1. Crabtree, Carole MSN, RN-BC

Article Content

Setting of Project: Medical center with multiple care settings including critical inpatient care, long-term care, and communitybased home care.


Problem addressed: In healthcare quality improvement, performance measures focus attention on critical processes and practices that impact patient outcomes, but accessing, reviewing, and analyzing the data can overwhelm even the most computer-savvy executive.


Objectives of project: The Balanced Nursing Report Card provides a condensed snapshot of how well performance measures are being met by distilling data into an overall score that balances a broad range of categories through a network of equations.


Intervention or change implemented, if any: The report card combines bottom-line data from reports and applies weighted equations to provide an overall letter grade for performance.


Actions, processes, and methods used to solve the problem and meet the objectives: Built on a Microsoft Excel platform, values are extracted from performance measure reports and entered in rows set up on individual unit-specific worksheets. Each data point is weighed against a benchmark, and a grade is calculated. Rows are grouped into categories of clinical outcome measures, process measures, direct care measures, and administrative measures. The category grades are combined into a letter grade for the unit. Category grades are also combined across units, which are grouped as acute care, continuing care, interventional, and clinics. The grades for units within each area are combined into overall grades for the groups and, finally, into an overall facility-wide grade. This structure allows the executive to view the report in reverse, beginning with the facility grade and drilling down to group and then to the individual unit.


Data, metrics, and methods used to determine whether the objectives were met:


* Data: patient outcome data and nursing sensitive indicators


* Metrics: performance measures related to clinical outcome, process, direct care, and administrative measures


* Methods: collaboration to determine which measures to include; MS Excel spreadsheet functions to weigh and balance performance measures and apply weighted grades.



Outcomes: The Balanced Nursing Report Card was accepted for facility-wide use by executive council and requested by other departments. The facility is preparing for inspection by the Joint Commission this spring or summer, at which time the Balanced Nursing Report Card will be presented as a tool for examining performance measures.


Lessons learned (conclusions and recommendations for practice): A key to maintaining usefulness of the report is in keeping the process open for growth and revision as a dynamic reporting tool.


Contact the corresponding author: Carole Crabtree (