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Introduction
In performance-managed health services across the world, there is an emphasis on “Ward-to-Board” accountability for nursing quality. Although healthcare systems may differ, all have a common goal: to improve service quality. In the 1990s, healthcare reform in the USA prompted nursing quality indicator (NQI) development. Databases such as the Californian Nursing Outcomes Coalition and the National Database of Nursing Quality IndicatorsTM (NDNQI®) incorporated executive and clinical information necessary for reporting on quality assurance (Montalvo, 2007; Aydin et al., 2008). Over the past decade in the UK, measuring compliance by applying well-defined indicators has supported professional transparency, accountability and quality improvement (NHS Quality Improvement Scotland, 2005; Welsh Assembly Government, 2010; Northern Ireland Practice Education Council, 2011; Department of Health, Social Services and Public Safety, 2011). Measuring care based on patient experience is a relatively new consideration and is now included in many nursing care indicators (Maben et al., 2012; McCance et al., 2012). Different quality measures allow managers to articulate the nursing profession’s contribution to quality care in tangible terms and assure hospital boards that the profession is providing safe, effective, person-centred care. NQIs also focus development activities in areas that are aligned to policy and organisational imperatives, which aim to proactively improve service quality. Including NQIs within performance management systems provides a robust framework that can support delivery and assurance on clinical and social care governance (McCance et al., 2012). However, in practice, articulating nursing value through quality indicators is both a challenge and an opportunity for the profession to accurately apply indicators, i.e., obtaining empirical evidence is far from straightforward (Burston et al., 2013). Defining potential indicators, demonstrating associations between indicators and nursing care, collecting and analysing data, and sharing the outcomes is complex (Doran et al., 2006; Needleman et al., 2009; Burston et al., 2013; Heslop and Lu, 2014).
Quality healthcare dimensions that inform the NQI framework
The American Nurses Association developed the NDNQI®, grounding it on the Donabedian framework (Gallagher and Rowell, 2003; Montalvo, 2007). Donabedian’s (1988) conceptual model provides a framework for examining healthcare quality through structure, process and outcome. He believed that care quality is not only reflected in each individual category, but also in the relationship between them. Several...