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

Abstract

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, then interrogating 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: 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; 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 healthcare and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice.