Identifying key performance indicators in relation to quality of nursing care.

Abstract

Nursing sensitive key performance indicators are quantitative measures reflecting a professional care standard which are used as guidelines to monitor and evaluate nursing care in a hospital setting. They are of value in the development of evidence-based nursing practice. Determining what aspects of nursing care should and can be measured is a top issue for health service management. The aim of the study was to identify the most important key performance indicators in relation to nursing care, their influence on quality of care and the feasibility of implementation of such indicators from a nursing management perspective. A descriptive, exploratory non-experimental design study was adopted to fulfill the aim and objectives. The study population consisted of departmental nursing managers, nursing officers and deputy nursing officers who were responsible in managing departments/wards in which nursing care was delivered. One-hundred and twelve respondents (n=112) participated in the study, with a response rate of 86%. A self-administered questionnaire was adopted from the literature, which included 65 indicators. The questionnaire was divided into sections reflecting Donabedian's framework of structure, process and outcome of care. Respondents were asked to rate each indicator for importance, influence on quality of care and feasibility of implementation. Descriptive and inferential statistics were performed to analyse quantitative data and significance of results was conducted were applicable. Results indicated that 'patient satisfaction' indicators were considered the most important and with the greatest influence on quality of care by the study population. The second most important and influential on quality of care were 'time and quality of care' indicators, followed by 'management and organisational leadership' indicators. The indicators most difficult to implement in the clinical setting were 'staffing and nursing resources', followed by 'facilities and budget' indicators. The least difficult indicators to implement were 'complications and adverse events'. The researcher has proposed the most important and influential nursing quality indicators for the clinical setting in Malta. These indicators would be useful for nursing managers as a first step in a performance management agenda to assess the quality of nursing care in the state acute hospital.