Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers

AIM

The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs).

BACKGROUND

Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers.

METHOD

This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'.

RESULT

Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.

Advancement, barriers and collaboration: the ABC's of addressing challenges and designing solutions between front-line physicians and business-oriented leaders

BACKGROUND

The complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education.

METHODS

The ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper.

RESULTS

Through this process, we identified four challenges: (1) the difference in thinking styles, which we term, 'mental model differences'; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or 'the chess game of stakeholder engagement'; (3) the language and precise methodology, or 'consistency of language and need for administrative resilience' and (4) the issue of teaching these concepts or bridging the learning gap.'

CONCLUSION

In an increasingly complex healthcare landscape, physicians and trainee's need to bridge gaps between the mental models of administrative and clinical workflow.

Performance management of generalist care for hospitalised multimorbid patients-a scoping review for value-based care

Objectives

Given the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients.

Design and setting

A scoping review of published literature was conducted. 30 publications which were relevant to performance management of generalist medical inpatient care were included in the review.

Outcome measures

The performance measures used across the studies were analysed and other qualitative findings were also obtained.

Results

We report an overall lack of research on performance management methods for generalist inpatient care. Relevant performance measures found include both outcome and process of care measures and both clinical and reported measures, with clinical outcome measures the most frequently reported. Length of stay, readmission rates and mortality were the most frequently reported. The insights from the papers emphasise the relevance of process of care measures for performance management, the advantages and disadvantages of types of measures and provide suggestions relevant for performance management of generalist inpatient care.

Conclusion

The findings of this scoping review outline a variety of performance measures valuable for generalist inpatient care including clinical outcome measures, reported outcome measures and process of care measures. The findings also suggest directions for implementation of such performance management, including emphasis on physician level performance management and the importance of documentation training. Further research for selecting and operationalising the measures for specific contexts and developing a comprehensive performance management system involving these measures will be important for achieving value-based healthcare for generalist inpatient care.

A mixed-method approach to examining the experiences of allied health clinicians and managers of the performance, appraisal and development framework in a regional health care service

INTRODUCTION

Evaluating employee performance is important for organisational success however, limited research exists across the allied health workforce.

OBJECTIVE

This study investigated allied health clinician and manager experiences and perceptions of the appropriateness of the performance and development (PAD) framework.

DESIGN

A mixed methods design with purposive sampling was conducted in a medium size hospital and health service in regional Queensland to investigate the appropriateness of the PAD framework. A 29 item online survey collected likert scale and open ended responses. Identified respondents also completed a semi-structured interview. Aggregated satisfaction scores identifying PAD alignment, processes, education, resources and perceptions were analysed to identify organisational PAD appropriateness. Themes from interviews provided concurrent experiential data.

FINDINGS

Eighty-five respondents completed the online survey and 20 interviews were conducted. A Chi-Square Goodness of Fit test revealed a significant (p < 0.05) clinician (n = 75) response of moderate dissatisfaction (36%) for the PAD framework, while managers (n = 10) were neither dissatisfied nor satisfied (50%) or moderately satisfied (40%). Clinician aggregated agreement responses were significantly (p < 0.05) higher for PAD alignment (45%), processes (63%), education (49%) and lower for feedback (33%) and resources (28%). Manager aggregated agreement responses were high for PAD alignment (85%), processes (55%), education (57%), feedback (65%) and perceptions (50%). Interviews (n = 20) revealed three themes: uncertainty around PAD framework; expectations for experienced leadership and importance of discipline specific knowledge.

DISCUSSION

This study draws on both clinician and manager input to assess the overall PAD framework with responses favouring clinician dissatisfaction to the current process.

CONCLUSION

The PAD framework is valuable for staff development when there is positive rapport and discipline alignment between both clinician and manager. Successful staff appraisals require efficient and appropriate documentation that promotes individual development, clinical performance and organisational priorities.

Characterising the performance measurement and management system in the primary health care systems of Malawi

BACKGROUND

 Performance Measurement and Management (PMM) systems are levers that support key management functions in health care systems. Just like many low- and middle-income countries (LMICs), Malawi strives to improve performance via evidence-based decision making and a suitable performance culture.

AIM

 This study sought to describe PMM practices at all levels of primary health care (PHC) in Malawi.

