Importance-Performance Analysis of Patient-Safety Nursing in the Operating Room: A Cross-Sectional Study

Purpose

This study attempted to assess the perceived importance and performance of patient-safety nursing among operating room (OR) nurses and to identify the "concentrate here" level using importance-performance analysis (IPA). The goal was to identify the educational priorities of patient-safety nursing and to use it as foundational data to develop educational programs.

Methods

The IPA of patient-safety nursing (infection control, patient identification, specimen management, surgical coefficient, medical equipment and supplies, high-alert medicines, and damage prevention) was surveyed online for nurses in general hospitals in Korea, and the data of 47 participants were analyzed. Differences in the importance and performance of patient-safety nursing were analyzed using Wilcoxon signed rank test, and IPA was conducted to identify areas on which improvement efforts should be focused.

Results

Within the six areas of OR patient-safety nursing, notable differences in importance and performance were observed in infection control and surgical count areas. The IPA revealed specific items that require "concentrate here", including handwashing, checking the cleanliness and sterility of medical equipment, and conducting 5-Rights checks before administering high-alert medications.

Conclusion

Regular training for OR nurses should encompass preoperative, intraoperative, and postoperative infection control, as well as appropriate surgical counts. In particular, training, monitoring, feedback, and intervention should be provided on hand hygiene, sterilization maintenance, and accurate administration of high-alert medications, which are items included in "concentrate here".

Importance-Performance Analysis of Clinical Forensic Services Quality at Bhayangkara Hospital Pekanbaru, Indonesia

Background

Service quality improvement efforts must focus on the utilisation of resources for continuous quality improvement. The importance-performance analysis (IPA) method is useful in finding service quality items that require corrective action. This study implemented the IPA method to obtain items that should be prioritised in improving the quality of a hospital's clinical forensic services.

Methods

A cross-sectional study of 284 clinical forensic patients at Bhayangkara Hospital, Pekanbaru, Indonesia was conducted. Self-administered and paper-based questionnaires, specifically the modified service quality (SERVQUAL)-based questionnaire, were used as the study instruments. Twenty-two service quality items were used as indicators and they were divided into five dimensions of service quality: i) reliability, ii) responsiveness, iii) assurance, iv) empathy and v) tangibility. The data were analysed using the IPA method.

Results

The results showed that only seven items had a gap and a level of conformity that met the expectations of clinical forensic patients. Improvements in service quality should prioritise four items: i) providing a more private examination room for clinical forensic patients, ii) improving healthcare workers' understanding of patient needs, iii) improving the readiness of healthcare workers to conduct examinations and iv) enhancing the clarity of information about examination procedures.

Conclusion

The IPA method yielded several high-priority items that need to be improved; therefore, the hospital must focus on improving the quality of clinical forensic services.

Perceived Importance and Performance of Critical Care Nursing Competency by Nurses' Clinical Expertise

Background and Purpose: To enhance critical care competency, it is necessary to develop and apply a clinical expertise-based competency training program. This study aimed to identify the perceived importance and performance of critical care nursing competency and the training priorities of competency-based training programs by nurses' clinical expertise. Methods: This was a cross-sectional descriptive survey with a convenience sample of 236 intensive care unit nurses. The critical care nursing competency of nurses was measured. Training needs were determined using an importance-performance analysis. Results: Competency areas with high training priority on the importance-performance matrix were skin assessment, emotional support, Code of Ethics, and collaboration for novice nurses, skin assessment and patient education for advanced beginner nurses, skin assessment and decision-making for competent nurses, and patient education and interprofessional collaboration for proficient nurses. Implications for Practice: Different training needs were identified according to the self-reported level of clinical expertise at four levels. Nursing administrators and educators should provide competency-based continuing education programs based on high-priority training areas according to the nurses' clinical expertise.

Using hybrid consistent fuzzy preference relations-importance-performance analysis model to improve shared decision-making quality based on orthopaedic nurses' perceptions

PURPOSE

To understand key factors for shared decision-making (SDM) and the quality improvement of nursing decisions in the orthopaedic clinical environment.

METHOD

This study applied the consistent consistent fuzzy preference relations (CFPRs) and importance-performance analysis (IPA) methods to explore the attribute weights and SDM performance, respectively. The dataset was collected from 16 orthopaedic clinical nurses' experiences in a third-grade and first-level general hospital in Taizhou, China. This study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

RESULTS

The results showed that "I made clear to my patient or patient's family that a nursing care decision needs to be made", "I explained the advantages and disadvantages of the nursing care options to my patient or patient's family" and "I told my patient or patient's family that there are different nursing care options for caring his/her medical condition" were key factors for affecting SDM. The statistical significance confidence and difference error of weight results were 98.321% and 1.679%, respectively. In addition, "I asked my patient or patient's family which nursing care option he/she prefers" was the key factor for improving orthopaedic clinical nursing in the case hospital.

