Abstract
BackgroundDespite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing’s contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system.MethodsWe carried out a systematic review of published literature across three databases (MEDLINE, EMBASE and CINAHL), focusing on literature between 1990 and 2008. Screening of 2,103 papers resulted in final selection of 101 papers. A detailed template was used to extract the data. For the analysis, we used the method of interpretive synthesis, focusing first on 31 papers with theoretical or conceptual frameworks; the remaining 70 articles were used to strengthen and consolidate the findings.ResultsCurrent conceptualizations of nursing care performance mostly reflect a system perspective that builds on system theory, Donabedian’s earlier works on healthcare organization, and Parsons’ theory of social action. Drawing on these foundational works and the evidence collated, the Nursing Care Performance Framework (NCPF) we developed conceptualizes nursing care performance as resulting from three nursing subsystems that operate together to achieve three key functions: (1) acquiring, deploying and maintaining nursing resources, (2) transforming nursing resources into nursing services, and (3) producing changes in patients’ conditions. Based on the literature review, these three functions are operationalized through 14 dimensions that cover 51 variables. The NCPF not only specifies core aspects of nursing performance, it also provides decision-makers with a conceptual tool to serve as a common ground from which to define performance, devise a common and balanced set of performance indicators for a given sector of nursing care, and derive benchmarks for this sector.ConclusionsThe NCPF provides a comprehensive, integrated and theoretically based model that allows performance evaluation of both the overall nursing system and its subsystems. Such an approach widens the view of nursing performance to embrace a multidimensional perspective that encompasses the diverse aspects of nursing care.
Highlights
Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing’s contribution most often remains invisible to policy-makers and managers
The objectives of the research were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system
The review revealed three parallel streams of activities that have contributed to varying degrees to conceptualizing and measuring performance in nursing care
Summary
Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing’s contribution most often remains invisible to policy-makers and managers. In the current context of health service reforms, driven partly by resource constraints and consumer pressures, increasing demands are being placed on nursing administrators and nursing care providers. They must ensure the performance of nursing services, give a more comprehensive and accurate picture of what they do, and demonstrate the value and benefits of their services in line with established objectives and standards [10,11]. Indicators to quantify nursing’s contribution to healthcare performance have been considered in several countries by influential organizations such as the Agency for Healthcare Research and Quality and the National Quality Forum in the United States, the Ontario Hospital Association in Canada, and the Council on Health Care Standards in Australia [12,13]
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