SETTING

 This study targeted three levels of PHC, namely the district health centres (DHCs), the zones, and the ministry headquarters.

METHODS

 This was a qualitative exploratory research study where decision-makers at each level of PHC were engaged using key-informant interviews (KII) and focus group discussions (FGDs).

RESULTS

 We found that there is a weak link among levels of PHC in supporting PMM practices leading to poor dissemination of priorities and goals. There is also failure to appropriately institute good PMM practices, and the use of performance information was found to be limited among decision-makers.

CONCLUSION

 Though PMM is acknowledged to be key in supporting health service delivery systems, Malawi's PHC system has not fully embarked on making this a priority. Some challenges include unsupportive culture and inadequate capacity for PMM.Contribution: This study contributes to the understanding of the PMM processes in Malawi and further highlights the salient challenges in the use of information for performance management. While the presence of policies on PMM is acknowledged, implementation studies that deal with challenges are urgent and imperative.

[Analysis and Research on Comprehensive Evaluation Method of Operation Performance of Hospital Valuable Equipment]

OBJECTIVE

To study the effective method of comprehensive evaluation and analysis of hospital valuable medical equipment performance.

METHODS

The operation performance of 6 valuable equipment was evaluated by cost-benefit method, comprehensive index method and public evaluation method.

RESULTS

Utilize equipment information management methods for data collection and evaluation, and construct an assessment data model based on evaluation indicators from three aspects: equipment operation status, profitability status, and scientific research contribution.

CONCLUSIONS

Through the performance analysis of different types of valuable medical equipment, a more real and comprehensive quantitative analysis is carried out, which plays a key role in the reasonable purchase, efficient operation and avoiding idling.

Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score

Introduction

This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate.

Methods

Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable.

Results

Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies.

Conclusions

The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.

Multi-Criteria Performance Analysis Based on Physics of Decision - Application to COVID-19 and Future Pandemics

The purpose of this study is to present a novel perspective on decision support based on the conventional SEIR pandemic model paradigm considering the risks and opportunities as physical forces deviating the expected performance trajectory of a system. The impact of a pandemic is measured by the deviation of the social system's performance trajectory within the geometrical framework of its Key Performance Indicators (KPIs). According to the overall premise of utilizing Ordinary Differential Equations to simulate epidemics, the deviations are connected to several alternative interventions. The model is essentially built on two sets of parameters: (i) social system parameters and (ii) pandemic parameters. The ultimate objective is to propose a multi-criteria performance framework to control pandemics that includes a combination of timely measures. On the one hand, the current study optimizes prospective strategies to manage the potential future pandemic, while on the other hand, it explores the COVID-19 epidemic in the state of Georgia (USA).

Using computer-based instruction to teach implementation of behavioral skills training

Behavioral skills training (BST) is considered one of the most effective staff training techniques to implement a wide variety of behavioral technologies; however, research has found a lack of implementation of BST across human service settings due to a shortage of organizational time and resources. The purpose of the present study was first to demonstrate the effectiveness of computer-based instruction (CBI) in teaching BST, and then to demonstrate that the CBI module was effective in training trainers to implement BST with trainees. Results of the present experiment not only demonstrate the effectiveness of CBI in teaching BST, but also demonstrate the generality of the BST to teach behavior therapists.

Preventing Knowledge Hiding Behaviors Through Workplace Friendship and Altruistic Leadership, and Mediating Role of Positive Emotions

Studies related to knowledge hiding prevention are limited and need attention. Hence, the present study attempts to measure the direct impact of workplace friendship and altruistic leadership on preventing the knowledge hiding behavior; and also, in the presence of positive emotions. The study has also checked the mediating role of positive emotions in these relationships. The target population of the study is the employees working in the government sector (sample size of 496). The present study has employed quantitative research techniques for testing the hypotheses. Smart-PLS 3 software has been employed to run the partial least square structural equation modeling. Findings of the study have given major indications about the positive role of workplace friendship and altruistic leadership in preventing the hiding of knowledge among employees. It has also been revealed that positive emotions play a significant role in augmenting the relationship of workplace friendship and altruistic leadership with knowledge hiding behavior. This study adds a significant contribution to the body of knowledge by measuring the mediating role of positive emotions in decreasing the knowledge hiding behavior in the presence of workplace friendship and altruistic leadership.

