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Amalgamation of Marginal Gains ( AMG ) as a potential system to deliver high‐quality fundamental nursing care: A qualitative analysis of interviews from high‐performance AMG sports and healthcare practitioners
Author(s) -
Pentecost Claire,
Richards David A.,
Frost Julia
Publication year - 2018
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.14186
Subject(s) - excellence , health care , nursing , quality (philosophy) , quality management , psychology , medicine , knowledge management , process management , computer science , business , operations management , engineering , management system , philosophy , epistemology , political science , law , economics , economic growth
Aims and objectives To investigate the components of the Amalgamation of Marginal Gains ( AMG ) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Background Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Design Qualitative interview study. Methods We undertook in‐depth interviews with healthcare and sports professionals experienced in AMG . We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory ( NPT ). We triangulated findings with AMG literature to develop an intervention logic model. Results We interviewed 20 AMG practitioners. AMG processes were as follows: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence‐based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. Conclusions We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice. Relevance to clinical practice The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials.