Metric-driven harm: An exploration of unintended consequences of performance measurement

Rambur, Betty; Vallett, Carol M.; Cohen, Judith A.; Tarule, Jill Mattuck

doi:10.1016/j.apnr.2013.09.001

Cited by 14 publications

(22 citation statements)

References 26 publications

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“…What is not apparent from the studies in this review is the potential impact of dashboard introduction on clinical workflow and patterns of communication with the broader health care team. These insights are important to explore given the existing literature on the effects that using quality measurement indicators at an organizational level may have on individual behaviors, such as tunnel vision or measurement fixation [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…Consequences can include tunnel vision (i.e. only focusing on the aspects of performance that are measured, while at the same time displacing other important but unmeasured aspects of performance) and measurement fixation (an emphasis on meeting the target rather than the overarching purpose of care) [20][21][22]. Whilst the use of visual information can help reduce information overload and improve understanding of data and the ability to remember information [23], it is unclear how the different types of visual display used in dashboards may affect comprehension and decision making, although the way in which information is presented (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Dashboards for improving patient care: Review of the literature

Dowding¹,

Randell²,

Gardner³

et al. 2015

International Journal of Medical Informatics

306

294

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Aim: This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments. Methods:A literature search was performed for the dates 1996 to 2012 on CINAHL, Medline, Embase, Cochrane Library, PsychInfo, Science Direct and ACM Digital Library. A citation search and a hand search of relevant papers were also conducted.Results: One hundred and twenty two full text papers were retrieved of which 11 were included in the review. There was considerable heterogeneity in implementation setting, dashboard users and indicators used. There was evidence that in contexts where dashboards were easily accessible to clinicians (such as in the form of a screen saver) their use was associated with improved care processes and patient outcomes. Conclusion:There is some evidence that implementing clinical and/or quality dashboards that provide immediate access to information for clinicians can improve adherence to quality guidelines and may help improve patient outcomes. However, further high quality detailed research studies need to be conducted to obtain evidence of their efficacy and establish guidelines for their design.4

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dashboards for improving patient care: Review of the literature

Dowding¹,

Randell²,

Gardner³

et al. 2015

International Journal of Medical Informatics

306

294

View full text Add to dashboard Cite

show abstract

“…The relationship to multiple dimensions of the healthcare delivery system make UNC an important and useful balancing measure that can help identify and minimize potential metricdriven harm. For example, tunnel vision is one type of metric-driven harm reported in nursing services (Rambur et al, 2013). Patterns of UNC suggest that nurses prioritize elements of care that are most likely to be audited and/or are financially incentivized (e.g.…”

Section: Usabilitymentioning

confidence: 99%

“…Patterns of UNC suggest that nurses prioritize elements of care that are most likely to be audited and/or are financially incentivized (e.g. elements of care bundles) over other equally important aspects of care such as teaching and emotional support (Jones et al, 2015b;Rambur et al, 2013). More intense auditing is expected to accompany the anticipated expansion of value-based purchasing initiatives to more nurse sensitive outcomes (Kavanaugh et al, 2012).…”

Section: Usabilitymentioning

confidence: 99%

Unfinished nursing care: An important performance measure for nursing care systems

2016

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Performance measurement is a core administrative function and an essential component of organizational quality programs. The prevalence of performance measurement initiatives increased significantly after the release of the Institute of Medicine series on quality. Nursing performance measures are limited in their scope, resulting in an underrepresentation of process measures. Development of performance indicators that reflect how effectively organizational units actually transform nursing resources into nursing services should be a high priority. Unfinished nursing care is a nursing process performance measure that reflects the complexity of the nursing care environment and can be useful in comparing process performance across systems and organizations. Unfinished nursing care is congruent with many of the National Quality Forum requirements for endorsement and warrants further refinement as an important nurse-sensitive performance measure.

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“…For example, one family of measures for diabetes includes metrics for glycemic control, blood pressure control, lipid control and several process measures related to eye care, foot care and renal care [4]. The unintended consequences of performance measurement are also well-known [5][6][7][8]. One potential consequence results from narrow focus on one measure without considering potential effects, e.g.…”

Section: Objectivementioning

confidence: 99%