gms | German Medical Science

Background and state of research: The nursing workforce contributes to the quality of health care, but there is limited research on nurse-sensitive outcome measures, data availability and benchmarking in Germany.

Research question and objectives, hypothesis: The aim of the study was to examine if and how selected German hospitals use nurse-sensitive clinical indicators and perspectives on national and international benchmarking.

Method: A qualitative study, based on 18 semi structured interviews, was conducted in 2020 with key informants from five selected German hospitals. Hospitals were among the first in Germany implementing Magnet^® or Pathway^® with the overall goals to improve the work environment and quality of care via organization-wide reforms. The interviews were analysed using content analysis and codes were formed deductively-inductively.

Results: Three major themes emerged: (i) limited pre-existence of and necessity for nurse-sensitive data, (ii) importance of creating an enabling data environment and (iii) challenges and opportunities in establishing benchmarking. Most interviewees reported the data collection of two nurse-sensitive indicators, hospital-acquired pressure ulcers and falls with injuries, but approaches and implementation varied. There was a felt need to develop additional nurse-sensitive clinical indicators for the German context. Fostering an enabling data environment comprised actively supporting the use of data in clinical practice, the importance of building employees acceptance, the establishment of a nurse-sensitive data culture, and workload reduction by using electronic health records. A need for national and international benchmarking was identified, both for Germany and Europe. The main benefits of benchmarking were seen in the benefit for patient care, the main challenges mentioned were related to the standardization of indicators, data collection and comparator groups.

Discussion: The implementation of nurse-sensitive clinical indicators is very limited in Germany. At hospital level, establishing a conducive data collection culture, involving and building employee acceptance for data collection, was identified as facilitators to using data in clinical care. There was a felt need to establish a nationwide or European benchmarking system. An initiative was started by hospitals in Germany to set up a German benchmark.

Implication for care: The development and standardized use of nurse-sensitive indicators should be fostered. To enable comparison of these indicators across hospitals and a resulting improvement in patient care, national benchmarking structures should be established and further developed.

Funding: Other funding; Förderung durch die B.Braun Stiftung, als Teil der Magnet-Pionier Studie