QUALITA' ORGANIZZATIVA: STUDIO SUI PIANI DI LAVORO INFERMIERISTICI DELL'AST DI MACERATA E PROPOSTA DI STANDARDIZZAZIONE

Introduction: Healthcare companies are responsible for ensuring increasingly high-quality assistance and care. Achieving high professional and organizational quality standards is a priority implemented in healthcare system reforms. Among the tools useful for optimizing quality within the healthcare system, the work plan is an operational short-term management tool whose main function is to ensure that every process is carried out in accordance with the established standards, reduce variability and optimize the use of resources, as well as facilitate communication between the different hierarchical and professional levels, promoting a more efficient and transparent organization. Objective: The overall objective of the study is to optimize the structure and terminology of the activities described in the nursing work plans used in the different Operating Units of the AST of Macerata, by analyzing their main structural and terminological criticalities and the literal terminological correspondence of the activities described. Materials and Methods: First step: Descriptive observational study of the nursing work plans through two phases. In the first phase, a semantic analysis of the descriptions contained in the work plans was carried out, aimed at identifying common macro-areas and subsequently assessing the terminological variability of the activities. In the second phase, for each activity, literal terminological correspondence was verified with respect to the expressions used in the various areas of the nurse’s professional profile. Second step: Development of a standardized format for drafting nursing work plans. Results: In the first phase of the first step, 115 activities divided into 17 macro-areas were identified. Each macro-area was analyzed to determine the frequency of description. This revealed a high descriptive variability for each macro-area (mean 6.76 different expressions referring to the same activity), with maximum descriptive variability for the “collaboration with the physician” area (13 different activity descriptions) and the “fundamental care” area (12 descriptive modes), and minimum variability (2 descriptions) for the “collaboration with colleagues” and “reordering and control” areas. The second phase of analysis shows that 38% of the activities are described with terminology corresponding to the nurse’s professional profile, while the remaining 62% present vague expressions and language not corresponding to that used in the nurse’s professional profile. Regarding the second step, the 14 expressions found not to correspond literally were modified by formulating standardized expressions. A validation form was also provided to allow continuous monitoring over time of adherence to the expected quality standards. Discussion: The analysis carried out highlights two fundamental criticalities: strong descriptive heterogeneity and poor terminological correspondence with the nurse’s professional profile. Work plans are operational tools that prove to be strategic for quality improvement when they are well structured, i.e., developed through shared, precise and correspondent terminology. For this reason, the need emerged to develop a standardized format for drafting work plans with precise and standardized terminology, usable by the different Operating Units. Conclusions: The lack of standardization and literal terminological correspondence in work plans could compromise the quality of care. With a view to continuous quality improvement, the design of a unique and standardized format, as well as long-term monitoring by the Directorate of Health Professions in the Nursing-Obstetric Area of adherence to the quality standards of work plans, represent useful strategies for improving the quality of care, promoting organizational efficiency and, consequently, contributing to the achievement of corporate objectives.