Usefulness and effects on costs and staff management of a nursing resource management information system

FINANCIAL COMPETENCIES AS INVESTIGATED IN THE NURSING FIELD: FINDINGS OF A SCOPING REVIEW

AIM

Mapping the extent of the research activity in the field of financial competencies and nursing, identifying main patterns, advances, gaps, and evidence produced to date.

BACKGROUND

Financial competencies are important indicators of professionalism and may influence the quality of care in nursing; moreover, these competencies are the basis of healthcare sustainability. Despite their relevance, studies available on financial competencies in the nursing field have not been mapped to date.

EVALUATION

A Scoping Review was guided according to (a) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review, and (b) the Patterns, Advances, Gaps and Evidence for practice and Research recommendations framework.

KEY ISSUE

A total of 21 studies were included. Main research patterns have been developing/evaluating the effectiveness of education programmes; investigating the nurse's role in context of financial management; challenges and needs perceived by them; and tool validation to assess these competencies. The most frequently concept used across studies was "financial management competencies" (n=19).

CONCLUSION

The sparse production of studies across countries suggests that there is a need to invest in this research field.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses with managerial roles should invest in their financial competencies by requiring formal training both at the academic and at the continuing education levels. They should also promote educational initiatives for clinical nurses, to increase their capacity to contribute, understand, and manage the emerging financial issues.

Automating Time-Consuming and Error-Prone Manual Nursing Management Documentation Processes

A German regulation requires nursing managers to document patient-nurse ratios. They have to combine heterogeneous hospital data from different sources. Missing documentation or ratios that are too high lead to sanctions. Automated approaches are needed to accelerate the time-consuming and error-prone documentation process. A documentation and visualization system was implemented. The system allows nursing managers to quickly and automatically create the documentation required by the regulation. Interactive visualization dashboards assist with the analysis of patient and staff numbers. The developed method was effectively used in nursing management tasks. No changes to the information technology infrastructure were needed. The new process is around 35 hours per month faster and less error-prone. The documentation functionality automatically reads the required information and correctly calculates the documentation. The visualization functionality allows nursing managers to assess the current patient-nurse ratios before the documentation is submitted. The method scales to multiple wards and locations. It calculates the sanctions to expect and is easily updatable. The proposed method is expected to decrease nursing administration workloads and facilitate the analysis of nursing management data in a cost-effective way.

NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Background

Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives

The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design

A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants

NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results

Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations

The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations

The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Study registration

This study is registered as PROSPERO CRD42016038132.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Exploring nurse managers' perception of using the RAFAELA system as a management tool in a Norwegian hospital setting

Aim

The aim of the study, being part of a Norwegian evaluation project of the RAFAELA system, was to explore nurse managers’ perception of the RAFAELA system as a management tool in a Norwegian hospital setting.

Design

We applied an explorative qualitative design using focus group interviews.

Methods

Two focus group interviews were performed with 12 nurses in different management positions during autumn 2013. The principles of qualitative content analysis were used for analysing data.

Results

Three themes emerged. The informants experienced the RAFAELA system to be a basis for a precise and common langue. Furthermore, the informants considered it to be a system defining quality standards of nursing care. Finally, the RAFAELA system provided daily documentation of nursing intensity and thus was considered an important management tool for balancing patient needs with appropriate staff.

Effectiveness of nursing management information systems: a systematic review

Objectives

The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness.

Methods

For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag^* and admin^*, and nurs^* were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria.

Results

Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings.

Conclusions

The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs.

Information systems use, benefits, and satisfaction among Ohio RNs

Contemporary forces, including the growing nursing shortage, the aging population, and the emphasis on patient safety, are increasing the pressure on healthcare facilities to use information systems to achieve better outcomes. Use of information systems improves nurses' ability to make decisions in a timely manner; however, nurses are still reluctant about or avoiding using information systems in their daily work. The purpose of this study was to explore the relationships among age, nursing education, computer experience, user involvement in implementation, nursing management support to use information systems, nurses' information system use, and information system outcomes (benefits and satisfaction). The study used an input-process-outcome framework, a descriptive correlational design, and a mailed survey with a random sample of staff nurses. Computer experience, user involvement, and nursing management support were found to significantly explain information system use. In addition, information system use was found to significantly explain nurses' perception of the benefits of using information systems and their satisfaction with using information systems. These results assist nursing administrators and leaders to change and/or restructure the appropriate work environment to enhance nurses' information system use and increase their satisfaction, thereby improving patient outcomes.

