Identification of Critical to Quality Elements for Intensive Care Rounds by Kano Analysis

Pediatric cardiac intensive care unit rounds require high levels of efficiency in data transfer and decision making to achieve optimal performance. Traditional survey methods do not discriminate and prioritize effectively the elements of rounds essential to a provider. In this study, we describe our experience with a novel survey method (Kano analysis) to assess customers' (surgeons, intensivists, cardiologists, advanced practice nurses, and nurses) requirements from rounds.

A 26-point survey divided into 3 domains (presentation, decision, and process elements) was conducted among Pediatric Intensive Care Unit (PICU) providers. Based on the survey, attractive, must be, performance, indifferent, and reverse categories were identified using methods described in the literature. Average satisfaction and dissatisfaction coefficients and percentages of attractive and mandatory elements in subgroups were compared. Results from the quantitative analysis were charted on a categorization plane.

The survey was returned by all providers with 96% valid responses. The highest satisfaction coefficient in the presentation domain was for "one line statement about the patient" (0.76), in the decision domain "rhythm/anti-arrhythmics" (0.54), and in the process domain "reformatting presentation script" (0.77). The highest dissatisfaction gradients were for "overnight events" (-0.91), "rhythm/anti-arrhythmics" (-0.71), and "asking families to join rounds" (-0.49). Among the 5 subgroups, surgeons required the largest percentage of items as mandatory or attractive and had the highest dissatisfaction coefficients in all 3 categories.

Kano survey can provide rapid and precise actionable data to restructure a new process. Further research potentially also involving patients and families in the Kano survey may provide insight on patient-centered care models.