A quality evaluation index system for sub-specialty management of operating rooms in China: based on the three-dimensional quality structure model

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Wang, R. Gong, J. Shen, Y. Ma, Q. Qian, Y. Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8371689/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective To develop an evaluation index system for assessing the management quality of sub-specialties in operating rooms across China. Methods This study employed a combination of literature review, semi-structured interviews, and the formulation of an initial version of the index system. The Delphi method was utilized to consult 22 Chinese experts, and the analytic hierarchy process was conducted using Yaahp 11.0 software to determine the weights of the indices. Results The effective recovery rates for the first and second rounds of expert consultation were 100% and 90.90%, respectively. The expert authority coefficients were 0.975 and 0.978, while the coefficient of variation (CV) values ranged from 0.00 to 0.30 and from 0.00 to 0.13. The Kendall harmony coefficients were 0.122 and 0.229, with P < 0.001. Ultimately, the management quality evaluation index system for the operating room sub-specialty comprises three first-level indicators, eight second-level indicators, and thirty third-level indicators, all exhibiting consistency coefficients (CR) of less than 0.1. Conclusion The developed quality evaluation index system for the sub-specialty management of operating rooms in China is highly scientific and reliable, serving as a reference for the standardized and refined management of operating room sub-specialties. Structure - Process - Result Operating Room Sub-specialty Quality Evaluation Indicator System Delphi Analytic Hierarchy Process Background As the primary technical unit for precise surgical interventions and emergency rescues within hospitals, the quality of operating room management significantly influences patient safety and the operational efficiency of the medical system. The National Health Commission of China explicitly outlines in the "Action Plan for Comprehensively Improving Medical Quality (2023–2025)" [ 1 ] and the "Action Plan for Enhancing Surgical Quality and Safety (2023–2025)" [ 2 ] the necessity of establishing a comprehensive risk prevention and control system, along with a dynamic quality improvement mechanism. These initiatives aim to advance the management of operating rooms toward more scientific and refined practices.In this context, the establishment of sub-specialties within the operating room, as an innovative management model aligned with the professional advancement of medical technology, is emerging as a crucial breakthrough for enhancing nursing quality both domestically and internationally. Globally, the sub-specialty system in operating rooms has developed into a mature model. In China[ 3 ], however, while tertiary hospitals typically implement sub-specialty grouping, significant challenges persist, including inadequate standardization efforts and a deficiency in quality control tools. This study, grounded in the internationally recognized Donabedian "structure-process-result" three-dimensional quality model [ 4 ], addresses the urgent need to develop an evaluation index system for managing sub-specialties within the operating room. This system aims to resolve the current challenge of inadequate quality management standards in sub-specialty administration by quantifying the structural dimension, standardizing the process dimension, and optimizing the result dimension. The findings will offer standardized evaluation tools for nursing managers, facilitate the implementation of a closed-loop management approach encompassing "specialized grouping - quality monitoring - continuous improvement," and enhance the quality of operating room nursing in China to align with international standards. Furthermore, this research not only aligns with China's national medical quality improvement strategy but also provides both theoretical support and practical guidance for establishing a sub-specialty management model for operating rooms that reflects Chinese characteristics [ 5 ]. Methods Study design This research was conducted through Delphi expert consultation. Sample and data collection A research team was formed, comprising two chief nurses and four deputy chief nurses, three of whom hold postgraduate degrees while three possess bachelor's degrees. Collectively, they have over 15 years of experience in operating room nursing. Their primary responsibilities include conducting literature retrieval, designing interview outlines, developing an initial pool of quality evaluation index items for sub-specialty management in the operating room, compiling expert consultation questionnaires, selecting consultation experts, implementing expert consultations, and organizing as well as statistically analyzing the results of expert inquiries. The preliminary construction of the management quality evaluation index system for the operating room sub-specialty involved a literature search utilizing the Chinese CNKI database. The search parameters included: (Subject: Operating Room Delphi) OR (Subject: Operating Room Sub-specialty) OR (Subject: Operating Room Structure - Process - Result) OR (Subject: Operating Room Indicators) OR (Subject: Operating Room Quality Evaluation) OR (Subject: Three-dimensional Quality of the Operating Room). Additionally, the source categories included Peking University Core and CSCD. The English search terms were "Sub-specialty of Operating Room/Quality Evaluation of Operating Room/Quality Standards of Operating Room/Structure Process Result/Three-dimensional Quality Evaluation/Delphi Expert Consultation." The search was conducted within the timeframe from January 2020 to January 2025 to assess the current status and trends in the quality evaluation of sub-specialty management in the operating room. The semi-structured interview utilized a purposive sampling method. A total of 10 nurses, each with over 15 years of experience in the operating room, including heads of operating room sub-specialties and nursing managers, were selected for the interviews. The interview outline was structured as follows: ① Structural level: What is your perception of the organizational structure of operating room sub-specialty management? What are the core elements of sub-specialty management in the operating room? ② Process level: What are the critical components in the management process of operating room sub-specialties? How should the evaluation indicators for sub-specialty management in operating rooms be differentiated from those used in conventional operating room management?