Method for Operationalizing Nursing-Sensitive Performance Measures Based on Routine Data

Main Article Content

Joachim Rapin
https://orcid.org/0000-0001-6525-0957
Gabrielle Cécile Santos
https://orcid.org/0000-0001-8104-1987
Sophie Pouzols
https://orcid.org/0000-0002-2750-3519
Danielle D'Amour
https://orcid.org/0000-0002-7132-4243
Carl-Ardy Dubois
https://orcid.org/0000-0001-7663-4796
Cedric Mabire
https://orcid.org/0000-0003-2666-8300

Abstract

Introduction: The operationalization of nursing-sensitive performance measures has been highly variable. It results in measures that are sometimes suboptimal and difficult for managers and nurses to access. The objective is to propose a rigorous method for operationalizing nurse-sensitive performance measures based on routine data.


Source of Information: The primary source of information for this article is an operationalization method adapted from a reporting guide and performance measure evaluation instrument. It includes 7 processes and 33 interrelated quality attributes. The application of this operationalization method was successfully tested in a university hospital.


Discussion: Operationalization of nursing-sensitive performance measures is a complex process. This method is an original proposal that allows for the justification and argumentation of the choices made. We discuss how this method is a response to 3 methodological issues: (1) heterogeneous and poorly detailed operationalization methods; (2) critical attributes (e.g., relevance, scientific validity, feasibility) that lack consensus and (3) heterogeneous data architecture models.


Implication and conclusion: This operationalization method provides a systematic and transparent approach to generating nursing-sensitive performance measures from routine data. It could improve their operationalization, facilitate their understanding and evaluation.

Article Details

How to Cite
Rapin, J., Santos, G. C., Pouzols, S., D’Amour, D., Dubois, C.-A., & Mabire, C. (2022). Method for Operationalizing Nursing-Sensitive Performance Measures Based on Routine Data. Science of Nursing and Health Practices, 5(1), 76–102. https://doi.org/10.7202/1090531ar
Section
Theoretical discussion and methodology articles

References

Aiken, L. H. (2008). Economics of nursing. Policy, Politics, & Nursing Practice, 9(2), 73-79. https://doi.org/10.1177/1527154408318253

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA: Journal of the American Medical Association, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2016). Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559-568. http://dx.doi.org/10.1136/bmjqs-2016-005567

Baernholdt, M., Dunton, N., Hughes, R. G., Stone, P. W., & White, K. M. (2018). Quality Measures: A Stakeholder Analysis. Journal of Nursing Care Quality, 33(2). https://doi.org/10.1097/NCQ.0000000000000292

Barchielli, C., Rafferty, A. M., & Vainieri, M. (2022). Integrating Key Nursing Measures into a Comprehensive Healthcare Performance Management System: A Tuscan Experience. International Journal of Environmental Research and Public Health, 19(3), 1373. https://www.mdpi.com/1660-4601/19/3/1373

Becker, M., Breuing, J., Nothacker, M., Deckert, S., Brombach, M., Schmitt, J., Neugebauer, E., & Pieper, D. (2019). Guideline-based quality indicators—a systematic comparison of German and international clinical practice guidelines. Implementation Science, 14(1), 71. https://doi.org/10.1186/s13012-019-0918-y

Biron, A. D., Vézina, M., St-Hilaire, C., Lavoie-Tremblay, M., & Richer, M. C. (2012). Role of performance measurement in a major redevelopment project: the case of the McGill University Health Centre Transition Support Office. Healthcare quarterly, 15(1), 34-40. https://doi.org/10.12927/hcq.2012.22768

Boyle, D. K., & Baernholdt, M. (2021). Overview of the Quality Health Outcomes Model. Dans M. Baernholdt & D. K. Boyle (dir.), Nurses Contributions to Quality Health Outcomes (p. 3-17). Springer International Publishing. https://doi.org/10.1007/978-3-030-69063-2_1

Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., Ivers, N., & Grimshaw, J. M. (2016). Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness. Annals of Internal Medicine, 164(6), 435-442. https://doi.org/10.7326/M15-2248

