The Construction Of The "Main-Basic Duality" Performance Appraisal Model For The Quality Of Nursing Service

BACKGROUNDJanuary in2010, the project of "Striving to be the Demonstration Unit of High Quality Nursing Service" with a theme of "strengthen basic care and fulfill responsibilities to offer high quality nursing service" was started in a nation-wide scale, which brought about a revolution in nursing working pattern. With the promotion and development of this project, organizers must need a proper appraisal tool to make objective assessment what can help the organization goals to be realized better.In 《Running Centipede——how to promote growing with evaluation》 Dingwei Jiang, Wei Cai pioneered the method of "Main-Basic Duality" This method divided the assessing content into two parts, which were "main performance" and "basic performance", and correspondingly designed different measurement standards. On one hand,"main performance" means the key of performance controlling, which can exert great influence to nursing quality. On the other side,"basic performance" derived from the basic work which is the basement of main performance, but not of the first importance at present. The final goal is to establish a performance appraisal model with nursing service as main performance and nursing technique as basic performance by different assessing criteria.The appraisal model of nursing quality under the theory of Main-Basic Duality has the advantages of simplicity, efficient and cost-saving method, compared with traditional performance appraisal system, which can better reflect importance and raise the efficient of management. The study aims at building a scientific and practical performance evaluation index system reflecting new requirement of revolution for hospital macro-controlling and then offering realistic evidences for nursing managers.OBJECTIVEThe study is aimed at building at proper, practical nursing quality evaluation index system by determining the indicators and dimensionality of "Main-Basic Duality" using Delphi method together with performance appraisal theory and management of clinical nursing quality, after this making nursing care quality assessing tool to elevate the quality of evaluation. Through the scientific performance evaluation, realize the security of staff treatment, fair distribution system, positive incentive mechanism, promote nursing work going, by building long-effect mechanism of high quality nursing service demonstration project to realize care reform.METHODS1. Literature researchThe practical experience of "Main-Basic Duality" were collected from Academic journals domestically and aboard the Ministry of Health and other related websites. Combining with the supporting documents of national politics about "striving to be high-quality nursing service demonstration project", the evaluation indicators were collected extensively, and then reserved indexes will be formed. 2. Clinical researchHave an interview with three head nurses who have got intermediate certificate and been clinical managers for more than five years, and six senior nurse who have been team leader for two years from one three-A hospital in Guangzhou.3. Delphi methodTwice specialist consultation of the reserved indexes were carried out by experts who are engaged in clinical nursing management, especially in the human resources management experience or participate in the performance evaluation of clinical nursing managers on the Main-Basic duality method. Screening optional indexes of nursing service quality performance evaluation reasonably and then determining the weight of all indexes, construct a theoretical evaluation model Main Basic duality nursing service quality performance.4. Scene investigationMake high quality nursing service demonstration project in the service quality of the clinical performance assessment questionnaire, and conduct a survey about performance assessment at three-A hospital in Guangzhou. The investigation for demonstration department nursing managers, quality control department in hospital, medical patients of investigation, collection of indexes of data, and interviewing the nursing leader from administrative department at public health hospitals ands, collect the relevant advice of how to build the evaluation index system.5. Statistical analysis methodThe results of specialist consultation and the questionnaires were inputted in computer by Microsoft Office Excel2003,and were calculated by software of SPSS13.0. According to the nature of the data, all the data were analyzed through description Statistic、nonparametric tests、reliability analysis. We also compute the value of standardized indicators and performance index. RESULTS1. Whether choosing appropriate experts is the key point to Delphi method. This study invited28senior experts who come from Guangzhou Province, Hunan Province, Shanxi Province (including8hospitals in all) and23experts engaging nursing management, clinical care and nursing education in Tertiary hospitals to join the consultation. There are5(18%) nursing educator,23(82%) nursing manager experts, aged (44.09±5.85, working for years (12.61±8.28). More than35%exp2. The Reliability of consultation results can be measured by the experts’ representativeness, positivity and authority, and coordination index of expert indicators. Experts positive index is reflected by the questionnaire’response rate, the response rates of two rounds investigation are82.1%、100%respectively, far above the standard≥(50%). Authoritative coefficient of experts are above0.8,while generally reliability coefficient (c≥0.70) is acceptable. Therefore, experts" forecast is based on practical and theoretical basis. After the second round of the expert consultation, the coordination index is0.33(P<0.001), which shows that the expert opinions’coordination is significant and the survey results are acceptable.3. The inclusion standard of indicators is decided by the average importance value of indicators (>4.0)、variation coefficient (<0.25) and selection rate (>70%). After first round, experts proposed29opinions on the third indicators, and came to11suggestions in the second round. Combining the change item proposals and the discussions of research team,2first class indicators were chose:nursing service, nursing technique. accompanied with8second class indicators and38third class indicators. There are54items which belong to2first class indicators and38second class indicators. It is using Likert measure table to set five grades:very bad (one point),bad (two points), medium (three points), good (four points), very good(five points). 4.100questionnaires were expected to be issued, now50of those were done,46of which were brought back(return ratio is92%).the number of effective questionnaires was41(89.1%).According to the need of this study, more questionnaires and data have to be collected.5. The outcome of the evaluation show different value in diverse samples which can reflect the real condition of development of the nursing performance appraisal. Through the reliability and validity analysis of the index system, the total Cronbach’s a coefficient is0.6224. So the reliability is available. The content validity is7.29, comparatively ideal result.CONCLUSIONS1. Main-Basic Duality performance evaluation method highlighted the key of the reform of nursing mode, that provides the high quality nursing service,offering corresponding assessing dimension. Assessment is divided into two parts, which contain nursing service and care in technology two aspects.2. The performance evaluation indexes system of the quality of nursing service has good reliability and validity, and can be more effective and reliable nursing service quality evaluation of performance3. It is proved that the indexes system of performance evaluation of nursing service quality is feasible which can facilitate the process of collection of related data and make the calculation of results of performance simpler. Users can flexibly design the assessment standards on actual need as well as employing two-wayevaluation of the results.4. Nursing service quality performance evaluation indexes system can overall reflect the performance level, moreover, it can analyze the performance the results of performance from four parts such as importance, basis, process and the results, then provide performance managers with practical experience.