How do they measure up? Differences in stakeholder perceptions of quality measures used in English community nursing

Abstract

Objectives To establish how quality indicators used in English community nursing are selected and applied, and their perceived usefulness to service users, commissioners and service providers. Methods A qualitative multi-site case study was conducted with five commissioning organizations and their service providers. Participants included commissioners, provider organization managers, nurses and service users. Results Indicator selection and application often entail complex processes influenced by wider health system and cross-organizational factors. All participants felt that current indicators, while useful for accountability and management purposes, fail to reflect the true quality of community nursing care and may sometimes indirectly compromise care. Conclusions Valuable resources may be better used for comprehensive system redesign, to ensure that patient, carer and nurse priorities are given equivalence with those of other stakeholders.

Incentivizing performance in health care: a rapid review, typology and qualitative study of unintended consequences

“…Increased Work a. Increased administrative burden Excessive time spent on administrative tasks (e.g., documentation, data collection and submission, justifying deviation from clinical reminders when not clinically relevant) [ 6 , 13 – 16 , 26 – 31 ] ✓✓ II. Poor Design or Use of Performance Data a.…”

“…Measure fixation Emphasis is placed on meeting the performance target rather than the associated objective [ 2 , 3 , 5 , 10 , 26 , 28 , 32 , 33 , 38 , 40 – 42 ] ✓✓ c. Suboptimization Focusing on one component of a total and making changes intended to improve that one component and ignoring the effects on other components (e.g., pursuit of narrow local objectives at the expense of broader organizational or system objectives) [ 2 , 10 , 33 , 41 ] ✓ d. Myopia Excessive concentration on short-term targets without consideration for long-term consequences [ 2 , 5 , 10 , 33 , 41 , 43 ] ✓ e. Quantification privileging Fixation on data that can be quantified causing qualitative aspects of healthcare to be missed [ 5 , 34 , 44 ] ✓ f. Anachronism Lag effect between data capture and data usage causes data to not help solve current problems [ 5 ] ✓ g. Insensitivity Assessment does not capture overall complexity of health performance, causing the wrong providers, units, or organizations to be penalised or rewarded (e.g., contextual factors not considered, risk adjustment not performed, good performance results in a disadvantage such as improved efficiency and cost savings resulting in a lower budget the following year) [ 3 , 5 , 6 , 10 , 31 , 37 , 39 , 45 …”