③ Outcome Level: How is the effectiveness of sub-specialty management in the operating room assessed? What positive impacts does sub-specialty management have on the development of surgical nurses, nursing research, and the overall quality of nursing? Based on literature review and interview findings, the research group formulated an initial item pool for the management quality evaluation index system for operating room sub-specialties, which includes 3 first-level indicators, 9 second-level indicators, and 34 third-level indicators [ 6 ]. Instruments The expert consultation for developing management indicators for sub-specialties in the operating room involved the creation of an expert inquiry questionnaire. This questionnaire comprises four sections. ① Introduction: This section outlines the purpose, background, and guidelines for completing the research form. ② Expert Consultation Form: Utilizing a 5-point Likert scale, scores range from 1 to 5, indicating importance from "very unimportant" to "very important." Following each indicator, a column is provided for suggestions regarding "Indicator Modification/Addition/Deletion." ③ Basic Information of Experts: This section gathers data on experts' age, educational background, position, and professional title. ④ Expert Familiarity and Judgment Basis: Familiarity is rated on a five-point scale from "very unfamiliar" to "extremely familiar," with corresponding values of 0.2, 0.4, 0.8, and 1.0 points. Experts are asked to select their basis for judgment from four categories: practical experience, theoretical analysis, reference to domestic and foreign literature, and intuitive perception, with three levels of significance: "large," "medium," and "small." The selection of experts for consultation is derived from the members of the Operating Room Nursing Professional Committee of the Chinese Nursing Association. Experts are chosen from the six major regions defined by the national statistical geographical division: Northeast, North China, East China, South China, Northwest, Central South, and Southwest [ 7 ]. Each region will have a minimum of 2 to 4 experts. The inclusion criteria are as follows: ① a Bachelor's degree or higher; ② an associate senior professional title or above; ③ a minimum of 10 years of experience in operating room nursing; and ④ the ability to participate in the research throughout its entirety. In 2025, expert consultations will be conducted through WeChat and email. The initial round of inquiries spanned two weeks. Following the collection of questionnaires, the research team organized and analyzed the experts' scores and recommendations. The average importance score was ≤ 3.5 points, with a coefficient of variation (CV) exceeding 0.25. A full score ratio of ≤ 20% serves as an exclusion criterion [ 8 ], prompting modifications to the second round of expert consultation questionnaires. The interval between the two rounds of questionnaires is four weeks. After two rounds of inquiries via letter, the experts' opinions were largely consistent. Statistical methods Data analysis was performed using SPSS 26.0. Descriptive statistical methods were employed to assess the basic information of experts and the importance scores of each item. The average values of the experts' familiarity (Cs) and the basis for judgment (Ca) were used to calculate the experts' authority (Cr), defined as Cr = (Ca + Cs) / 2. The coefficient of variation (CV) and Kendall's W were utilized to evaluate the coordination and consistency of expert opinions. Additionally, the Yaahp 11.0 software facilitated the analytic hierarchy process (AHP) to determine the weights of indicators across all levels [ 9 ]. Results Basic Information of Experts: This study engaged a total of 22 experts from 18 provinces and municipalities across China, including Beijing, Tianjin, Zhejiang, Sichuan, Liaoning, and Guangxi. The cohort comprised 1 doctor (4.5%), 11 individuals with master's degrees (50%), and 10 individuals with bachelor's degrees (45.5%). Among the participants, there were 7 deputy directors or higher in the Nursing department (31.8%), 11 head nurses of departments (50%), and 4 head nurses of operating rooms (18.2%). Additionally, 14 were chief nurses (63.6%) and 8 were associate chief nurses (36.4%). The sample included 21 tertiary grade A general hospitals (95.5%) and 1 tertiary grade B specialized hospital (4.5%). The average age of the experts was (50.32 ± 5.52)years, and their average length of service in the operating room was (29.95 ± 6.59)years . In the initial round of expert engagement, 22 questionnaires were distributed, and all were successfully retrieved. In the subsequent round, 22 questionnaires were again distributed, yielding 20 returns. The effective recovery rates for the questionnaires were 100% and 90.90%, respectively. The two rounds of correspondence inquiries concerning expert authority yielded Ca values of 0.959 and 0.990, Cs values of 0.965 and 0.990, and Cr values of 0.975 and 0.978. Experts with Cr values of 0.70 or higher demonstrate a relatively high level of authority [ 10 ]. The consistency of expert opinions is assessed using the coefficient of variation (CV) and Kendall's coefficient of concordance (W) across various indicators. The coefficient of variation ranges for the first and second rounds were 0.00 to 0.30 and 0.00 to 0.13, respectively [ 11 ]. The degree of coordination among expert opinions is presented in Table 1 . Table 1 Degree of coordination of expert opinions Metric First round Second round Kendall's W value x 2 P Kendall's W value x 2 P Primary indicator 0.141 6.222 0.045 0.390 15.600 0.003 Secondary indicator 0.164 28.921 < 0.001 0.279 39.124 < 0.001 Third-level indicator 0.115 83.331 < 0.001 0.208 120.753 < 0.001 Ensemble 0.122 120.834 < 0.001 0.229 183.400 < 0.001 Following the initial round of expert consultation, adjustments were made based on the feedback received. One secondary indicator, "sub-specialty Nursing," was merged, two tertiary indicators were eliminated, and four tertiary indicators were consolidated into two. Specifically, ① "The operating room environment is clean and hygienic, meeting the requirements of hospital infection control" was deleted due to a coefficient of variation (CV) value exceeding 0.25; ② "A nursing process with complete sub-specialty characteristics and continuous optimization" was removed because it lacked a clear definition. Additionally, ③ "Be fully equipped with sub-specialty emergency drugs and equipment, and regularly check the expiration date of the drugs and the integrity of the equipment" and "Have complete