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Using competition to invigorate improvement

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Using Competition to Invigorate Improvement

Sheena Huish: Tissue Viability Clinical Nurse Specialist; Pia Prince: Tissue Viability Clinical Nurse Specialist; Mike Ellis: Tissue Viability Clinical Nurse Specialist


There is significant focus and scrutiny on individual clinical areas to achieve reductions in pressure ulcer prevention. Nurses can feel overwhelmed by pressures from outside their immediate clinical area when negative reinforcement is used to promote positive outcomes. An alternative approach to achieving targets through positive reinforcement was developed.


Long term competition: Wards that achieve 50, 100, 200 and 360 days without pressure ulceration will be issued with a certificate of achievement from the Director of Nursing. Short term competition: All staff were invited to submit a Christmas themed song or poem to promote core principles of pressure ulcer prevention and/or a Christmas card, the winning entry received a Christmas hamper. 


Since the introduction of achievement certificates, pressure ulcer incidence has reduced.  In June 2014 the rate was 1.24 1000-1 and in June 2015 this had fallen to 0.8 1000-1. Since the Christmas competition launch, pressure ulcer incidence across the organisation has fallen below the national average for incidence and maintained consistency in this level.


Using competition as a vehicle for improvement has proved a useful approach. Clinical areas actively seek their certificates of achievement in order to display them for the public to see. The certificates provide a visible representation of the improvement work that has been undertaken in their specific clinical area. There is evidence to suggest that providing certificates of achievement improves performance in meeting educational goals 1. This has been extrapolated to the healthcare setting for meeting goals for pressure ulcer prevention. This visual display of achievement has been reported by staff within those areas as ‘…positive and morale boosting’. They also  strive to maintain their success as they ‘…don’t want to have their certificates taken off display’. Short term competitions such as the Christmas competition provide a defined focus for a short period of time. Competition has been generallyfound to be a positive way of engaging individuals and teams in improvement projects2. Having acknowledgment from the senior nursing and medical leadership within the organisation gives further validation for the efforts of individual clinical areas.


The use of certificates will continue for the foreseeable future as they provide visual reminders of good work. A range of other competitions will be used periodically throughout the year with consideration given to targeting specific staff groups or clinical areas as well as trust-wide opportunities.


1. Sansgiry, S. S., Chanda, S., Lemke, T., & Szilagyi, J. E. (2006). Effect of incentives on student performance on Milemarker examinations. American journal of pharmaceutical education, 70(5).

2. Wilson, T., Berwick, D. M., & Cleary, P. D. (2003). What do collaborative improvement projects do? Experience from seven countries. Joint Commission Journal on Quality and Patient Safety, 29(2), 85-93.

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