CONCLUSION

The hybrid CFPRs-IPA model can help hospital managers effectively understand the key factors of SDM quality and improve the orthopaedic clinical nursing performance from nurses' perspectives.

RELEVANCE TO CLINICAL PRACTICE

A quantitative decision-making model can help nurses understand the key factors affecting the quality of SDM in nursing decision-making and promote nursing decision-making and patient-centred nursing service quality. A series of corresponding SDM training courses (i.e. concepts, knowledge and skills) can be provided for hospital and nursing department managers to maximise the potentially available resources.

PATIENT OR PUBLIC CONTRIBUTION

The clinical care process should be committed to involving patients in their care decisions and also provide an opportunity for patients to gain a comprehensive understanding of the care decision-making process in order to inform future patient contributions to care decisions.

Operating room nurses' perceptions of the impact of surgical smoke and its countermeasures: A mixed-methods study

Although surgical team members are exposed to surgical smoke, most do not fully recognize the hazards of such exposure during surgery. This study aimed to explore the perceptions of surgical smoke and its countermeasures in the operating room, specifically among nurses who have been exposed to surgical smoke for a long time. This was a mixed-methods study involving focus groups and a descriptive survey. The focus group revealed that nurses believed harmful substances accumulating in the body were proportional to the years worked, and many were unaware of the existent hazards in their work environment. They encouraged the formulation of self-protection measures and perceived that the recognition of rules and collaboration should take precedence among potential countermeasures. Our survey showed that properly wearing personal protective equipment and being educated on surgical smoke hazards were identified as essential coping methods for nurses. These findings will help create awareness regarding surgical smoke hazards in operating rooms. Policies and systems need to be established at the hospital administration level to substantially reduce the risks associated with surgical smoke for operating room nurses.

Measuring Online Teaching Service Quality in Higher Education in the COVID-19 Environment

The use of the Internet to develop new technologies has generated a considerable change in teaching and student learning in higher education. The pandemic caused by COVID-19 has forced universities to switch from face-to-face to online instruction. Furthermore, this transfer process was planned and executed quickly, with urgent redesigns of courses originally conceived for live teaching. The aim of this work is to measure the service quality of online teaching delivered during the COVID-19 period. The methodology was based on an importance-performance analysis using a structural equations model. The data were obtained from a sample of 467 students attending a university in southern Spain. The results reveal five priority attributes of online teaching that need to be improved in order to enhance the service quality of the virtual instruction provided to students. Universities need to redefine their online format by integrating methodological and technological decisions and involving collaboration between teachers, students and administration staff and services. The results do not apply to educational institutions that exclusively teach courses online, but to those institutions that had to rapidly adapt, and shift course material originally designed for face-to-face training.

Importance-Performance Analysis of Health Perception among Korean Adolescents during the COVID-19 Pandemic

This study assessed the health perceptions of 333 Korean adolescents during the coronavirus disease (COVID-19) pandemic via an online questionnaire administered in October 2020, which queried the perceived importance and actual performance of health behaviors. The health perception scales used in the survey consists of the six dimensions of mental health, disease, physical activity, sleep, diet, and sanitary health. The data were primarily analyzed using paired sample t-test for analysis of difference and importance-performance analysis (IPA). The IPA results were presented in four quadrants-"keep up the good work," "concentrate here," "low priority," and "possible overkill." The results indicated that first, there was a positive relationship between the importance and performance of all the subdimensions of health perception. Second, sanitary healthcare was rated as being of the greatest importance and was performed most, while physical activity management was rated least important and performed least. Third, statistically significant differences were found between importance and performance for all items of mental health, disease, physical activity, sleep, and diet dimensions, and some differences were found for items assessing the hygiene control dimension. Fourth, in the two-dimensional IPA model, "sanitary health" and "disease" are in Quadrant I (keep up the good work); "mental health," in Quadrant II (concentrate here); and "physical activity," "sleep," and "diet," in Quadrant III (low priority). No components of healthcare were in Quadrant IV (possible overkill). Based on these results, we emphasize the importance of adolescent health education and discuss solutions to enhance the performance of healthcare activities.

Assessing the Social Value of Ecosystem Services for Resilient Riparian Greenway Planning and Management in an Urban Community

Ecosystem services depend on the interrelation between people and the environment, and people are increasingly recognizing the social value of ecosystem services. Based on humans needs related to the values of ecosystem services, riparian greenways, properly planned and managed for resiliency, could provide great opportunities for social ecological change and transformation toward sustainability. We focus on the ecosystem service values of such greenways based on resilience in urban communities. The purpose of this study is to assess the social value of ecosystem services for resilient riparian greenway planning and management based on a survey of residents living near the Yangjaecheon riparian greenway in Gwacheon, South Korea. First, cluster analysis was performed with data from 485 completed surveys to identify different groups of respondents. Importance-performance analysis (IPA) was then applied to develop planning and management guidance for the riparian greenway based on group characteristics. Two distinct groups were identified: the Strong Social Value of Ecosystem Services group and the Neutral Social Value of Ecosystem Services group. Different distributions were found between the two groups based on gender and residency period, and significant differences were also found for age and familiarity with the riparian greenway. The results show what each group perceived to be important and how well the riparian greenway met their expectations regarding ecosystem services. These results indicate the perceived value of ecosystem services on the basis of the group characteristics, helping establish the direction for resilient riparian greenway planning and management approaches.