sub-specialty surgical common equipment and specialized equipment, and regularly maintain and calibrate them to ensure good equipment performance" were merged into a single indicator: "Have complete sub-specialty surgical instruments, consumables, and equipment, along with comprehensive emergency plans and procedures for managing unexpected events."The phrases "Standardization, normalization and process orientation of sub-specialty nursing operations" and "nurses' proficiency in sub-specialty surgical nursing cooperation" have been consolidated into "Sub-specialty nurses' proficiency in sub-specialty surgical nursing cooperation, operation procedures, and the use of instruments and equipment." During the second round of inquiries, several experts provided suggestions for revising specific descriptive details. The Cronbach's α values for the two rounds of expert consultation questionnaires were 0.909 and 0.863, respectively, indicating a high level of intrinsic reliability for the indicators. Ultimately, an indicator system was established, comprising three first-level indicators, eight second-level indicators, and thirty third-level indicators (Table 2 ). The establishment of indicator weights utilized the Delphi method. Experts assessed the relative importance of each indicator and employed the Analytic Hierarchy Process (AHP) alongside the Yaahp 11.0 software to compute both the individual and combined weights of the indicators. The consistency coefficients (CR) were all below 0.1, indicating that the judgment matrix satisfied the consistency test, and the calculated weights were consistent [ 12 ]. Table 2 Quality Evaluation Index System for Operating Room Sub-specialty Management Metric Significance assignment (± s) Coefficient of variation (CV) Full score rate (%) Weight Combination weight 1 Structure 4.55 ± 0.50 0.11 55 0.3274 0.3274 1.1 Sub-specialty Organization Structure and Management 4.95 ± 0.22 0.04 60 0.7502 0.2456 1.1.1 It has a sound management system for sub-specialties, with well-defined workflows and operational protocols that are regularly updated and optimized. 5 0 100 0.2754 0.0676 1.1.2 Allocate nursing staff for subspecialty based on the number of operating rooms and surgical workload 4.95 ± 0.22 0.04 95 0.1624 0.0399 1.1.3 The head of a sub-specialty unit must hold a mid-level or higher professional title, have at least three years of experience in nursing coordination within the sub-specialty, and possess provincial-level or higher certification or training as a surgical unit specialist nurse. 5 0 100 0.2657 0.0653 1.1.4 The proportion of senior nurses in the subspecialty group should be ≥ 20%, and they should master subspecialty nursing skills. 4.75 ± 0.54 0.11 80 0.0893 0.0219 1.1.5 The entry criteria for nursing staff in the subspecialty group require at least 2 years of experience as operating room nurses. 4.60 ± 0.58 0.13 65 0.0389 0.0096 1.1.6 Regularly evaluate the outcomes of subspecialty nursing and establish a feedback mechanism 4.95 ± 0.22 0.04 95 0.1683 0.0413 1.2 Sub-specialty environment and equipment 4.45 ± 0.50 0.11 45 0.2498 0.0818 1.2.1 The layout of the specialized operating room is scientifically and reasonably designed, meeting the needs of sub-specialized surgeries. 4.90 ± 0.30 0.06 90 0.2420 0.0198 1.2.2 Equipped with comprehensive surgical instruments, consumables, and equipment for subspecialty procedures, along with a well-established emergency response plan and standardized procedures for incident management. 4.95 ± 0.22 0.04 95 0.7580 0.0620 2 Process 5 0 100 0.5640 0.5640 2.1 Quality of Sub-specialty Nursing 5 0 100 0.5579 0.3147 2.1.1 Sub-specialty nurses are proficient in coordinating surgical nursing, operating procedures, and using medical equipment. 4.95 ± 0.22 0.04 95 0.2806 0.0883 2.1.2 Sub-specialty nurses possess emergency response capabilities for sub-specialty emergencies 5 0 100 0.3218 0.1013 2.1.3 Improve the management system of infection control in subspecialty to prevent surgical site infection 4.90 ± 0.30 0.06 90 0.1613 0.0508 2.1.4 Establishing Sub-specialty Nursing Quality Sensitivity Indicators 4.90 ± 0.30 0.06 90 0.1601 0.0504 2.1.5 Application of quality management tools to implement continuous improvement projects in subspecialty nursing quality 4.70 ± 0.46 0.10 70 0.0761 0.0239 2.2 Education of Sub-specialty Nurses 4.70 ± 0.46 0.10 70 0.3301 0.1862 2.2.1 There are well-established training programs for subspecialty nursing and specialized work manuals, which are regularly updated. 5 0 100 0.5536 0.1031 2.2.2 Clear sub-specialty training assessment guidelines are established, with regular evaluations to ensure training quality. 4.75 ± 0.43 0.09 75 0.3293 0.0613 2.2.3 Encourage nurses to participate in domestic and international academic exchanges in subspecialty nursing to enhance their professional competence. 4.60 ± 0.49 0.11 60 0.1171 0.0218 2.3 Scientific Research and Innovation in Sub-specialty Nursing 4.40 ± 0.58 0.13 45 0.1119 0.0631 2.3.1 Implementing Sub-specialty Research Innovation Projects to Cultivate Research Competence of Sub-specialty Nurses 4.45 ± 0.50 0.11 45 0.2206 0.0139 2.3.2 Application of Scientific Research Achievements in Sub-specialty Nursing in Clinical Practice 4.45 ± 0.50 0.11 45 0.2291 0.0145 2.3.3 Conducting Sub-specialty Multidisciplinary or Cross-professional Exchange and Cooperation 4.60 ± 0.49 0.11 60 0.5503 0.0347 3 Results 4.40 ± 0.50 0.11 40 0.1086 0.1086 3.1 Safety Evaluation of Sub-specialty Nursing 4.95 ± 0.22 0.04 95 0.5587 0.0607 3.1.1 Sub-specialty nursing quality assessment, including the completeness rate of surgical instrument preparation, standardization rate of nursing procedures, accuracy rate of instrument transfer, and compliance rate of specialized equipment usage. 