PERFORMANCE IMPROVEMENT RESEARCH 7
Performanceimprovement research in nursing
Effectivehealthcare management system is based on the analysis and measurementof performance. Many organizations have, therefore, developed andimplemented performance improvement research strategy that includesmonitoring and evaluating the appropriateness of the services offeredto beneficiaries. In nursing, performance improvement researchinvolves scrutinizing the steps of processes to identify those thatcan be eliminated to reduce errors and improve flow of operation.This ensures that problems are identified, a strategy is developed,change is instituted, and an outcome is assessed. Effectiveperformance improvement is then achieved by monitoring the outcomesof the services and comparing them with the established standards.The data gathered in the performance improvement research helps toguide quality control and total quality management.
Accordingto Hoeman (2008), the nurse manager should endeavor to create a workculture that is committed to performance improvement and learning,rather than simply correcting deficiencies. Hoeman adds that themanager should seek to improve the quality of care, institutepractice changes based on evaluation, as well as, supportinterdisciplinary performance improvement efforts to improve patientcare. It is crucial that all staff be involved in performanceimprovement activities as some level, either to provide feedback andinput in the organization’s current performance, and wayperformance can be improved. Furthermore, the nurse manager shouldensure that the staff nurses are aware of the organization’smission, vision, and long-term strategic plans.
AdvancedPractice Nurses and Performance Improvement and outcomes
Advancedpractice nursing (APN) is the patient focused application thatinvolves expanding specialized clinical knowledge with the aim toimprove healthcare outcome for patients and the population within aspecialized clinical area. The key element in advanced practicenursing is specialization of clinical knowledge and skills throughmaster’s or doctoral education, APN certification, andidentification of core competencies that prepare nurses forspecialization, expansion and advancement of practice. Advancedpractice nurses effectively bridge the gap through their advancededucation and practice experience. Similarly, performance improvementis based on overall improvement of the system and includes thecustomer in the process. Health care organizations are required tohave an internal performance improvement program to ensure that theprogram achieves minimum performance levels on standardized qualitymeasures. This allows the organizations to undertake performanceimprovement projects in various clinical and nonclinical areas.
Asin performance improvement program, advanced practice nursing hassignificant outcomes on health service delivery. According toArbuckle and Herrick (2005), APNs use innovation that has helped tocurve out new roles in delivering timely, cost-effective, and qualityhealth care to the poor, including the older population, children andpeople residing in rural areas and slums. Researchers argue that thecare provided by the APNs including clinical nurse specialist,certified midwives and nurse practitioners, is of high quality andcost effective than care provided by physicians alone (McLaughlin&Kaluzny, 2006).Thus, in U.S, APNs have played a major role of improving patientcare. Likewise, performance improvement plan has proven to be avariable tool in improving the overall performance of healthcareorganizations. The desired outcome of performance improvementincludes cost reduction, improved patient health, high qualityservice and evidence supporting practice among others.
Roleof Advanced Practice Nurses in performance improvement
Advancedpractice nursing provides the greatest impacts in performanceimprovement, cost reduction and access improved health care. Advancedpractice nurses play a major role in improving performance byassisting staff on clinical questions that help to improve practice,findings and evaluating the research evidence, as well as, helpingstaff to retrieve and critique the studies and other evidence onselected topics (McLaughlin&Kaluzny, 2006).Their role provides significant leadership in the organizationprocess, and role modeling changes in the practice. Furthermore, APNswho have the required knowledge and skills are more likely toencourage the development and adoption of clinical innovation thathelp to improve the overall process of health care services(McLaughlin&Kaluzny, 2006).
Researchindicates that APN has evolved in the recent years and has helped tomeet the main aim of performance improvement. The APNs have specifiedgoals, which is to prevent illness, promote and restore health, aswell as, alleviate suffering to improve health care service. Theseresponsibilities should involve ethical leadership for change, applyknowledge and skills, and influence to lead a group of personstowards a shared goal of improving aspects of health care and healthdelivery. Jansen and Stauffacher (2009) adds that care provided byAPNs, therefore, meets customer needs, leads to high performance,supports creative ideas in the organization, builds revenue, and isinstitutionalized in a culture that values continuous improvement. Inorder to ensure improved performance in heath care systems, advancedpractice nursing must be continually reinforced and sustained.
