Module Components

• Overview
• Assignments

Topics

• Why performance improvement?
• The performance improvement process
• Data and information technology in improving practice
• Additional Resources

Nurs 659 - Organizational/Professional Dimensions

Module 6: Performance Improvement

Data and information technology in improving practice

Requisite ANP skills in Data and Outcomes Management
Advanced nurse practitioners work in a variety of settings and in a variety of roles.  Information for performance improvement and outcomes management is found in multiple places using multiple extraction methods.  It is expected that practitioners are capable of data extraction, use of large data sets, and data mining. For success in outcomes evaluation/management, the ANP must determine the types of large data sets available within the organization and externally, and the types of information management systems and the data available within each.  Organizations often have information management systems for the storage of a wide range of data, including, but not limited to, clinical, financial, risk, quality, medical records coding, nursing acuity, etc.  It is imperative that the practitioner become knowledgeable regarding all sources of available information and how to access the data.

A conceptual model for identifying  and coordinating cross continuum outcomes data is displayed in chapter 24 (Hamric et. al., 2014).  This example notes that for the population being studied, there are multiple service points, and each service point generates a potential indicator/measure  - each with their own specific data sources.  This is important as it underscores the range of potential indicators and data sources for use.
*Note the HIPPA requirements for confidentiality when extracting and using data.

The Outcomes Evaluation Plan
Hamric (2014) identifies a comprehensive Three (3) Phase Outcome Evaluation Plan designed to respond to the needs of program evaluation and practitioner outcomes.  The discussion includes (1) a step-wise plan for evaluation, (2) a process for clear prioritization of indicators, (3) resources for national comparative performance and benchmarking data, and (4) a sample outcome evaluation plan. Note in detail the key steps and the practitioner expectations to follow the process accurately and completely.  (See p. 674).

Among the  particular advantages of this model are:

1. the linkage of  role performance expectations with organizational goals,
2. the extensive process that allows for program evaluation activities,  
3. the involvement of stakeholders,  
4. the use of large data sets, and
5. the application of benchmarking activities.

This allows for the practitioner to more accurately articulate roles within the organization, and to demonstrate a value added* component.
(*value added activities are those that meet all three of the following criteria:1) The customer is willing to pay for this activity; 2) It must be done right the first time, and, 3) The action must somehow change the product or service in some manner.) 

Summary
There is a pressing need for measuring the effect of advanced practice nursing on the patients and the health care system.  Current market forces, historical trends of linking ANP practice with collaborating physicians, reimbursement decisions, and the invisibility within the practice settings, create an urgency for all practitioners to (1) appreciate the need for, and begin to measure and monitor the practice using ANP-sensitive indicators; 2) participate in, and expand the discussion on establishing a common/core set of ANP-sensitive indicators and standards that support the collection of data, and (3) networking for sharing and continued work towards a consensus list of indicators (Hamric et. al., 2014).

The outcomes model above coordinates and defines the elements requisite to the development and implementation of processes to demonstrate the APN’s value and contribution to the health care setting (Hamric, 2014). The plan is also critical to support or refute program/personnel changes in your setting.

This is an excellent opportunity to expand skill in developing outcomes evaluation. Owing to the extensiveness of the plan, it is not a requirement, but is an optional exercise that one should consider developing as a pre-requisite to the actual practice. It is a tool that can and should be transferred to the APN’s practice setting as a measure of his/her value to the organization. Review the components in Hamric, determine the requisite elements, and project how this tool will be implemented in your setting.