4.85 ± 0.48 0.10 90 0.3204 0.0194 3.1.2 Occurrence of adverse events in subspecialties 4.90 ± 0.30 0.06 90 0.5598 0.0340 3.1.3 Implementation of Sub-specialty Consumables Management Standards 4.60 ± 0.60 0.13 65 0.1198 0.0073 3.2 Satisfaction with subspecialty nursing services 4.55 ± 0.50 0.11 55 0.3265 0.0355 3.2.1 Patient satisfaction with the attitude and environment of subspecialty surgical nursing services 4.55 ± 0.50 0.11 55 0.1396 0.0050 3.2.2 Satisfaction of Sub-specialty Nurses with Work Environment, Team Collaboration, and Management Support 4.60 ± 0.49 0.11 60 0.3070 0.0109 3.2.3 Satisfaction of doctors with sub-specialty nurses in handwashing, round-the-clock cooperation, etc. 4.70 ± 0.46 0.10 70 0.4214 0.0150 3.2.4 Satisfaction of the surgical departments with the work of the operating room nurses 4.55 ± 0.50 0.11 55 0.1320 0.0046 3.3 Growth and Development of Sub-specialty Nurses 4.70 ± 0.46 0.10 70 0.1148 0.0125 3.3.1 Assessment of Sub-specialty Nursing Skills and Training Compliance 4.70 ± 0.46 0.10 70 0.4385 0.0055 3.3.2 Participation of Sub-specialty Nurses in Continuing Education and Professional Training 4.50 ± 0.59 0.13 55 0.3043 0.0038 3.3.3 Individual achievements of nurses in subspecialties 4.45 ± 0.59 0.13 50 0.0808 0.0010 3.3.4 Achievements of the Sub-specialty Team 4.60 ± 0.49 0.11 60 0.1764 0.0022 Discussion The significance, scientific rigor, and reliability of developing a quality evaluation index system for sub-specialty management in operating rooms are paramount. The trend of sub-specialty management within operating rooms has gained traction in recent years. However, current quality management evaluation standards for operating rooms do not include indicators tailored specifically for sub-specialty management. As a crucial component of overall operating room management, the establishment of a scientific, comprehensive, and systematic quality evaluation index system for sub-specialty management is essential. This study employed a three-dimensional quality model encompassing structure, process, and result. It integrated literature retrieval, semi-structured interviews, and the development of an initial version of the indicator system. To ensure the objectivity and scientific rigor of the indicator system, two rounds of expert consultations were conducted using the Delphi method [ 13 ]. In consideration of the geographical distribution across the country, 22 members of the Operating Room Professional Committee of the Chinese Nursing Association from 18 provinces and municipalities participated in the expert consultations. The expert authority coefficient (Cr) was 0.975 and 0.978, reflecting a high level of expert authority [ 14 ]. The Kendall's coefficient of conformity for the second round of expert inquiries was 0.229 (P < 0.001), with the average score for item importance ranging from 4.40 ± 0.50 to 5.00 points, and the coefficient of variation (CV) values ranged from 0.00 to 0.13, indicating a consensus among expert opinions [ 15 ].This study established a quality evaluation index system for the management of operating room sub-specialties, comprising three first-level indicators, eight second-level indicators, and thirty third-level indicators. The structural indicators, which include two secondary indicators and eight tertiary indicators, account for a combined weight of 0.327. The process indicators, consisting of three secondary indicators and eleven tertiary indicators, have a combined weight of 0.5640. Lastly, the outcome indicators, which include three secondary indicators and eleven tertiary indicators, contribute a combined weight of 0.1086. The weights of these indicators were determined using the Analytic Hierarchy Process (AHP), with consistency ratio (CR) values all less than 0.1, indicating that the weight distribution is reasonable, scientific, and objective. This evaluation index is both scientific and reliable [ 15 ]. Analysis of the Content of the Management Quality Evaluation System for the Operating Room Sub-specialty This study examines the operating room sub-specialty and provides insights into the qualifications of sub-specialty group leaders, assigning an importance score of 5 points and a full score rate of 100%. The leaders in this domain serve as a crucial link in advancing specialized practices, nursing quality, and team collaboration, thereby constituting the core of specialized nursing. Their contributions are vital for improving the overall nursing standards within specialized departments and enhancing patient satisfaction. Furthermore, "sub-specialty nurses possess the emergency response capabilities to address sub-specialty emergencies," which is also rated with an importance score of 5 points and a full score rate of 100%.The subdivision of specialized fields within the operating room allows specialized nurses to effectively enhance the efficiency of the medical team during emergencies. The research indicators encompass not only the quality of sub-specialty nursing (0.3147) but also the scientific research innovation of sub-specialty nursing (0.0651) and the growth and development of sub-specialty nurses (0.0125) as secondary evaluation metrics. Studies indicate a positive correlation between nurses' professional identity and their scientific research capabilities; specifically, an enhancement in professional identity corresponds with an improvement in scientific research ability [ 16 ]. The advancement of nursing research will augment nurses' knowledge of clinical services [ 17 ] and foster the ongoing development of the nursing profession. Nurse growth serves as a measure of an individual's career progression within a department and plays a crucial role in reducing turnover intention among nurses, stimulating their work enthusiasm, enhancing core competitiveness, and improving the quality and safety of nursing care [ 18 – 19 ].Emphasizing the development of nurses can enhance departmental cohesion and centripetal force. The assessment of the third-level indicator, the achievements of the Central Asia Specialized Team (0.0022), evaluates the overall strength and teamwork capabilities of the operating room sub-specialty. This evaluation serves to stimulate the enthusiasm and creativity of team members, thereby providing robust support for the department's continuous development [ 20 ]. The quality evaluation system for sub-specialty management in the operating room, constructed in this study, offers a comprehensive assessment based on indicators such as nursing quality, nursing education, nursing research, nurse development, and team achievements. This system provides a scientific foundation for optimizing the management of the operating room sub-specialty. Conclusions This study developed a management quality evaluation system for the operating room sub-specialty, utilizing a three-dimensional model encompassing structure, process, and result. The scientific rigor of the constructed index system was ensured through the Delphi expert consultation method and the Analytic Hierarchy Process. This evaluation system serves as a tool for operating room managers to assess the quality of sub-specialty management, allowing nursing staff to clearly comprehend the orientation and quality standards of their work. Such clarity fosters the advancement of sub-specialties within the operating room and permits adjustments based on actual conditions during implementation. In the future, we aim to further establish quality evaluation standards tailored to the unique characteristics of different sub-specialties. Limitation This study acknowledges