Performanceimprovement activities in Nursing
Inmost cases, the board of director is responsible for the quality ofservice received by the client that is provided by the organization.Therefore, the board must see into it that the improvement activitiesimplemented help to identify problems and concerns in the care ofpatients, evaluate the frequent, the severity and source of suspectedproblems, resolves identified problem and implements solutions. Theperformance improvement activities in nursing include self-assessmentactivities, training and coaching, assessment, annual organizationevaluation and reward system among others. Many health careorganizations employ job training programs and coaching approaches toensure employees are provided with up-to-date information required toperform the tasks in the job description. Hamric et al. (2013) urgesthat organizations should encourage those with advanced training suchas the APNs to practice the full extent of their education andtraining to deliver high quality care. In addition, key organizationmanagement staff should undertake education concerning the approachesand methods of process improvement.
Selfassessment is encouraged for APNs as it is through assessment thatnurses are able to examine their clinical performances, as well as,identify the strengths and areas for improvement. Through theimplementation of self-assessment, the organizations can identify aproblem, and develop plans to assist nurses in gaining skills andknowledge they need to meet the outcome of the delivery of service.Hamric et al. (2013) adds that an ongoing performance assessment isessential for the survival and success of advanced practice nursingas it is capable of gauging baseline clinical outcomes and measureimpacts of an intervention.
Performanceimprovement on skin care and Donabedian-guided mode
Ina performance improvement project focused on a wound or skin care,the health care institution may opt to collect important data to meetthe necessary standards. In this case, helpful data includeperformance improvement data such as treatment, diagnosis, infectioncontrol data, co-morbidity and complications. By developing arelationship with the department collecting these data, nurses incharge of can have access to information without having to strain. Itis also relevant to the organization to provide these relevant datato medical staff nurse and other departments to ensure data used isreliable.
Donabedianframework can be applied to address effective control, treatment, andmanage quality in health setting. This model is used for healthcaremeasures to differentiate three main domains namely structural,process, and outcome measure (Yih, 2011). The application of theDonabedian model in wound and skin care allow assess of quality inthe health care arena based on the process and outcome. The Processof skin care according to the Donabedian guided model allowsorganizations to measure their ability to foster and focus onpositive interactions between the receiver of health care service andthe provider of service throughout the course of care. On the otherhand, outcome helps to motivate meaningful improvement, promotewholes-system perspective, as well as, stimulate innovation andinvention. The main attribute of the Donabedian outcome includessafety, high quality health care, efficiency, effectiveness andequity.
Innursing, performance improvement is an essential process for qualitymeasurement in the management system, as it is integral forcontinually improving performance. If well designed, used andimplemented, it provides relevant and timely feedback, which can beused for proactive performance improvement actions. Based on thiscritique, many organization and nurse are currently willing to takeup the challenge to improve performance and advance their practice,in order to improve health care service delivery. However, theprocess must be based on a systematic perspective and be part of acomprehensive performance management system. For the process to meetfull potential, a culture of measurement for monitoring andevaluation must be designed, modeled and sustained.
Arbuckle,M. B., & Herrick, C. A. (2010). Child& adolescent mental health: interdisciplinary systems of care.Sudbury, Mass.: Jones and Bartlett Publishers.
Hamric,A. B., Tracy, M. F., Hanson, C. M., & O`Grady, E. T. (2013).AdvancedPractice Nursing: An Integrative Approach.Philadelphia: W.B. Saunders Co..
Hoeman,S. P. (2009). Rehabilitationnursing: prevention, intervention, and outcomes(4th ed.). St. Louis, Mo.: Mosby/Elsevier.
Jansen,M. P., & Stauffacher, M. (2010). AdvancedPractice Nursing: Core Concepts for Professional Role Development(4th ed.). New York, NY: Springer.
McLaughlin,C. P., & Kaluzny, A. D. (2006). Continuousquality improvement in health care.Sudbury, Mass: Jones and Bartlett.
Yih,Y. (2011). Handbookof Healthcare Delivery Systems.Boca Raton, FL: CRC Press.