Abstract
Background: Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals’ perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work. Methods: A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer. Results: On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals’ joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality. Conclusion: Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.
Highlights
In healthcare, quality and safety are increasingly monitored through the collection of quality indicators
The participants worked either as a nurse (82.5%), a medical specialist or resident (13.2%) or in other professions such as dieticians or physician assistants (4.3%). This distribution is representative of the number of physicians, nurses and other healthcare professionals working in the included focus areas
The results of this study provide a comprehensive overview of all the types of quality indicators collected in the studied focus areas and the related burden as perceived by healthcare professionals
Summary
Quality and safety are increasingly monitored through the collection of quality indicators. Quality indicators are measures of aspects of care used to monitor, evaluate and guide quality improvements.[1] Due to changes in healthcare reimbursement systems, and increased public interest in healthcare quality resulting from the publicity of various serious quality issues, new accountabilities and controls were introduced at the end of the last century These new accountabilities involved insurers and regulators becoming accountable for the efficiency, sustainability, and transparency of the quality of healthcare, leading them to hold care providers, including the traditionally self-regulating medical profession, accountable.[2,3] This made information about the quality of care paramount in fulfilling the purposes of accountability systems.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