several limitations. While progress has been made in developing the quality evaluation index system for sub-specialty management of operating rooms in China, notable constraints remain. First, there are sample limitations: the Delphi method consultation involved only 22 experts, resulting in a relatively small sample size. Additionally, the geographical distribution of these experts may not adequately reflect the diverse realities of operating room management across various regions and hospital tiers in the country, potentially affecting the generalizability of the index system.Secondly, there are methodological limitations: The research primarily depends on literature retrieval, semi-structured interviews, and the Delphi method to develop an index system. While these methods possess a degree of scientific rigor and reliability, they lack empirical validation. Furthermore, the index system has not been applied or tested in actual sub-specialty management scenarios within the operating room, rendering it impossible to assess its operability and effectiveness in practice. Declarations Acknowledgements The authors extend their heartfelt gratitude to all participants for their invaluable involvement and contributions to this study, with special thanks for their essential role in the data collection process. Author contributions Wang W. completed data statistics and manuscript writing, Gong R. summarized data, Ma Y. designed a questionnaire, Shen J. reviewed and analyzed literature, Qian Q. guided and reviewed the paper, and Sun Y. designed and reviewed the paper. Funding Special Research on Perioperative Nursing Quality Management of the Institute of Hospital Management, National Health Commission, Project Number NHAHL2522 Data availability The datasets used and analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate Ethical approval for this study was obtained from the institutional reviewboard of China-Japan Friendship Hospital. Informed consent was obtained from all participants in the online survey bypresenting a consent form. All methods were performed in accordance withthe relevant guidelines and regulations.Research was performed in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Nursing Department of Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai ,China; 2 Nursing Department of Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China; 3 Nursing Department of China-Japan Friendship Hospital, Beijing, China References National Health Commission, National Administration of Traditional Chinese Medicine. Notice on Carrying Out the Action to Comprehensively Improve Medical Quality (2023–2025) [EB/OL].(2023-05-29)[2024- 08-17].http://www.nhc.gov.cn/yzygj/s3585/ 202305/cfe6b26bce624b9f894cef021a363f3e.shtml. National Health Commission. Notice of the General Office of the National Health Commission on Printing and Distributing the Action Plan for Improving Surgical Quality and Safety. 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The Development and Implementation of a Model to Facilitate Self-Awareness of Professionalism for Enrolled Nurses. J Holist Nurs. 2023;41(4):377–93. https://doi.org/10.1177/08980101221134758 . Gifford WA, Squires JE, Angus DE, Ashley LA, Brosseau L, Craik JM, Domecq MC, Egan M, Holyoke P, Juergensen L, Wallin L, Wazni L, Graham ID. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implement Sci. 2018; 27;13(1):127. https://doi.org/10.1186/s13012-018-0817-7 Heydari N, Rakhshan M, Torabizadeh C, Salimi G. Research article Individual innovation from the perspective of nursing students: A qualitative study. BMC Nurs. 2023;22(1):163. https://doi.org/10.1186/s12912-023-01311-y . Additional Declarations No competing interests reported. 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The National Health Commission of China explicitly outlines in the \"Action Plan for Comprehensively Improving Medical Quality (2023\u0026ndash;2025)\" [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and the \"Action Plan for Enhancing Surgical Quality and Safety (2023\u0026ndash;2025)\" [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] the necessity of establishing a comprehensive risk prevention and control system, along with a dynamic quality improvement mechanism. These initiatives aim to advance the management of operating rooms toward more scientific and refined practices.In this context, the establishment of sub-specialties within the operating room, as an innovative management model aligned with the professional advancement of medical technology, is emerging as a crucial breakthrough for enhancing nursing quality both domestically and internationally. Globally, the sub-specialty system in operating rooms has developed into a mature model. In China[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], however, while tertiary hospitals typically implement sub-specialty grouping, significant challenges persist, including inadequate standardization efforts and a deficiency in quality control tools.\u003c/p\u003e \u003cp\u003eThis study, grounded in the internationally recognized Donabedian \"structure-process-result\" three-dimensional quality model [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], addresses the urgent need to develop an evaluation index system for managing sub-specialties within the operating room. This system aims to resolve the current challenge of inadequate quality management standards in sub-specialty administration by quantifying the structural dimension, standardizing the process dimension, and optimizing the result dimension. The findings will offer standardized evaluation tools for nursing managers, facilitate the implementation of a closed-loop management approach encompassing \"specialized grouping - quality monitoring - continuous improvement,\" and enhance the quality of operating room nursing in China to align with international standards. Furthermore, this research not only aligns with China's national medical quality improvement strategy but also provides both theoretical support and practical guidance for establishing a sub-specialty management model for operating rooms that reflects Chinese characteristics [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis research was conducted through Delphi expert consultation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample and data collection\u003c/h3\u003e\n\u003cp\u003eA research team was formed, comprising two chief nurses and four deputy chief nurses, three of whom hold postgraduate degrees while three possess bachelor's degrees. Collectively, they have over 15 years of experience in operating room nursing. Their primary responsibilities include conducting literature retrieval, designing interview outlines, developing an initial pool of quality evaluation index items for sub-specialty management in the operating room, compiling expert consultation questionnaires, selecting consultation experts, implementing expert consultations, and organizing as well as statistically analyzing the results of expert inquiries.