The Performance Diagnostic Checklist - Human Services: Guidance for Assessment Administration

The Performance Diagnostic Checklist - Human Services (PDC-HS) is an assessment designed to assess the environmental variables contributing to employee performance concerns in human-service settings. Recent research has demonstrated that interventions indicated by the PDC-HS result in improved employee performance across several human-service settings and that the assessment has acceptable reliability and validity. Although PDC-HS-indicated interventions have been effective at increasing employee performance, there is a need for additional guidance when using the assessment given the limited nature of the original administration guidelines. Thus, the purpose of the current manuscript is to introduce additional guidance for use of the PDC-HS across a variety of situations.

Talent management challenges during COVID-19 and beyond: Performance management to the rescue

The COVID-19 pandemic has resulted in significant talent management challenges including (a) hiring freezes and layoffs; (b) salary freezes, canceled bonuses, and pay reductions; (c) how work is done (i.e., teleworking); and (d) increased employee stress and burnout. Also, COVID-19 has made it evident that many organizations do not implement state-of-the-science performance management systems and, instead, have just performance appraisal systems that typically involve a once-a-year evaluation and review, little effort to provide feedback and coaching on an ongoing basis, little alignment between employee performance and the organization’s strategic goals, a focus on past performance only, and ownership by the human resources function instead of those rating and being rated. Thus, the lack of value contributed by the usual performance evaluation and review process is the reason why so many organizations are postponing or even completely discontinuing performance evaluations. We argue that when implemented using evidence-based recommendations, performance management (rather than appraisal) serves important administrative, strategic and communication, developmental, organizational maintenance, and documentation purposes and therefore can be particularly useful in addressing contemporary talent management challenges. We offer five recommendations on how to adapt and improve performance management that will help organizations navigate crises like COVID-19 and, just as importantly, allow them to thrive after the crisis is over: (1) measure results in addition to behaviors, (2) measure adaptive performance, (3) conduct stay interviews to retain top performers, (4) implement a multisource performance management system, and (5) collect and use performance promoter scores.

JEL CLASSIFICATION: J5 Labor–Management Relations, Trade Unions, and Collective Bargaining; M1 Business Administration; M5 Personnel Economics

The Challenges of Hospitals' Planning & Control Systems: The Path toward Public Value Management

In the last decades, public management has been subjected to a shift from the New Public Management (NPM) paradigm to the Public Value Management (PVM) one. Thus, management practices such as Planning and Control (P&C) systems have been called to evolve accordingly. The health care sector has not escaped this process. This paper focuses on the evolution of hospitals’ P&C systems to support the paradigm shift from the NPM paradigm to the PVM one. In particular, the paper aims at exploring whether hospitals’ P&C systems in Italy evolved, or are evolving, consistently with PVM and what are the expected benefits related to such a paradigm switch. To address the research aim, the paper is based on a review of scientific and grey literature and the case study of the diabetic-foot pathway in an Italian Regional Healthcare System. The results of this study show that the current P&C systems in Italian hospitals are not yet designed to support the shift toward the PVM approach and are still mainly focused on financial aspects and intra-organizational dynamics. Combining traditional P&Cs with performance measures assessing the system’s outcomes may support hospitals in aligning their goals with the health system they are operating within and, therefore, P&C systems may represent an important driving force toward change. Such results provide suggestions for both practitioners and academics on how to adapt P&C systems to better support the implementation of current strategies of the public sector.

The "Okay" Gay Guys: Developing Hegemonic Sexuality as a Tool to Understand Men's Workplace Identities

This research investigates gender and sexuality identity management among gay men. Thirty self-identified gay men participated in semi-structured, in-depth interviews and provided their accounts of how they manage performances of gender and sexuality in the workplace. This research contributes to the scholarship of gender and sexuality by highlighting how sexuality, as an organizing principle, contributes to the further marginalization of an already marginalized population of gay men, via a concept I call hegemonic sexuality. The men's narratives help us understand how certain performances of sexuality permit some men to be recognized as "acceptable," while others are labeled "too gay" in different work environments. I investigate the motivations and consequences of men's concerted workplace identity management strategies. I conclude by suggesting that hegemonic sexuality be used as a tool to understand how some gay men are deemed more acceptable than others in additional social spaces.

