Exploring how key performance indicators influence nursing and midwifery practice: A mixed‐methods study

Abstract

Aims:To scope the key performance indicators (KPIs) used in nursing and midwifery across the United Kingdom and Republic of Ireland and explore how they influence practice in healthcare organizations. Design:The study adopted a sequential, exploratory mixed-methods design.Methods: Phase 1 incorporated a multiple-choice questionnaire completed by 77 Directors of Nursing recruited using voluntary response sampling. In phase 2, 35 nurses and midwives who were working at executive, senior manager and clinical levels, participated in semi-structured interviews. Data collection of both phases was conducted from January 2016 to October 2016.Findings: Quantitative data revealed over 100 nursing and midwifery-specific KPIs.National requirements were a deciding factor in KPI selection, while clinical involvement was mainly through data collection. Respondents stated that they used patient experience KPIs, but only one was assessed as valid. Thematic analysis identified two themes: The leadership challenge (including 'voiceless in the national conversation', 'aligning KPIs in the practice context' and 'listening to those who matter'); and taking action (including 'establishing ownership and engaging staff', 'checks and balances' and 'closing the loop'). Conclusion:The large volume of KPI measurement taking place makes meaningful evaluation of performance and quality of care difficult, both in and across organizations. Nurses and midwives require enhanced knowledge of the nature and purpose of KPIs, as evidence gained from KPI data collection is insufficient to lead to improvements in practice. A practice context that encourages collective leadership, where multiple sources of evidence are gathered and everyone is included in KPI evaluation and subsequent decision-making, is key.

The experience of staff utilizing data to evaluate and improve person‐centred practice: An action research study

“…Facilitative and collaborative processes enabled teams to reflect on the data, maintain momentum throughout the action cycles and develop person‐centred practice changes. Similar findings were highlighted by Gray et al (2021) who found that facilitative support to was key to generating shared learning and engagement when undertaking research utilizing KPIs. The findings of this study also corroborate with the findings from studies reported by McCance et al (2016), McCance, Dickson, et al (2020) and Wilson et al (2021) that used the person‐centred KPIs.…”

“…A number of tools have been developed to measure nursing practice, but very few capture the contribution of nursing in relation to the patient experience and person‐centredness (Gray et al, 2021; Wilson et al, 2021). One response to this identified gap was the development of eight person‐centred nursing key performance indicators (KPIs) (see Table 1) by McCance et al (2012).…”

“…However, measuring their influence on the patient experience in relation to person‐centredness has been underrepresented in research and practice (McCance, Lynch, et al, 2020; Phelan et al, 2020). Extensive amounts of data are routinely collected to measure the patient experience; however, a large proportion is quantitative and of negative or technical foci, for example, pressure injuries, falls, medication errors (Gray et al, 2021; Sim et al, 2018). Whilst these data provide information regarding technical nursing skills and shortcomings related to patient care, it fails to capture the person‐centred aspect of nursing/midwifery care experienced by patients.…”

“…It is the nature of the evidence and utilization of knowledge (data) in practice that leads to change (Hunter et al, 2020). Whilst the value of KPIs in evidencing the contribution of nurses has been demonstrated, there is limited literature available focusing on how nurses and midwives utilize data collected through KPIs to inform person‐centred practice change (Gray et al, 2021) and the influence this has on them as individuals. The research study reported in this paper sought to address this gap by exploring how nurses and midwives engage with patient experience data collected via a mobile health (mHealth) app and the influence this has on the development of person‐centred practice.…”

Implementation of a mobile app (iMPAKT) for improving person-centredness in nursing and midwifery practice: Protocol for a multi-methods evaluation study

“…For example, KPI 5 (Time spent by nurses with the patient) is informed by survey data, observations, and the patient stories. The KPIs and measurement framework has been evaluated in a range of contexts [5][6][7]. This work has been underpinned by the MRC guidelines for the development, evaluation and implementation of complex interventions [8].…”