title: Nurses' perceptions of feedback to nursing teams on quality measurements: An embedded case study design.
abstract: BACKGROUND
  Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses' well-being and performance.
  
  
  OBJECTIVE
  Building on the Job Demands-Resources model this study explores: (1) whether and how nurses' perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses' well-being and performance; and (2) whether and how team reflection influences nurses' perceptions.
  
  
  METHODS
  An embedded case study.
  
  
  METHODS
  Four surgical wards within three different acute teaching-hospital settings in the Netherlands.
  
  
  METHODS
  During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards.
  
  
  RESULTS
  The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses' well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses' well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the feedback to jointly reflect and analyse their performance and strategies will be able to better translate information about quality measurements into corrective behaviours, which may result in more positive perceptions of feedback on quality measurements among individual nurses.
  
  
  CONCLUSIONS
  To better understand the impact of feedback to nursing teams on quality measurements, we should take nurses' individual perceptions of this feedback into account. Supporting nursing teams in team reflection after them having received feedback on quality measurements may help in eliciting positive perceptions among nurses, and therewith create positive effects of feedback on both their well-being and performance.
authors: Canisius-Wilhelmina Hospital, PO Box 9015, NL-6500 GS Nijmegen, The Netherlands; Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, The Netherlands. Electronic address: s.giesbers@cwz.nl.
authors: A P M Suzanne
authors: AP
authors: Giesbers
authors: Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, The Netherlands. Electronic address: r.schouteten@fm.ru.nl.
authors: Roel L J
authors: RL
authors: Schouteten
authors: Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, The Netherlands. Electronic address: e.poutsma@fm.ru.nl.
authors: Erik
authors: E
authors: Poutsma
authors: Radboud University, Institute for Management Research, PO Box 9108, NL-6500 HK Nijmegen, The Netherlands; Open University of the Netherlands, School of Management, PO Box 2960, NL-6401 DL Heerlen, The Netherlands; Kingston University, Kingston Business School, Kingston Hill, Kingston upon Thames KT2 7LB, United Kingdom. Electronic address: b.vanderheijden@fm.ru.nl.
authors: Beatrice I J M
authors: BI
authors: van der Heijden
authors: KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000 Leuven, Belgium; Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands; Uppsala University, Department of Public Health and Caring Sciences, Box 256, 751 05 Uppsala, Sweden. Electronic address: theo.vanachterberg@kuleuven.be.
authors: Theo
authors: T
authors: van Achterberg
mesh_terms: D030141:Feedback, Psychological; D009726:Nurses / Q000523:psychology*; D009746:Nursing, Team; D010465:Perception; D011787:Quality of Health Care
keywords: Feedback; Healthcare; Hospitals; Motivating; Nursing; Quality improvement; Quality indicators; Team