Brown, B., Gude, W. T., Blakeman, T., van der Veer, S. N., Ivers, N., Francis, J. J., Lorencatto, F., Presseau, J., Peek, N., & Daker-White, G. (2019). Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research. Implementation Science, 14(1), 40. https://doi.org/10.1186/s13012-019-0883-5

Clarke, S. P., & Donaldson, N. E. (2008). Nurse Staffing and Patient Care Quality and Safety. Dans R. G. Hughes (dir.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses (p. 2-111; 2-135). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK2676/

Centers for Medicare & Medicaid Services. (2021). CMS Measures Inventory Tool https://cmit.cms.gov/CMIT_public/ListMeasures

CPSI. (2012). The Economics of Patient Safety in Acute Care: Technical Report. Canadian Patient Safety Institute.

D'Amour, D., Dubois, C. A., Tchouaket, E., Clarke, S., & Blais, R. (2014). The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review. International Journal of Nursing Studies, 51(6), 882-891. https://doi.org/10.1016/j.ijnurstu.2013.10.017

Damschroder, L. J., Robinson, C. H., Francis, J., Bentley, D. R., Krein, S. L., Rosland, A. M., Hofer, T. P., & Kerr, E. A. (2014). Effects of Performance Measure Implementation on Clinical Manager and Provider Motivation. Journal of General Internal Medicine, 29(4), 877-884. https://doi.org/10.1007/s11606-014-3020-9

Di Zio, M., Fursova, N., Gelsema, T., Gießing, S., Guarnera, U., Petrauskienė, J., Quenselvon Kalben, L., Scanu, M., ten Bosch, K. O., van der Loo, M., & Walsdorfer, K. (2016). Methodology for data validation 1. European Commission, Eurostat. https://ec.europa.eu/eurostat/cros/system/files/methodology_for_data_validation_v1.0_rev-2016-06_final.pdf

Doran, D., Mildon, B., & Clarke, S. P. (2011). Vers un bulletin national de la pratique infirmière : Synthèse des connaissances. http://www.nhsru.com/wp-content/uploads/8083781_FR_Knowledge_Synthesis_Toward_a_National_Nursing_Report_Card_March_111.pdf

Doran, D. M. (2003). Preface. Dans D. M. Doran (dir.), Nursing Outcomes : The State of the Science,(p. vii-x). Jones & Bartlett Learning.

Dubois, C.-A., D’Amour, D., Brault, I., Dallaire, C., Déry, J., Duhoux, A., Lavoie-Tremblay, M., Mathieu, L., Karemere, H., & Zufferey, A. (2015). Indicateurs prioritaires pour évaluer la contribution infirmière à la qualité des soins : revue systématique des écrits. Secrétariat international des infirmières et infirmiers de l'espace francophone. https://sidiief.org/produit/indicateurs-prioritaires-pour-evaluer-la-contribution-infirmiere-a-la-qualite-des-soins-revue-systematique-des-ecrits/

Dubois, C. A., D'Amour, D., Brault, I., Dallaire, C., Dery, J., Duhoux, A., Lavoie-Tremblay, M., Mathieu, L., Karemere, H., & Zufferey, A. (2017). Which priority indicators to use to evaluate nursing care performance? A discussion paper. Journal of Advanced Nursing, 73(12), 3154-3167. https://doi.org/10.1111/jan.13373

Dubois, C. A., D'Amour, D., Pomey, M. P., Girard, F., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BMC Nursing, 12(7). https://doi.org/10.1186/1472-6955-12-7

Dubois, C. A., D'Amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal for Quality in Health Care, 25(2), 110-117. https://doi.org/10.1093/intqhc/mzt019

Englebright, J., & Jackson, E. (2017). Wrestling with Big Data: How Nurse Leaders Can Engage. Dans C. W. Delaney, C. A. Weaver, J. J. Warren, T. R. Clancy, & R. L. Simpson (dir.), Big Data-Enabled Nursing: Education, Research and Practice (p. 115-137). Springer International Publishing. https://doi.org/10.1007/978-3-319-53300-1_7

Gagalova, K. K., Leon Elizalde, M. A., Portales-Casamar, E., & Görges, M. (2020). What You Need to Know Before Implementing a Clinical Research Data Warehouse: Comparative Review of Integrated Data Repositories in Health Care Institutions. JMIR formative research, 4(8), e17687-e17687. https://doi.org/10.2196/17687

Gallant, S., & Perrenoud, B. (2016). Check-list CLARITY [document inédit]. Centre des formations de la Direction des Ressources humaines et Commission recherche & développement de la Direction des soins du CHUV.