Averting Maternal Death and Disability in an Urban Network of Care in Dar es Salaam, Tanzania: A Descriptive Case Study

The non-governmental organization Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) developed a multi-facility maternal and neonatal Network of Care (NOC) among 22 government hospitals and catchment facilities operating across Dar es Salaam. While facility delivery rates were above 90% in the Dar es Salaam region, the quality of services was substandard, leading to an excess of preventable maternal and neonatal morbidity and mortality. In partnership with the Dar es Salaam regional health authorities CCBRT developed a plan to improve the quality of service delivery at childbirth by through a system strengthening approach, capacitating lower-level facilities to provide routine care during pregnancy and uncomplicated deliveries, as well as improving care at secondary level referral hospitals and developing an inter-connected strengthened referral system. The Regional-CCBRT partnership implemented interventions across the continuum of care that included clinical training in basic and comprehensive emergency obstetric care, investments in infrastructure, and a rigorous maternal and perinatal death audit and follow-up program. Routine data generated were reflected upon at quarterly quality improvement meetings to follow up on problems identified. The government has initiated the replication of the model. This descriptive case study uses the four domains of the Networks of Care framework to document the wide-ranging efforts made to build and maintain the CCBRT Network of Care in order to solve for specific challenges in maternal and neonatal health service delivery in the urban context of the Dar es Salaam region.

Case-mix for assessing primary care value (CPCV)

Measuring primary care (PC) performance and designing payment systems that reward value rather than volume have been a great challenge due in large part to lack of reliable risk adjustment mechanisms pertinent to primary care. Using risk scores designed for total resource needs to assess PC performance or set PC payment rates is inadequate because high-cost patients may not have high needs in PC and vice versa. The greatest challenge in developing a risk algorithm for PC is that significant components of PC providers' workload are unobservable but needed in the modeling. In this study, we sought to overcome this challenge by analyzing 5,172,773 patients in the U.S. Veterans Affairs (VA) healthcare system to identify potential proxies of the unobservable PC workload. By combining the number of PC visits and prescription drug classes, we formed a proxy for the expected PC workload, which enabled us to develop a case-mix algorithm pertaining to primary care. The resultant algorithm with high explanatory power (R² = 0.702) is based on a publicly available patient classification system to account for patient comorbidities and thus can be used by other health systems to compare PC performance, workload, staffing levels, and to set more equitable payment rates.

Performance management in primary healthcare: Nurses' experiences

BACKGROUND

The use of the performance management (PM) system is highly contested by public servants in South Africa, although its value as essential to the appraisal and management of staff is undeniable.

OBJECTIVES

The aim of this study was to explore nurses' perceptions and experiences of the PM system at primary healthcare (PHC) facilities in relation to the current health system's reforms.

METHOD

An exploratory, descriptive and qualitative design was utilised. Participants were selected through purposive sampling. A semi-structured interview tool was used to collect data from 18 nurses in four sub-districts of Dr. Kenneth Kaunda district in the North West province. Data were analysed through thematic analysis.

RESULTS

The findings of this study confirmed that PM is implemented to some extent. However, various loopholes in its implementation threaten the accuracy and transparency of the system and leave it vulnerable to perceived organisational injustice and unfairness, with the objectivity of the system questioned. The limitations of the current PM system revealed by this study include (1) the lack of alignment with current health system reforms towards comprehensive and integrated care that demands person-centred care; (2) the system's usefulness for career progression, performance improvement and rewarding exceptional performance.

CONCLUSION

Performance management is inadequately applied in PHC facilities at district level and needs to be realigned to include the appraisal of key attributes required for the current health system's reforms towards comprehensive and integrated care, including the provision of person-centred care, which is central for responding adequately to South Africa's changing disease profile towards multi-morbidity.

Impact of using data from electronic protocols in nursing performance management: A qualitative interview study

Aim

To explore the impact of using electronic data in performance management to improve nursing compliance with a protocol.

Background

Electronic data are increasingly used to monitor protocol compliance but little is known about the impact on nurses’ practice in hospital wards.

Method

Seventeen acute hospital nursing staff participated in semi‐structured interviews about compliance with an early warning score (EWS) protocol delivered by a bedside electronic handheld device.

Results

Before electronic EWS data was used to monitor compliance, staff combined protocol‐led actions with clinical judgement. However, some observations were missed to reduce noise and disruption at night. After compliance monitoring was introduced, observations were sometimes covertly omitted using a loophole. Interviewees described a loss of autonomy but acknowledged the EWS system sometimes flagged unexpected patient deterioration.