\u003c/p\u003e \u003cp\u003eThe preliminary construction of the management quality evaluation index system for the operating room sub-specialty involved a literature search utilizing the Chinese CNKI database. The search parameters included: (Subject: Operating Room Delphi) OR (Subject: Operating Room Sub-specialty) OR (Subject: Operating Room Structure - Process - Result) OR (Subject: Operating Room Indicators) OR (Subject: Operating Room Quality Evaluation) OR (Subject: Three-dimensional Quality of the Operating Room). Additionally, the source categories included Peking University Core and CSCD. The English search terms were \"Sub-specialty of Operating Room/Quality Evaluation of Operating Room/Quality Standards of Operating Room/Structure Process Result/Three-dimensional Quality Evaluation/Delphi Expert Consultation.\" The search was conducted within the timeframe from January 2020 to January 2025 to assess the current status and trends in the quality evaluation of sub-specialty management in the operating room.\u003c/p\u003e \u003cp\u003eThe semi-structured interview utilized a purposive sampling method. A total of 10 nurses, each with over 15 years of experience in the operating room, including heads of operating room sub-specialties and nursing managers, were selected for the interviews. The interview outline was structured as follows: ① Structural level: What is your perception of the organizational structure of operating room sub-specialty management? What are the core elements of sub-specialty management in the operating room? ② Process level: What are the critical components in the management process of operating room sub-specialties? How should the evaluation indicators for sub-specialty management in operating rooms be differentiated from those used in conventional operating room management?③ Outcome Level: How is the effectiveness of sub-specialty management in the operating room assessed? What positive impacts does sub-specialty management have on the development of surgical nurses, nursing research, and the overall quality of nursing? Based on literature review and interview findings, the research group formulated an initial item pool for the management quality evaluation index system for operating room sub-specialties, which includes 3 first-level indicators, 9 second-level indicators, and 34 third-level indicators [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eThe expert consultation for developing management indicators for sub-specialties in the operating room involved the creation of an expert inquiry questionnaire. This questionnaire comprises four sections. ① Introduction: This section outlines the purpose, background, and guidelines for completing the research form. ② Expert Consultation Form: Utilizing a 5-point Likert scale, scores range from 1 to 5, indicating importance from \"very unimportant\" to \"very important.\" Following each indicator, a column is provided for suggestions regarding \"Indicator Modification/Addition/Deletion.\" ③ Basic Information of Experts: This section gathers data on experts' age, educational background, position, and professional title. ④ Expert Familiarity and Judgment Basis: Familiarity is rated on a five-point scale from \"very unfamiliar\" to \"extremely familiar,\" with corresponding values of 0.2, 0.4, 0.8, and 1.0 points. Experts are asked to select their basis for judgment from four categories: practical experience, theoretical analysis, reference to domestic and foreign literature, and intuitive perception, with three levels of significance: \"large,\" \"medium,\" and \"small.\"\u003c/p\u003e \u003cp\u003eThe selection of experts for consultation is derived from the members of the Operating Room Nursing Professional Committee of the Chinese Nursing Association. Experts are chosen from the six major regions defined by the national statistical geographical division: Northeast, North China, East China, South China, Northwest, Central South, and Southwest [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Each region will have a minimum of 2 to 4 experts. The inclusion criteria are as follows: ① a Bachelor's degree or higher; ② an associate senior professional title or above; ③ a minimum of 10 years of experience in operating room nursing; and ④ the ability to participate in the research throughout its entirety.\u003c/p\u003e \u003cp\u003eIn 2025, expert consultations will be conducted through WeChat and email. The initial round of inquiries spanned two weeks. Following the collection of questionnaires, the research team organized and analyzed the experts' scores and recommendations. The average importance score was \u0026le;\u0026thinsp;3.5 points, with a coefficient of variation (CV) exceeding 0.25. A full score ratio of \u0026le;\u0026thinsp;20% serves as an exclusion criterion [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], prompting modifications to the second round of expert consultation questionnaires. The interval between the two rounds of questionnaires is four weeks. After two rounds of inquiries via letter, the experts' opinions were largely consistent.\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eData analysis was performed using SPSS 26.0. Descriptive statistical methods were employed to assess the basic information of experts and the importance scores of each item. The average values of the experts' familiarity (Cs) and the basis for judgment (Ca) were used to calculate the experts' authority (Cr), defined as Cr = (Ca\u0026thinsp;+\u0026thinsp;Cs) / 2. The coefficient of variation (CV) and Kendall's W were utilized to evaluate the coordination and consistency of expert opinions. Additionally, the Yaahp 11.0 software facilitated the analytic hierarchy process (AHP) to determine the weights of indicators across all levels [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBasic Information of Experts: This study engaged a total of 22 experts from 18 provinces and municipalities across China, including Beijing, Tianjin, Zhejiang, Sichuan, Liaoning, and Guangxi. The cohort comprised 1 doctor (4.5%), 11 individuals with master's degrees (50%), and 10 individuals with bachelor's degrees (45.5%). Among the participants, there were 7 deputy directors or higher in the Nursing department (31.8%), 11 head nurses of departments (50%), and 4 head nurses of operating rooms (18.2%). Additionally, 14 were chief nurses (63.6%) and 8 were associate chief nurses (36.4%). The sample included 21 tertiary grade A general hospitals (95.5%) and 1 tertiary grade B specialized hospital (4.5%). The average age of the experts was (50.