Health information system implementation: a qualitative meta-analysis

Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.

Moderating and Mediating Roles of Nurses' Beliefs

Health care is rapidly increasing the types of information systems (IS) that are used to manage patient care. The extent to which nurses move to a paperless system will be contingent on their beliefs about IS. The study explores the moderating and mediating effects of nurses' beliefs about IS use on the relationship between IS use and perceived benefits and satisfaction. A descriptive, correlational, cross-sectional design is used, and a random sample of 201 staff nurses working in hospitals was surveyed via a mail questionnaire. Nurses' beliefs have mediating effects on the relationship between nurses' IS use and their perceptions of IS benefits and satisfaction. The results can guide nurse administrators to improve nurses' perceptions about IS by using such methods as providing a training program to increase nurses' computer self-efficacy. Enhancing nurses' use of IS and their perceptions of IS benefits can ultimately improve patient safety and outcomes.

Benchmarking in nursing care by the RAFAELA patient classification system - a possibility for nurse managers

AIM

The aim of the study was to explore the possibilities of benchmarking with the RAFAELA system. In this study, comparisons are made between: (1) costs for one nursing care intensity point; (2) the nursing care intensity per nurse; (3) the relationship between nursing care intensity per nurse and (4) the optimal nursing care intensity.

BACKGROUND

During the period from 1994 to 2000 a new system for patient classification, the RAFAELA system, was developed in Finland.

METHODS

86 wards from 14 different hospitals in Finland took part in the study.

RESULTS

The costs for one nursing care intensity point on the adults' wards were on average 7.80euro. The average workload was 25.2 nursing care intensity points per nurse. The optimal nursing care intensity was exceeded during 49.5% of the days and under during 20% of the days.

CONCLUSIONS

The study shows that benchmarking with the RAFAELA system provides many opportunities for the nurse managers' resource allocation and their personnel administration.

Methods to evaluate health information systems in healthcare settings: a literature review

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

Matching nurse skill with patient acuity in the intensive care units: a risk management mandate

AIM

This paper aims to highlight the need for the traditional concept of nursing skill mix to be reconfigured within a new concept of skill matching.

BACKGROUND

Substantive literature describes staff deployment and patient-dependency models. However, limited information exists as to what informs decision making regarding nurse skill assessment and subsequent patient allocation in intensive care units.

KEY ISSUES

In intensive care units, nurse numbers, available nursing skills and patient allocation decisions, impact directly on care provision and outcomes. This paper argues that staffing decisions that are based on insufficient knowledge which lack consideration of all pertinent factors result in poor 'skill matching', potential adverse events and poor outcomes. A critical inextricable link exists between staffing decisions, patient safety and risk in the intensive care unit. Use of a multifactorial skill-matching approach within a dedicated staffing decision-support system is recommended.

CONCLUSION

This commentary paper adds a new perspective to nurse-staffing decision practices and their relationship to risk management in the intensive care unit and offers a new research direction.

Diffusion of Information Technology Supporting the Institute of Medicineʼs Quality Chasm Care Aims

This article examines the degree to which healthcare information technology (HIT) supporting the Institute of Medicine's (IOM) six care aims is utilized in the hospital setting and explores organizational factors associated with HIT use. Guided by the IOM's Crossing the quality chasm report and associated literature, 27 applications and/or capabilities are classified according to one or more of the six care aims. A structured survey of Florida hospitals identified the use of HIT. Results suggest that, on average, hospitals have not yet embraced HIT to support the IOM's care aims and that associated organizational factors vary according to care aim.

Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration

The importance of including patient preferences in decisions regarding their care has received increased emphasis over recent years. Medical informatics can play an important role in improving patient-centered care by developing decision support systems to support the inclusion of patient preferences in clinical decision making. However, development of such systems is a complex task that requires the integration of knowledge from four major research areas: (1) the clinical domain, for understanding of the decision problem, (2) decision science and research on shared decision making, to provide the theoretical underpinnings and techniques for eliciting patient preferences; (3) medical informatics, to provide the technology and algorithms for the collection, processing, structure, presentation and integration of patient preferences into patient care; and (4) organizational knowledge, to adapt the decision support system to the practices and work flows of clinicians and the organizational and professional context of the clinical practice settings. This paper describes a conceptual model comprising eight key components that are important to be considered in the development, implementation, and evaluation of decision support systems for shared decision making in patient care. The example of CHOICE, a decision support system to assist nurses in eliciting and integrating rehabilitation patients' preferences for functional performance in patient care is used to illustrate the eight components.