Conclusions

Introducing automated electronic systems to support nursing tasks can decrease nursing burden but remove the ability to record legitimate reasons for missing observations. This can result in covert resistance that could reduce patient safety.

Implications for nursing management

Providing the ability to log legitimate reasons for missing observations would allow nurses to balance professional judgement with the use of electronic data in performance management of protocol compliance.

Using the Performance Diagnostic Checklist-Human Services to identify an indicated intervention to decrease employee tardiness

We assessed and reduced the tardiness of 4 direct-care staff employed at a school that provides educational services to children with autism. The Performance Diagnostic Checklist - Human Services was administered to participants and their supervisors to identify one or more indicated interventions. Relative to baseline, tardiness was lower during intervention. The most effective intervention included task clarification, a problem-solving discussion, tokens exchangeable for back-up reinforcers, and weekly graphic feedback. Moreover, participants reported that the intervention components, particularly praise and a token, had high acceptability.

Quality, safety and performance management in primary health care: from scoping review to research priority setting and implementation plan in the Eastern Mediterranean Region

INTRODUCTION

Strong primary health care (PHC) leads to better health outcomes, improves health equity and accelerates progress towards universal health coverage (UHC). The Astana Declaration on PHC emphasised the importance of quality care to achieve UHC. A comprehensive understanding of the quality paradigm of PHC is critical, yet it remains elusive in countries of the Eastern Mediterranean Region (EMR). This study used a multistep approach to generate a policy-relevant research agenda for strengthening quality, safety and performance management in PHC in the EMR.

METHODS

A multistep approach was adopted, encompassing the following steps: scoping review and generation of evidence and gap maps, validation and ranking exercises, and development of an approach for research implementation. We followed Joanna Briggs Institute guidelines for conducting scoping reviews and a method review of the literature to build the evidence and gap maps. For the validation and ranking exercises, we purposively sampled 55 high-level policy-makers and stakeholders from selected EMR countries. We used explicit multicriteria for ranking the research questions emerging from the gap maps. The approach for research implementation was adapted from the literature and subsequently tailored to address the top ranked research question.

RESULTS

The evidence and gap maps revealed limited production of research evidence in the area of quality, safety and performance management in PHC by country and by topic. The priority setting exercises generated a ranked list of 34 policy-relevant research questions addressing quality, safety and performance management in PHC in the EMR. The proposed research implementation plan involves collaborative knowledge generation with policy-makers along with knowledge translation and impact assessment.

CONCLUSION

Study findings can help inform and direct future plans to generate, disseminate and use research evidence to enhance quality, safety and performance management in PHC in EMR and beyond. Study methodology can help bridge the gap between research and policy-making.

"It breaks your soul": An in-depth exploration of workplace injustice in nursing

AIM(S)

To understand nurses' experiences of injustice in the workplace and to identify the impact of injustice on well-being.

BACKGROUND

Little is known about how nurses view injustice or its effects on their well-being, although research indicates that such perceptions are central to workplace practices such as performance management and outcomes such as employee well-being.

METHOD(S)

A qualitative study was conducted with semi-structured interviews for nurses employed in Australian public hospitals. Data were analysed using content analysis.

RESULTS

Experiences of injustice and unfairness negatively impacted on performance and the personal health of nurses. Unfair treatment was met with reduced effort and commitment.

CONCLUSION(S)

This study provides valuable insights into how nurses perceive and experience injustice at work and supports the link between injustice and nurses' decreased well-being and effectiveness.

IMPLICATIONS FOR NURSING MANAGEMENT

Implications for nurse managers include the need for managers to engage in regular conversations regarding systemic barriers to performance and implementing performance management as an ongoing dialogue designed for employee voice and relationship management. This process also suggests a need for leadership development in nursing management. Using such steps and strategies would significantly enhance best practice in nursing management.