Impacts of service robots on service quality

With rapid advances in technologies, especially in artificial intelligence, smart sensors, big data analytics, and robotics, the service industry began introducing robots to perform a variety of functions. While the main purpose of deploying robots has been productivity improvement, the current COVID-19 pandemic has brought more urgent purpose, providing contactless service for social distancing. This study explores the service quality provided by robots based on real data in a hotel setting. A sample of 201 guests provided their expected service quality by robots and the actual performance experience after the service. We analyzed this relationship using importance performance analysis (IPA) and the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). The results revealed that customers’ top priorities for robots’ service quality are assurance and reliability, while tangible and empathy were not as important. Customers were not satisfied with robots’ responsiveness, but this construct was found to be a low priority.

An Integrated Approach to Determining Rural Tourist Satisfaction Factors Using the IPA and Conjoint Analysis

Rural tourists satisfaction has a pivotal role in the development of sustainable rural tourism. As a method of identifying critical satisfaction factors, an importance and performance analysis (IPA) technique has attracted growing interest from academics due to it being able to deliver the importance and performance of a product’s attributes from the standpoint of customers. However, IPA is based on the presumption that a linear and symmetrical relationship exists between the performance and overall satisfaction, which has been criticized by many researchers due to its deviation from the facts. On measurement of importance, researchers have not reached an agreement on whether direct or indirect approach should be applied. To measure satisfaction more effectively, this study presents a revised IPA method that integrates IPA, conjoint analysis and importance grid analysis. Based on mathematical psychology and psychometrics theory, the conjoint analysis method can be used to analyze multi-attributes of various products and derive relative importance of attributes in customer satisfaction research. The importance grid analysis method has been applied to categorize attributes by many researchers. It can be used to measure the nonlinear relationship between the performance of attributes and overall satisfaction. In this paper, an empirical study on rural tourists’ satisfaction was undertaken using this integrated method. The results show that the integrated approach is more responsive to attribute performance, thus allowing for improvement of a certain target attribute in the customer satisfaction enhancement process.

Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care

BACKGROUND

A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis.

AIMS

The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care.

METHODS

Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting.

RESULTS

Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals.

CONCLUSIONS

Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

Needs assessment survey for simulation-based training for gastrointestinal endoscopy nurses

The optimal performance of gastrointestinal (GI) endoscopy nurses is required for patient safety and quality improvement. The aim of the present study was to assess the educational needs for simulation-based training for Korean GI endoscopy nurses using importance-performance analysis. A cross-sectional survey was conducted with 238 Korean nurses from 25 endoscopy units. The educational needs of these nurses were identified using the 35 item clinical competence importance-performance scale. Exploratory factor analysis of the scale identified the following eight factors: emergency care, patient monitoring, evidence-based practice, documentation and referral, patient safety, nursing process, patient assessment, and infection control. A significant overall mean difference was identified between importance and performance for all eight factors, with emergency care showing the largest difference. It was also ranked the highest priority for continuing education in the importance-performance analysis matrix. Therefore, simulation-based training should focus on enhancing emergency care competence for GI endoscopy nurses to improve patient safety and quality of care.

Importance-Performance Analysis (IPA) of Foodservice Operation, Dietary Life Education, and Nutrition Counseling Tasks of Nutrition Teachers and Dietitians in Jeju, Korea

The purpose of this study was to analyze foodservice operation, dietary life education, and nutrition counseling tasks of nutrition teachers and dietitians in elementary, middle, and high schools in Jeju, Korea, and to provide effective ways to implement dietary life education and nutrition counseling in schools. This study surveyed 94 nutrition teachers and 46 dietitians working at elementary, middle, and high schools in Jeju during 7-14 May 2015. The importance and performance of 16 tasks of nutrition teachers and dietitians were measured using questionnaires. The data was analyzed by using the SPSS software and Importance-Performance Analysis (IPA). Importance was ranked in the order of foodservice operation (4.72), dietary life education (4.37), and nutrition counseling (4.24); and performance was ranked in the order of foodservice operation (4.48), dietary life education (3.70), and nutrition counseling (3.22). The importance-performance matrix showed that in Quadrant 4, the "Concentrate Here" item was "nutrition and dietary life education for students", while in Quadrant 2, the "Possible Overkill" item was "cost control and office management". These findings suggest that it is important to reduce unnecessary administrative and office management tasks in order for nutrition teachers and dietitians to implement effective nutrition education, dietary life education, and nutrition counseling programs.

An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation

Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.