Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Abstract

Background: Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals’ perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work. Methods: A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer. Results: On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals’ joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality. Conclusion: Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

“…Another outcome scarcely measured is staff satisfaction; we only identified one study [ 127 ]. A growing body of literature outlines the staff’s fundamental role in healthcare [ 133 , 134 , 135 ], highlighting the need for analytical attention and technological solutions focused on minimizing the burden experienced by physicians and nurses [ 134 ]. The findings imply that most intervention studies still focus on efficiency improvement in a department rather than taking a holistic perspective to optimize the outcomes across the entire patient journey process.…”

Track and Trace of Administrative Costs in the Dutch Long-Term Care System

“…This is realistic because professionals understand that some administration is necessary. For instance, a study in Dutch hospitals found that only 36% of quality registrations were perceived as useful for everyday practice (Zegers et al, 2020). However, we also need to prevent useful administrative tasks from being lost in blunt eradication exercises.…”

Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation—a before-and-after study

“…Yet another explanation for the stability of autonomous motivation may be that EHRs have a variety of motivation-relevant effects beside the changes in work characteristics analysed in the current paper. On the one hand, the EHR supports healthcare workers in achieving their work-related goals and values, but on the other hand the administrative burden resulting from an EHR may impair autonomous motivation [ 14 , 20 , 61 , 62 ]. More specifically, the instrumental value of the EHR is likely to contribute to healthcare workers’ sense of identified regulation.…”