Glossary

The glossary provides definitions of selected terms from authoritative sources and also aims to show how terms and concepts are presented and interpreted in current policy and practice. There are links to actual documents where possible.
See also the four country overviews: England, Northern Ireland, Scotland and Wales.

Please send any ideas for additions to the glossary using the feedback form.

Some of the resources below are in PDF format - see how to access PDF files.

A

Adverse (Healthcare) Event

"An event or omission arising during clinical care and causing physical or psychological injury to a patient".
Source: Department of Health (2000) An organisation with a memory. London: The Stationery Office p.xii .

B

Benchmarking

An externally-agreed comparator to compare performance between similar organisations or systems.
Source: NHS Institute for Innovation and Improvement (n.d.) The good indicators guide. Coventry: NHS Institute p.30. [You will need to register and log-in on the NHS Institute website to access].

"Clinical practice benchmarking is a process benchmarking approach, identifying as factors for benchmarking the processes that support the attainment of a patient focused outcome , and providing for  each of these processes a measurement for comparison, to which all should aspire".
Source: Ellis J (2006) All inclusive benchmarking. Journal of Nursing Management 14(5) pp.377-83 (p.378)  [available online via the RCN e-library].

A benchmark "acts as a standard against which:
• services and practices can be compared
• difficulties can be shared
• practical support and encouragement can be offered by peers, in a clinical setting".
Source: Royal College of Nursing (2007) Understanding benchmarking: RCN guidance for nursing staff working with children and young people (PDF 1.6MB). London: RCN p.3.

'Essence of care' is an example of a benchmarking tool. It identifies twelve fundamentals of care each of which has its own set of benchmarks. 
Source: Department of Health (2010) Essence of Care 2010. London: Department of Health.

C

Caldicott Guardian

Caldicott Guardians are senior staff in the NHS and social services appointed to protect patient information.
"Acting as the 'conscience' of an organisation, the Guardian should actively support work to facilitate and enable information sharing and advise on options for lawful and ethical processing of information as required".
Source: Department of Health (2010) The Caldicott Guardian Manual 2010. London: Department of Health  p.6.

Care Pathway

"An integrated care pathway is a multidisciplinary outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes".
Source: Middleton S et al (2001) What is an integrated care pathway (PDF 154.45KB) . London: Hayward Medical Communications  p.1.

"Care pathways are a methodology for the mutual decision making and organization of care for a well-defined group of patients during a well-defined period".
Source: European Pathways Association (2005) Clinical/care pathway definition. EPA website.

Clinical Audit

"Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change".
Source: Scrivener R et al. (2002) Principles for best practice in clinical audit. Abingdon: Radcliffe Medical  p.1. (Made available on the NICE website).

Clinical Effectiveness

"Clinical effectiveness is thinking critically about what you do, questioning whether it is having the desired result, making a change to practice.  It is based on evidence of what is effective in order to improve patient care and experience".
Source: NHS Scotland: Managing clinical effectiveness: Definition. Clinical Governance (Educational resources) website: para 3.

"It builds on clinical audit and quality improvement and provides a framework for linking research, implementation and evaluation in clinical practice" …..It is "about doing the right thing in the right way for the right patient at the right time".
Source: Royal College of Nursing (1996) What is clinical effectiveness. London: RCN  p.3.

Clinical Governance

"Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish".
Source: Department of Health: Clinical governance. Department of Health website para 1.

Clinical Guidelines

"Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances".
Source: Field MJ and  Lohr KN Eds. (1990) Clinical practice guidelines: directions for a new program - Institute of Medicine (IOM). Washington, D.C.: National Academy Press p.50.

Clinical Supervision

"Clinical supervision brings practitioners and skilled supervisors together to reflect on practice. Supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues".
Source: United Kingdom Central Council for Nursing Midwifery and Health Visiting (1996) Position statement on clinical supervision for nursing and health visiting. London: UKCC  p.3.

Competence

"The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one's professional responsibilities".
Source: Roach (1992) The human act of caring: a blueprint for the health profession. Ottowa: Canadian Hospital Association Press cited by Royal College of Nursing (2009) Integrated core career and competence framework for registered nurses (PDF 1.50MB). London: RCN p.3.

Competences "describe the performance criteria, knowledge and understanding needed for an individual to carry out a work function effectively".
Source: Skills for Health: Glossary. Skills for Health website.

See also Competences/National Occupational Standards (NOS) FAQ(frequently asked questions). Skills for Health website.

Continuing Professional Development

"Continuing Professional Development (CPD) is fundamental to the development of all health and social care practitioners, and is the mechanism through which high quality patient and client care is identified, maintained and developed".
Source: Royal College of Nursing et al (2007) A joint statement on continuing professional development for health and social care practitioners (PDF 164.6KB). London: RCN  p.2.