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52)years, and their average length of service in the operating room was (29.95\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59)years .\u003c/p\u003e \u003cp\u003eIn the initial round of expert engagement, 22 questionnaires were distributed, and all were successfully retrieved. In the subsequent round, 22 questionnaires were again distributed, yielding 20 returns. The effective recovery rates for the questionnaires were 100% and 90.90%, respectively. The two rounds of correspondence inquiries concerning expert authority yielded Ca values of 0.959 and 0.990, Cs values of 0.965 and 0.990, and Cr values of 0.975 and 0.978. Experts with Cr values of 0.70 or higher demonstrate a relatively high level of authority [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The consistency of expert opinions is assessed using the coefficient of variation (CV) and Kendall's coefficient of concordance (W) across various indicators. The coefficient of variation ranges for the first and second rounds were 0.00 to 0.30 and 0.00 to 0.13, respectively [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The degree of coordination among expert opinions is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDegree of coordination of expert opinions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFirst round\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eSecond round\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eKendall's W\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eKendall's W\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary indicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary indicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-level indicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e120.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnsemble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFollowing the initial round of expert consultation, adjustments were made based on the feedback received. One secondary indicator, \"sub-specialty Nursing,\" was merged, two tertiary indicators were eliminated, and four tertiary indicators were consolidated into two. Specifically, ① \"The operating room environment is clean and hygienic, meeting the requirements of hospital infection control\" was deleted due to a coefficient of variation (CV) value exceeding 0.25; ② \"A nursing process with complete sub-specialty characteristics and continuous optimization\" was removed because it lacked a clear definition. Additionally, ③ \"Be fully equipped with sub-specialty emergency drugs and equipment, and regularly check the expiration date of the drugs and the integrity of the equipment\" and \"Have complete sub-specialty surgical common equipment and specialized equipment, and regularly maintain and calibrate them to ensure good equipment performance\" were merged into a single indicator: \"Have complete sub-specialty surgical instruments, consumables, and equipment, along with comprehensive emergency plans and procedures for managing unexpected events.\"The phrases \"Standardization, normalization and process orientation of sub-specialty nursing operations\" and \"nurses' proficiency in sub-specialty surgical nursing cooperation\" have been consolidated into \"Sub-specialty nurses' proficiency in sub-specialty surgical nursing cooperation, operation procedures, and the use of instruments and equipment.\" During the second round of inquiries, several experts provided suggestions for revising specific descriptive details. The Cronbach's α values for the two rounds of expert consultation questionnaires were 0.909 and 0.863, respectively, indicating a high level of intrinsic reliability for the indicators. Ultimately, an indicator system was established, comprising three first-level indicators, eight second-level indicators, and thirty third-level indicators (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe establishment of indicator weights utilized the Delphi method. Experts assessed the relative importance of each indicator and employed the Analytic Hierarchy Process (AHP) alongside the Yaahp 11.0 software to compute both the individual and combined weights of the indicators. The consistency coefficients (CR) were all below 0.1, indicating that the judgment matrix satisfied the consistency test, and the calculated weights were consistent [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuality Evaluation Index System for Operating Room Sub-specialty Management\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance assignment \u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e(\u0026plusmn;\u0026thinsp;s)\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoefficient of variation (CV)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFull score rate (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCombination weight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1 Structure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.1 Sub-specialty Organization Structure and Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.7502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.2456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.1 It has a sound management system for sub-specialties, with well-defined workflows and operational protocols that are regularly updated and optimized.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.2 Allocate nursing staff for subspecialty based on the number of operating rooms and surgical workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.3 The head of a sub-specialty unit must hold a mid-level or higher professional title, have at least three years of experience in nursing coordination within the sub-specialty, and possess provincial-level or higher certification or training as a surgical unit specialist nurse.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0653\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.4 The proportion of senior nurses in the subspecialty group should be \u0026ge;\u0026thinsp;20%, and they should master subspecialty nursing skills.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.5 The entry criteria for nursing staff in the subspecialty group require at least 2 years of experience as operating room nurses.