Exploring the use of key performance indicators to influence nursing and midwifery practice

  • Olivia Gray

Student thesis: Doctoral Thesis


Internationally, the use of Key Performance Indicators (KPI’s) in nursing and midwifery is recognised as a reliable and accurate means of measuring and reporting on practice. The use of KPI’s should lead to safe, high-quality care. However, there is little evidence of how KPI’s influence decisions throughout organisations, or how they act on the data collected.

Aim: To scope the KPI’s used in nursing and midwifery and explore how they influence practice.

Methodology: A two-phased sequential mixed methods approach was chosen. Phase one involved a questionnaire disseminated across the United Kingdom and Republic of Ireland. Phase two consisted of interviews conducted at meso and micro levels of nursing and midwifery in eight organisations.

Results: Quantitative data revealed over 100 nursing and midwifery specific KPI’s being used in practice. National requirements were a deciding factor in KPI selection, while clinical involvement was mainly through data collection. Respondents stated that they used patient experience KPI’s, but only one measure was identified. Thematic analysis identified two themes: The Leadership Challenge including - ‘voiceless in the national conversation’, ‘aligning KPI’s within the practice context’ and ‘listening to those who matter’, while Taking Action includes - ‘establishing ownership and engaging staff’, ‘checks and balances’ and ‘closing the loop’.

Conclusion: Nurses and midwives require enhanced knowledge of the nature and purpose of KPI’s, as evidence gained from KPI data collection is insufficient to lead to improvement. A practice context which encourages collective leadership, where multiple sources of evidence are gathered and everyone is included in KPI evaluation and subsequent decision-making is key. It is suggested that implementation science, in general, and the Promoting Action on Research Implementation in Health Services Framework, offer effective tools for successfully realising KPI’s potential to activate and sustain improvements in practice.
Date of AwardOct 2018
Original languageEnglish
SponsorsBelfast Health and Social Care Trust & Department of Education and Learning
SupervisorTanya Mc Cance (Supervisor) & Donna Brown (Supervisor)


  • Implementation science
  • Quality improvement

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