Griffiths, P., Richardson, A., & Blackwell, R. (2012). Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review. European Journal of Oncology Nursing, 16(3), 238-246. https://doi.org/10.1016/j.ejon.2011.06.004

Hall, L. M., Doran, D., Laschinger, H. S., Mallette, C., Pedersen, C., & O'Brien-Pallas, L. L. (2003). A balanced scorecard approach for nursing report card development. Outcomes Management, 7(1), 17-22.

Hermann, R. C., & Palmer, R. H. (2002). Common ground: a framework for selecting core quality measures for mental health and substance abuse care. Psychiatric Services, 53(3), 281-287.

Idvall, E., Rooke, L., & Hamrin, E. (1997). Quality indicators in clinical nursing: a review of the literature. Journal of Advanced Nursing, 25(1), 6-17. https://doi.org/10.1046/j.1365-2648.1997.1997025006.x

Iezzoni, L. I. (2013). Risk adjustment for measuring health care outcomes (4e éd.). Health Administration Press ; AUPHA.

Irvine, D., Sidani, S., & Hall, L. M. (1998). Linking outcomes to nurses' roles in health care. Nursing Economics, 16(2), 58-64, 87.

Jones, T. L. (2016). Outcome Measurement in Nursing: Imperatives, Ideals, History, and Challenges. Online Journal of Issues in Nursing, 21(2), 1.

Kelley, E. T., Arispe, I., & Holmes, J. (2006). Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report. International Journal for Quality in Health Care, 18 Suppl 1, 45-51. https://doi.org/10.1093/intqhc/mzl027

Kötter, T., Blozik, E., & Scherer, M. (2012). Methods for the guideline-based development of quality indicators--a systematic review. Implementation Science, 7(1), 21. https://doi.org/10.1186/1748-5908-7-21

Langendam, M. W., Piggott, T., Nothacker, M., Agarwal, A., Armstrong, D., Baldeh, T., Braithwaite, J., Castro Martins, C., Darzi, A., Etxeandia, I., Florez, I., Hoving, J., Karam, S. G., Kötter, T., Meerpohl, J. J., Mustafa, R. A., Muti-Schünemann, G. E. U., van der Wees, P. J., Follmann, M., & Schünemann, H. J. (2020). Approaches of integrating the development of guidelines and quality indicators: a systematic review. BMC health services research, 20(1), 875-875. https://doi.org/10.1186/s12913-020-05665-w

Montalvo, I. (2007). The National Database of Nursing Quality IndicatorsTM (NDNQI®). OJIN: The Online Journal of Issues in Nursing, 12(3), Manuscript 2. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.aspx

Morin, D. (1997). Génériques ou spécifiques: réflexion critique sur les indicateurs de résultats en soins infirmiers. Recherche en soins infirmiers, 49, 67-73.

Muntlin Athlin, Å. (2018). Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review. Journal of Clinical Nursing, 27(11-12), 2230-2247. https://doi.org/https://doi.org/10.1111/jocn.14155

Myers, H., Pugh, J. D., & Twigg, D. E. (2018). Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review. Collegian, 25(4), 447-456. https://doi.org/10.1016/j.colegn.2017.10.004

The National Institute for Health and Care Excellence. (2021). The NICE menu of general practice and clinical commissioning group indicators. https://www.nice.org.uk/standards-and-indicators

Nothacker, M., Stokes, T., Shaw, B., Lindsay, P., Sipilä, R., Follmann, M., Kopp, I., & on behalf of the Guidelines International Network Performance Measures Working, G. (2016). Reporting standards for guideline-based performance measures. Implementation Science, 11(1), 6. https://doi.org/10.1186/s13012-015-0369-z