A requirement for CPD is part of the Nursing and Midwifery Council's post-registration education and practice (PREP) standards, where the PREP (CPD) standard is to:
"- undertake at least 35 hours of learning activity relevant to your practice during the three years prior to your renewal of registration
- maintain a personal professional profile (PPP) of your learning activity
- comply with any request from the NMC to audit how you have met these requirements".
Source: Nursing and Midwifery Council (2011) The Prep handbook (97.8KB). Rev.ed. London: NMC p.8.

Critical Appraisal

"Critical appraisal is an essential part of evidence-based clinical practice that includes the process of systematically finding, appraising and acting on evidence of effectiveness".
It is "the process of systematically examining research evidence to assess its validity, results and relevance before using it to inform a decision".
Source: Hill A and Spittlehouse C (2003) What is critical appraisal (PDF 415.05KB). London: Hayward Medical Communications p.1.

E

Evidence Based Practice

"Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources".
Source: Dawes M et al (2005) Sicily statement on evidence- based practice BMC Medical education 5(1) January. Abstract para 1.

I

Indicators / Nursing Indicators

"Indicators are succinct measures that aim to describe as much about a system as possible in as few points as possible".
"Indicators help us understand a system, compare it and improve it".
Source: NHS Institute for Innovation and Improvement (n.d.)The good indicators guide. Coventry: NHS Institute p.5 [You will need to register and log-in on the NHS Institute website to access].

"To be useful, indicators must be measurable with available data at reasonable cost.
There must be evidence that the quality or quantity of nursing substantially contributes
to changes measured by the indicator. The indicator must be recognised as important
(by the public, managers and nurses) and nursing's contribution must be recognised
(by nurses and others)".

"Indicators serve to foster understanding of a system and how it can be improved, and
to monitor performance against agreed standards or benchmarks. Crucially, indicators
provide a mechanism by which care providers can be accountable for the quality of their
nursing services".
Source: Griffiths, P. et al (2008)  State of the art metrics for nursing: a rapid appraisal(PDF 357KB). London: National Nursing Research Unit, King's College London p.1,2.

Clinical quality indicators are described as "Evidenced based indicators that support the measurement of the quality, safety and reliability of care. The CQIs focus on quality improvement rather than a measure of performance. They are currently process indicators which measure aspects of nursing care such as assessment and interventions".
Source: Leading Better Care: Clinical Quality Indicators (CQIs) para 1. Information about this initiative in Scotland is made available as part of the NHS Education for Scotland Evidence into practice website.

Information Technology / Information and Communications Technology

"IT or more properly ICT (Information & Communications Technology) is the machinery the hardware (computers, personal digital assistants, palm pilots, mobile phones and other devices) and the software (the information systems) that enable information to be manipulated and transmitted from one place to another".
Source: Royal College of Nursing (2006) Putting information at the heart of nursing care (PDF 1.3MB). London: RCN p.3.

L

Lifelong learning

"Being a lifelong learner means that you should engage in learning activities throughout life, improving your knowledge, skills and/or competence in a range of topics - not just nursing."
Source: RCN Learning Zone (2010) Being a flexible learner. RCN website, para 1. (You can access this learning area using your RCN membership number).

M

Mentoring

"A process by which one person (the mentor) encourages another individual (mentee) to manage his or her own learning so that the mentee becomes self reliant in the acquisition of new knowledge, skills and abilities and develops a continuous motivation to do so.�
Source: Klasen N and Clutterbuck D (2002) Implementing mentoring schemes, Oxford: Butterworth-Heinemann. Cited in Royal College of Nursing (2010) RCN mentorship resources. An overview of the RCN mentorship framework. London: RCN p.6. 

N

National Service Frameworks

"National Service Frameworks set national healthcare standards. They are designed to improve the quality of health services and make sure that everyone gets the same level of care. NSFs set measurable goals and ensure that progress is made within agreed time scales".
Source: NHS Choices: What are National Service Frameworks (NSFs)? . NHS Choices website Para 1(page transferred from NHS Direct).

"Long term strategies for improving specific areas of care".
Source: Department of Health: National service frameworks (NSFs). DH glossary  M-O.  Department of Health website.

"National Service Frameworks provide a systematic approach on which to tackle the agenda of improving standards and quality across health care sectors".
Source: Welsh Assembly Government: National Service Frameworks for Wales. Welsh Assembly Government website para 1.

P

Patient and Public Involvement

"Patient and public involvement: Involving the public in shaping a care system's development, and keeping patients well informed of clinical processes and decisions".
Source: Department of Health: Patient and public involvement. DH glossary P-R. Department of Health website.

"Patient and Public Involvement is about giving people the chance to get involved in improving their local health services by offering their views about these services and making recommendations for changes in the future".
Source: NHS Direct Wales health encyclopaedia: Patient and Public Involvement Forums. NHS Direct website para 1.

