Using clinical performance information to improve the quality of care in a specialist NHS trust.

This article offers a case study of how an National Health Service trust specializing in neurology and neurosurgery used clinical performance information to underpin its quality improvement strategy. This involved developing a clinical effectiveness framework and identifying trust-specific clinical indicators, an exercise which involved both staff and patients. Writing from personal experience as clinical effectiveness manager, the author argues that clinical indicators can be powerful tools for monitoring the quality and effectiveness of health care at a system-wide level. In the case of nursing care, the use of appropriate, nursing-sensitive indicators can provide a valuable complement to the qualitative information generated by the benchmarking approach used in 'Essence of Care'. The article contains details of the sort of problems encountered along the way--such as resistance from clinicians and general managers, and difficulties with the existing information technology infrastructure--and suggests how other trusts might approach them.