a multi-stage process of looking at cases,
  • Coproduced: working closely with NMC colleagues, several points for input and feedback
  • Robust: through internal and external checks, and scale
  • Pragmatic: there is no single way to arrange codes
  • Live: acknowledging that reporting needs and interests change

The last point is particularly important. We went into the process with the belief that the data should inform the codeframe, not the other way around – a fundamental principle of qualitative research:

“Qualitative research refrains from setting up a well-defined concept of what is studied and  from formulating hypotheses in the beginning in order to test them. Rather, concepts…are developed and refined in the process of the research.” [2]

The rich body of data we produced allowed the NMC to identify differences between allegations made against nurses and midwives, which stage certain types of allegations reached in the Fitness to Practice process, and whether certain types of allegations co-occurred.

As the codeframe was a living thing, NMC staff needed to know how to look after it. We created a user guide to help ensure consistency and clarity in how the codes are applied. This included do’s and don’t’s, examples and how to use different codes in conjunction. We also designed a series of training workshops with over 80 staff members, initially led by OPM Group before handing the training over to the NMC’s internal training team.

In so many of the consultation reports I write, the coding framework is solely a means to an end – an intermediate stage between the raw data and the final report. Working on developing the Nursing and Midwifery Council’s allegations framework has been a different and refreshing experience. We did produce a report of our findings, but it was the codeframe itself that was the star of the show – a key deliverable in its own right which, as a tool that continues to be modified and adjusted, will help the NMC to make the most of its allegations data and achieve one of its strategic priorities around use of intelligence:

By better using evidence from data and research we will gain insights into what we do, helping us to be more effective, transparent and proportionate.”

[1] Nursing and Midwifery Council, July 2017, Annual Report and Accounts 2016-2017 and Strategic Plan 2017-2018 pg12

[2] Graham R. Gibbs, 2007, Analysing Qualitative Data pg xi