"PPI is the active participation of patients, users, carers, community representatives and the public in the development of health services and as partners in their own health care".
Source: Lambeth PCT (2006) Toolkit for involving patients and the public in Lambeth PCT (PDF 1.34MB). Lambeth PCT p.2. 

Patient Safety

See also the RCN Patient safety resource glossary.

"The process by which an organisation makes patient care safer. This should involve: risk assessment; the identification and management of patient-related risks; the reporting and analysis of incidents; and the capacity to learn from and follow-up on incidents and implement solutions to minimise the risk of them recurring".
Source: National Patient Safety Agency (2004) Seven steps to patient safety: full reference guide. London: NPSA p.17.

Protocols

"These are the detailed descriptions of the steps taken to deliver care or treatment to a patient, and are sometimes called the 'integrated care pathway'. They are designed at a local level to:

  • implement the national standards
  • determine care provision by using the best available evidence if national standards are not available.

Local protocols are developed by multidisciplinary teams, reflecting local services and staffing arrangements, and integrate the care provided by these different groups. They include specific information on who carries out key parts of the care or treatment, and where that should be delivered. Examples of local protocols are:

  • patient group directions
  • referral advice".
    Source: NHS Institute for Innovation and Improvement (2008) Quality and service improvement tools: Protocol based care. NHS Institute website. (taken from: National Institute for Clinical Excellence and NHS Modernisation Agency (2002) Protocol based care … underpinning improvement). 

Public Health

"Public health is concerned with improving the health of the population, rather than treating diseases of individual patients".
Source: Department of Health: What is public health? Department of Health website para 1.

A range of quotes from writings and speeches of Sir Liam Donaldson. Department of Health website. 
Source: Department of Health (2007) CMO quotes - Public health.

The Wanless review defines public health as "the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals".
Source: Wanless D and HM Treasury (2004) Securing good health for the whole population: final report. London: Department of Health Chapter 2, p.1.

Three domains of public health:  health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health), health protection (including infectious diseases, environmental hazards and emergency preparedness), and health services (including service planning, efficiency and audit, and evaluation).
Source: HM Government (2011) Healthy lives, healthy people: update and way forward cmnd paper. London: the Stationery Office Para 2.4 p. 9 (made available on the Department of Health’s website).

Quality

A broad term to describe the multiple dimensions of an organisation's function. Dimensions might include effectiveness, efficiency,responsiveness and accessibility. 
Source: NHS Institute for Innovation and Improvement (n.d.) The good indicators guide. Coventry: NHS Institute p.31. [You will need to register and log-in on the NHS Institute website to access].

" Institute of Medicine six Dimensions of Quality …. will remain the key foundation of our approach to systems-based healthcare quality improvement:
- Person centred: providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions
- Safe: avoiding injuries to patients from care that is intended to help them
- Effective: providing services based on scientific knowledge
- Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy
- Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status
- Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care".
Source: Scottish Government (2010) The healthcare quality strategy for NHSScotland. Edinburgh: Scottish Government p.7.

Quality Improvement

Quality improvement is defined as "the combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development".
Source: Batalden PB and Davidoff F (2007) What is ''quality improvement'' and how can it transform healthcare? Quality and Safety in Health Care 16(1) February pp.2-3 (p2).

Quality of Care

"… quality defined as clinically effective, personal and safe".

"High quality care should be as safe and effective as possible, with patients treated with compassion, dignity and respect. As well as clinical quality and safety, quality means care that is personal to each individual".

"High quality care is care where patients are in control, have effective access to treatment, are safe and where illnesses are not just treated, but prevented".
Source: Department of Health (2008) High quality care for all: NHS Next Stage Review final report. London: Department of Health pp.8-9,11,45.

R

Risk Management

"Identifying, assessing, analysing, understanding and acting on risk issues in order to reach an optimal balance of risk, benefit and cost".
Source: National Patient Safety Agency (2004) Seven steps to patient safety: full reference guide. London: NPSA p.29.

S

Standards

"A standard is a level of quality against which performance can be measured. It can be described as 'essential'- the absolute minimum to ensure safe and effective practice, or 'developmental', - designed to encourage and support a move to better practice".
Source: Department of Health, Social Services and Public Safety (2006) The quality standards for health and social care (PDF 537.28KB). Belfast: DHSSPS p.2.

Systematic Review

"High quality systematic reviews seek to:
- Identify all relevant published and unpublished evidence
- Select studies or reports for inclusion
- Assess the quality of each study or report
- Synthesise the findings from individual studies or reports in an unbiased way
- Interpret the findings and present a balanced and impartial summary of the findings with due consideration of any flaws in the evidence".

"Systematic reviews appear at the top of the 'hierarchy of evidence' that informs evidence based practice (practice supported by research findings) when assessing clinical effectiveness".
Source: Hemingway P and Brereton N (2009) What is a systematic review? (PDF 182.56KB) 2nd.ed. London: Hayward Medical Communications pp.1 and 6.