National Quality Forum. (2021). Measure evaluation criteria and guidance for evaluating measures for endorsement. http://www.qualityforum.org/Measuring_Performance/Endorsed_Performance_Measures_Maintenance.aspx

O'Brien, A., Weaver, C., Settergren, T., Hook, M. L., & Ivory, C. H. (2015). EHR Documentation: The Hype and the Hope for Improving Nursing Satisfaction and Quality Outcomes. Nursing Administration Quarterly, 39(4). https://doi.org/10.1097/NAQ.0000000000000132

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005-1022. https://doi.org/https://doi.org/10.1002/nop2.654

Oracle. (2021). Définition d’un data warehouse. Oracle. https://www.oracle.com/ch-fr/database/what-is-a-data-warehouse/

Qureshi, S. M., Purdy, N., & Neumann, W. P. (2021). Developing a modelling approach to quantify quality of care and nurse workload — Field validation study. Operations Research for Health Care, 29, 100301. https://doi.org/https://doi.org/10.1016/j.orhc.2021.100301

Rapin, J., D’Amour, D., & Dubois, C.-A. (2015). Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses. Nursing Research and Practice, 2015, 861239. https://doi.org/10.1155/2015/861239

Rapin, J., D’Amour, D., Penseyres, T., Santos, G., Adatte, V., Lehn, I., & Mabire, C. (2017). Développement d’un système de gestion de la performance des soins dans un centre hospitalier universitaire suisse. Recherche en soins infirmiers, 131(4), 61-70. https://doi.org/10.3917/rsi.131.0061

Reiter, A., Fischer, B., Kötting, J., Geraedts, M., Jäckel, W. H., Barlag, H., & Doebler, K. (2007). QUALIFY: Instrument for the Assessment of Quality Indicators. https://www.researchgate.net/publication/267256474_QUALIFY_Instrument_for_the_Assessment_of_Quality_Indicators

Schwirian, P. M. (1981). Toward an explanatory model of nursing performance. Nursing Research, 30(4), 247-253.

Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC health services research, 17(1), 88. https://doi.org/10.1186/s12913-017-2031-8

Secrétariat international des infirmières et infirmiers de l'espace francophone. (2015). La Qualité des soins et la Sécurité des patients: une priorité mondiale. https://www.sidiief.org/wp-content/uploads/SIDIIEF-M-moire-Qualit-des-soins.pdf

Sinuff, T., Muscedere, J., Rozmovits, L., Dale, C. M., & Scales, D. C. (2015). A qualitative study of the variable effects of audit and feedback in the ICU. BMJ Quality & Safety, 24(6), 393. https://doi.org/10.1136/bmjqs-2015-003978

Souissi, L. (2009, mai). Processus de construction des indicateurs de mesure de performance dans un établissement de soins privé. 30e congrès de l'AFC, Strasbourg, France. https://halshs.archives-ouvertes.fr/halshs-00460548/document

Tchouaket, E., Dubois, C.-A., & D'Amour, D. (2017). The economic burden of nurse-sensitive adverse events in 22 medical-surgical units: retrospective and matching analysis. Journal of Advanced Nursing. https://doi.org/10.1111/jan.13260

Unruh, L., & Wan, T. T. H. (2004). A Systems Framework for Evaluating Nursing Care Quality in Nursing Homes. Journal of Medical Systems, 28(2), 197-214. https://doi.org/10.1023/B:JOMS.0000023302.80118.74

Veillard, J., Champagne, F., Klazinga, N., Kazandjian, V., Arah, O. A., & Guisset, A. L. (2005). A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. International Journal for Quality in Health Care 17(6), 487-496. https://doi.org/10.1093/intqhc/mzi072

Westra, B. L., Latimer, G. E., Matney, S. A., Park, J. I., Sensmeier, J., Simpson, R. L., Swanson, M. J., Warren, J. J., & Delaney, C. W. (2015). A national action plan for sharable and comparable nursing data to support practice and translational research for transforming health care. Journal of the American Medical Informatics Association, 22(3), 600-607. https://doi.org/10.1093/jamia/ocu011