Evaluating the Performance Diagnostic Checklist-Human Services to assess incorrect error-correction procedures by preschool paraprofessionals

The Performance Diagnostic Checklist-Human Services (PDC-HS) has been used to assess variables contributing to undesirable staff performance. In this study, three preschool teachers completed the PDC-HS to identify the factors contributing to four paraprofessionals' inaccurate implementation of error-correction procedures during discrete trial training sessions. The PDC-HS indicated insufficient training as a contributing factor. We then implemented a nonindicated intervention (posting reminders), followed by an indicated intervention (behavioral skills training). The nonindicated intervention failed to produce desired performance improvements; however, the PDC-HS indicated intervention resulted in improvements for all paraprofessionals.

A Method for Key Performance Indicator Assessment in Manufacturing Organizations

Key Performance Indicators (KPIs) are an essential element of an organization's ability to monitor its strategic health, helping to ensure the strategic goals of the organization are achieved. However, KPI assessment and improvement is often an ad hoc and consultant-driven process rather than one undertaken using scientific principles. This paper outlines the development and subsequent deployment of a method for KPI assessment founded in scholarly literature and balancing practitioner concerns for ease of use. The proposed method draws heavily on organizational stakeholder involvement at varying levels throughout the KPI assessment process, improving current methods by introducing a mathematical foundation based on value-focused thinking. The proposed method allows stakeholders to evaluate the organization's KPIs in an effort to determine organizational performance against predetermined KPI thresholds. The method is demonstrated on a case study and suggestions for future research are offered.

Lean thinking in emergency departments: concepts and tools for quality improvement

The lean approach is a viable framework for reducing costs and enhancing the quality of patient care in emergency departments (EDs). Reports on lean-inspired quality improvement initiatives are rapidly growing but there is little emphasis on the philosophy behind the processes, which is the essential ingredient in sustaining transformation. This article describes lean philosophy, also referred to as lean, lean thinking and lean healthcare, and its main concepts, to enrich the knowledge and vocabulary of nurses involved or interested in quality improvement in EDs. The article includes examples of lean strategies to illustrate their practical application in EDs.

Which priority indicators to use to evaluate nursing care performance? A discussion paper

AIMS

A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care.

BACKGROUND

Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard.

DESIGN

Discussion paper drawing on a systematic assessment of selected performance indicators.

DATA SOURCES

Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the specific evidence supporting 25 selected indicators, focusing on systematic syntheses, meta-analyses and integrative reviews.

IMPLICATIONS FOR NURSING

This study has identified a set of 12 indicators that have sufficient breadth and depth to capture the whole spectrum of nursing care and that could be implemented on a priority basis.

CONCLUSIONS

This study sets the stage for new initiatives aiming at filling current gaps in operationalization of nursing care performance. The next milestone is to set up the infrastructure required to collect data on these indicators and make effective use of them.

Measuring Outcomes: Lessons From the World of Public Education

The quality and efficiency of American health care are increasingly measured using clinical and financial data with a goal of improving clinical practice. Proponents believe such efforts can improve outcomes, motivate clinicians, and inform the public about quality. Detractors point to problems with the accuracy of these measures and the risk of creating perverse incentives for both physicians and patients. Drawing on lessons from similar performance management policies in public education, we provide guidance about this trend for primary care physicians and health care policy makers. We argue that public school teacher evaluations that use value-added modeling foretell specific pitfalls for the use of similar models to evaluate physician effectiveness, and that unintended consequences of performance management in both education and health care can include the narrowing of purpose, deprofessionalization, and a loss of local/community control.

Using Information Systems to Improve a Mid-Sized Local Health Department's Effectiveness in a Time of Rapid Change

BACKGROUND

Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner.

OBJECTIVE

The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance.

METHODS

The mid-sized LHD described here was chosen for its "best practices" in informatics capacity building and use by NACCHO's study advisory committee. To conduct the case study, authors reviewed departmental documents and conducted semistructured interviews with key informants in the agency. Interviews were recorded, transcribed, thematically coded, and analyzed.

RESULTS AND CONCLUSIONS

Findings from the case study suggest that including capacity building in informatics as a strategic priority is one of the most effective ways to ensure that informatics are assessed, updated, and included in resource decisions. Leadership at all levels is critical to the successful implementation of informatics as is proactive partnership with community partners who have overlapping goals. The efficiency and effectiveness of LHDs rely on informatics capacity, especially when resources are challenged.

