Abstract

BackgroundNursing care quality varies between hospitals, and even between departments within the same institution. Suboptimal care can have deleterious consequences for patients such as lengthened hospital stay, nosocomial infection, pressure ulcers or death. Experts recommend the implementation of nursing performance improvement systems to assess team performance and monitor patient outcomes and efficiency savings. In practice, these systems are expected to include feedback processes directed towards nursing teams and interprofessional staff in order to facilitate adjustments and improve their performance. Unfortunately, feedback appears somewhat haphazard and, at times, overlooked. This could be explained by an ongoing absence of clear recommendations. As a result, feedback effects are inconclusive: some teams improve their practice, others do not. Although feedback has been conceptualised and studied from different theoretical perspectives, ongoing empirical inconsistencies remain unexplained. The goal of this rapid realist review protocol is to develop a theory that explains how feedback shared with interprofessional health care teams shape nursing performance improvement systems.MethodThis study follows standard guidelines established for realist reviews. Mechanisms at work will be analysed using Actor-Network Theory. All scientific documents are selected from five databases, are published in both English and French between 2010 and 2018, and include empirical research, reviews and grey literature. First, selection of documents will proceed on the basis of titles and abstracts; followed by a second selection by reading the remaining full texts. Inclusion criteria and a data extraction form will be pilot tested with 40 articles prior to completion by two reviewers. Data will be summarised in the form of [context, mechanism, outcome] equations to theorise operational feedback.DiscussionThe innovative combination of Actor-Network Theory with a realist methodology holds promise for the identification of explanatory equations in complex systems and theory development. A rapid realist review is relevant to address an enduring knowledge gap which requires theory development. This preliminary study lays the groundwork for a pioneering theory on feedback in nursing performance improvement systems that will subsequently inform a multiple case study.Systematic review registrationProspero CRD42018110128

Highlights

  • Nursing care quality varies between hospitals, and even between departments within the same institution

  • A rapid realist review is relevant to address an enduring knowledge gap which requires theory development. This preliminary study lays the groundwork for a pioneering theory on feedback in nursing performance improvement systems that will subsequently inform a multiple case study

  • An Nursing performance improvement systems (NPIS) is designed to measure a set of valid and reliable indicators relevant to nursing— e.g. changes in human resources, quality of care and patient outcomes—in order to assess the performance of nursing services and the effects of improvement initiatives [15, 16]

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Summary

Discussion

Our proposed combination of ANT with a realist methodology is original These approaches hold promise for the identification of mechanisms in complex cyber-social systems and their various interactions (CM). Exogenous entities can eventually be connected to endogenous entities through the action of mediators [57] This underscores the crucial influence of chronology, in the case of feedback processes that can evolve over time and become more effective in NPIS [25]. In this way, both ANT methodology, as suggested by Bilodeau and Potvin [23], and the transitive domain of the realist theory [21] concur.

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