A Preliminary Study Of The Difficulty Coefficient Care Project In Beijing

Background:Quantitative performance appraisal is one of the most important nursing reform contents of the High Quality Nursing Service Demonstration Project. Objective and reasonable workload measurement method is the basic of Quantitative performance appraisal. However, the current methods for measuring nursing workload are unscientific as not reflecting the difference of strength, risk and technology of nursing work. Difficulty coefficient is really an important tool that allows for a more reasonable calculation of nursing workload.Objectives:To establish the performance appraisal nursing items that are suitable for difficulty evaluation, the content of difficulty dimensions and the weight of each dimension. To assess the difficulty coefficient of nursing items acquired in the study.Methods:Questionnaire survey, Semi-structured interview, Expert discussion meeting, Delphi and Expert meeting were adopted in the study. Literature review, questionnaire survey, semi-structured interview and expert discussion meeting were used to obtain nursing items, difficulty dimension and dimension weight at the beginning of the study, and AHP was adopted to determine dimension weight., Project team designed the first round questionnaire for Delphi according to the above results.30experts in four fields-clinical nursing administration management, clinical nursing management, clinical nursing and nursing education took part in the two-round consultations. Then experts evaluation method was used to strengthen the objectivity of Delphi results.. In the final stage, difficulty coefficient verification questionnaire srvey was adopted to the second assessment of difficulty coefficient of12nursing items.Results:In the study,64nursing items were considered to be suitable for difficulty evaluation,4difficulty evaluation dimensions-the complexity of operation skills, operator requirements, load intensity and operating risk were obtained, the weight of each dimension was0.3354,0.2017,0.1176and0.2017. After two-round Delphi consultations,16experts from10hospitals were invited to a meeting for difficulty coefficient verification,12nursing items’difficulty coefficient was considered unreasonable.15experts selected from Delphi Method were asked to do a second difficulty evaluation of12nursing items with unreasonable difficulty coefficient.64nursing items’difficulty coefficient was formed at the end of the study. Pick up postoperative patients after Level4operation got the highest difficulty coefficient, the difficulty coefficient of Shop spare bed was2.0379, just above the benchmark project Body weight measurement. Kendall coefficient of two-round Delphi consultations were0.66and0.83, and authoritative coefficient were0.86and0.85.Conculsion:64nursing items are the most common nursing activities. Difficulty coefficient obtained in the study possesses objectivity, but its rationality and practicality need to be verified in the further study. These resuls can provide a scientific statistic method for nursing workload measurement, provide the possibility for quantitative performance appraisal of the implementation.