Making parks make a difference: poor alignment of policy, planning and management with protected-area impact, and ways forward

Policy and practice around protected areas are poorly aligned with the basic purpose of protection, which is to make a difference. The difference made by protected areas is their impact, defined in program evaluation as the outcomes arising from protection relative to the counterfactual of no protection or a different form of protection. Although impact evaluation of programs is well established in fields such as medicine, education and development aid, it is rare in nature conservation. We show that the present weak alignment with impact of policy targets and operational objectives for protected areas involves a great risk: targets and objectives can be achieved while making little difference to the conservation of biodiversity. We also review potential ways of increasing the difference made by protected areas, finding a poor evidence base for the use of planning and management ‘levers’ to better achieve impact. We propose a dual strategy for making protected areas more effective in their basic role of saving nature, outlining ways of developing targets and objectives focused on impact while also improving the evidence for effective planning and management.

A Performance Management Initiative for Local Health Department Vector Control Programs

Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative.

Development of Performance Dashboards in Healthcare Sector: Key Practical Issues

Background:

Static nature of performance reporting systems in health care sector has resulted in inconsistent, incomparable, time consuming, and static performance reports that are not able to transparently reflect a round picture of performance and effectively support healthcare managers’ decision makings. So, the healthcare sector needs interactive performance management tools such as performance dashboards to measure, monitor, and manage performance more effectively. The aim of this article was to identify key issues that need to be addressed for developing high-quality performance dashboards in healthcare sector.

Methods:

A literature review was established to search electronic research databases, e-journals collections, and printed journals, books, dissertations, and theses for relevant articles. The search strategy interchangeably used the terms of “dashboard”, “performance measurement system”, and “executive information system” with the term of “design” combined with operator “AND”. Search results (n=250) were adjusted for duplications, screened based on their abstract relevancy and full-text availability (n=147) and then assessed for eligibility (n=40). Eligible articles were included if they had explicitly focused on dashboards, performance measurement systems or executive information systems design. Finally, 28 relevant articles included in the study.

Results:

Creating high-quality performance dashboards requires addressing both performance measurement and executive information systems design issues. Covering these two fields, identified contents were categorized to four main domains: KPIs development, Data Sources and data generation, Integration of dashboards to source systems, and Information presentation issues.

Conclusion:

This study implies the main steps to develop dashboards for the purpose of performance management. Performance dashboards developed on performance measurement and executive information systems principles and supported by proper back-end infrastructure will result in creation of dynamic reports that help healthcare managers to consistently measure the performance, continuously detect outliers, deeply analyze causes of poor performance, and effectively plan for the future.

Determining doctors' views on performance measurement and management of their clinical practice

Introducing performance measurement and management of clinicians' practice may improve clinical productivity and quality of patient care; however the attitudes of doctors to such approaches are poorly defined. This was investigated through an anonymous qualitative postal questionnaire in a large district general hospital. A total of 93 from an invited cohort of 368 senior grade doctors participated. The results suggested that doctors understood the need to evaluate and manage their performance in medical practice, and address poor performance, but felt that current methods were inadequate. This principally related to poor validation and a lack of clinical ownership of data. The role of financial incentivisation was unclear but value was attributed to local clinical leadership, professional autonomy, recognition, and peer-group comparisons. This suggests that clinicians support the use of data-based performance measurement and management; however how it is undertaken is key to successful clinical engagement.

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol.

An evaluation of the Performance Diagnostic Checklist-Human Services to assess an employee performance problem in a center-based autism treatment facility

The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human services settings. We administered the PDC-HS to 3 supervisors to assess the variables that contributed to poor performance by 4 staff members when securing clients in therapy rooms at a treatment center for children with autism. The PDC-HS identified a lack of appropriate consequences as contributing to poor staff performance. We then evaluated a PDC-HS-indicated intervention as well as an intervention not suggested by PDC-HS results. The PDC-HS-indicated intervention (graphed feedback) was effective to increase performance; the non-PDC-HS-based intervention was ineffective.

Turning point revisited: launching the next generation of performance management in public health

A decade ago, the Turning Point Performance Management Excellence Collaborative (Turning Point) developed the first public health-specific performance management (PM) system, with accompanying resource materials, assisted by the Public Health Foundation. Since then, dramatic advancements in PM and quality improvement activities have occurred in public health. Public Health Foundation gathered data that revealed Turning Point was still relevant but difficult to implement within public health. To reflect recent advances and current challenges, Public Health Foundation refreshed the Turning Point model and related guidance tools and developed new resources to facilitate PM implementation. In addition, a new fifth component, "Visible Leadership," was added to the 4-quadrant model and the Self-Assessment Tool. In the future, public health organizations should take an active leadership role in innovating and sustaining PM systems, ensuring they become accountable for producing outcomes, leveraging technology advances, and incorporating best practices from all stakeholders.

Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative

INTRODUCTION

Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI).

OBJECTIVE

Evaluate the extent to which NPHII awardees have achieved program goals.

DESIGN

NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics.

SETTING

Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds.

PARTICIPANTS

NPHII performance improvement managers or principal investigators.

MAIN OUTCOME MEASURE(S)

Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness.

RESULTS

Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness.

CONCLUSIONS

NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

Assessing the implementation of performance management of health care workers in Uganda

BACKGROUND

The performance management concept is relatively new to the Ugandan health sector. Uganda has been implementing health sector reforms for nearly two decades. The reforms included the introduction of the results-oriented management in the public sector and the decentralisation of the management of health care workers from central to local governments. This study examined the implementation of performance management of health care workers in order to propose strategies for improvement.

METHODS

The study was a descriptive survey carried out in the Kumi, Mbale, Sironko and Tororo districts and utilising mixed research methodology. A self-administered questionnaire was used to collect quantitative data from the health care workers. A semi-structured interview guide was used to collect qualitative data from the health service managers. The sample for the quantitative method was selected using stratified random sampling. Purposive sampling was used to select health service managers. Quantitative data were analysed using Statistical Package for Social Sciences (version 18.0). Qualitative data were categorised according to the themes and analysed manually.

RESULTS

The findings show that to some extent performance management is implemented in the health sector; however, there were loopholes in its implementation. There were inadequacies in setting performance targets and performance management planning was hardly done. Although many health care workers had job descriptions, the performance indicators and standards were not clearly defined and known to all workers and managers. Additionally the schedules for performance assessments were not always adhered to. There were limited prospects for career progression, inadequate performance feedback and poor rewarding mechanisms.

CONCLUSIONS

Performance management of health care workers is inadequately done in the districts. Performance management is a key component of attempts to improve health sector outcomes. As a result of this study, suggestions to enhance health sector performance management in the districts have been put forward. The authors are optimistic that if these suggestions are implemented, the performance of health care workers is likely to improve.

Identifying and managing performance concerns in community pharmacists in the UK

OBJECTIVES

To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK.

METHODS

Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies.

RESULTS

A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues.

CONCLUSIONS

Being 'for-profit' organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals' performance.

Effects of and preference for pay for performance: an analogue analysis

We examined the effects of 2 payment systems on the rate of check processing and time spent on task by participants in a simulated work setting. Three participants experienced individual pay-for-performance (PFP) without base pay and pay-for-time (PFT) conditions. In the last phase, we asked participants to choose which system they preferred. For all participants, the PFP condition produced higher rates of check processing and more time spent on task than did the PFT condition, but choice of payment system varied both within and across participants.

Academic health centres: managing the transition from good to great

Academic health centres (AHCs) bring significant economic and health benefits to a community. This study focuses on four integrated AHCs in the USA. They are described as the 'traditional great' or 'transformational great', where a number of common characteristics have been identified on how these organisations have demonstrated superior performance over time. The conceptual framework of 'good to great' provides a structure to explore key factors that support enhanced performance.

An efficient management system for wireless sensor networks

Wireless sensor networks have garnered considerable attention recently. Networks typically have many sensor nodes, and are used in commercial, medical, scientific, and military applications for sensing and monitoring the physical world. Many researchers have attempted to improve wireless sensor network management efficiency. A Simple Network Management Protocol (SNMP)-based sensor network management system was developed that is a convenient and effective way for managers to monitor and control sensor network operations. This paper proposes a novel WSNManagement system that can show the connections stated of relationships among sensor nodes and can be used for monitoring, collecting, and analyzing information obtained by wireless sensor networks. The proposed network management system uses collected information for system configuration. The function of performance analysis facilitates convenient management of sensors. Experimental results show that the proposed method enhances the alive rate of an overall sensor node system, reduces the packet lost rate by roughly 5%, and reduces delay time by roughly 0.2 seconds. Performance analysis demonstrates that the proposed system is effective for wireless sensor network management.