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.6 Regularly evaluate the outcomes of subspecialty nursing and establish a feedback mechanism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.2 Sub-specialty environment and equipment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.1 The layout of the specialized operating room is scientifically and reasonably designed, meeting the needs of sub-specialized surgeries.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.2 Equipped with comprehensive surgical instruments, consumables, and equipment for subspecialty procedures, along with a well-established emergency response plan and standardized procedures for incident management.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.7580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 Process\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.5640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.1 Quality of Sub-specialty Nursing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.1 Sub-specialty nurses are proficient in coordinating surgical nursing, operating procedures, and using medical equipment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0883\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.2 Sub-specialty nurses possess emergency response capabilities for sub-specialty emergencies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.3 Improve the management system of infection control in subspecialty to prevent surgical site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.4 Establishing Sub-specialty Nursing Quality Sensitivity Indicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.5 Application of quality management tools to implement continuous improvement projects in subspecialty nursing quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.2 Education of Sub-specialty Nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.1 There are well-established training programs for subspecialty nursing and specialized work manuals, which are regularly updated.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.2 Clear sub-specialty training assessment guidelines are established, with regular evaluations to ensure training quality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.3 Encourage nurses to participate in domestic and international academic exchanges in subspecialty nursing to enhance their professional competence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.3 Scientific Research and Innovation in Sub-specialty Nursing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.1 Implementing Sub-specialty Research Innovation Projects to Cultivate Research Competence of Sub-specialty Nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.2 Application of Scientific Research Achievements in Sub-specialty Nursing in Clinical Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.3 Conducting Sub-specialty Multidisciplinary or Cross-professional Exchange and Cooperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3 Results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.1086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.1 Safety Evaluation of Sub-specialty Nursing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.1 Sub-specialty nursing quality assessment, including the completeness rate of surgical instrument preparation, standardization rate of nursing procedures, accuracy rate of instrument transfer, and compliance rate of specialized equipment usage.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.2 Occurrence of adverse events in subspecialties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.3 Implementation of Sub-specialty Consumables Management Standards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.2 Satisfaction with subspecialty nursing services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.1 Patient satisfaction with the attitude and environment of subspecialty surgical nursing services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.2 Satisfaction of Sub-specialty Nurses with Work Environment, Team Collaboration, and Management Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.3 Satisfaction of doctors with sub-specialty nurses in handwashing, round-the-clock cooperation, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.4 Satisfaction of the surgical departments with the work of the operating room nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.3 Growth and Development of Sub-specialty Nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3.1 Assessment of Sub-specialty Nursing Skills and Training Compliance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3.2 Participation of Sub-specialty Nurses in Continuing Education and Professional Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3.3 Individual achievements of nurses in subspecialties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3.4 Achievements of the Sub-specialty Team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe significance, scientific rigor, and reliability of developing a quality evaluation index system for sub-specialty management in operating rooms are paramount. The trend of sub-specialty management within operating rooms has gained traction in recent years. However, current quality management evaluation standards for operating rooms do not include indicators tailored specifically for sub-specialty management. As a crucial component of overall operating room management, the establishment of a scientific, comprehensive, and systematic quality evaluation index system for sub-specialty management is essential.\u003c/p\u003e \u003cp\u003eThis study employed a three-dimensional quality model encompassing structure, process, and result. It integrated literature retrieval, semi-structured interviews, and the development of an initial version of the indicator system. To ensure the objectivity and scientific rigor of the indicator system, two rounds of expert consultations were conducted using the Delphi method [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In consideration of the geographical distribution across the country, 22 members of the Operating Room Professional Committee of the Chinese Nursing Association from 18 provinces and municipalities participated in the expert consultations. The expert authority coefficient (Cr) was 0.975 and 0.978, reflecting a high level of expert authority [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The Kendall's coefficient of conformity for the second round of expert inquiries was 0.229 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the average score for item importance ranging from 4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50 to 5.00 points, and the coefficient of variation (CV) values ranged from 0.00 to 0.13, indicating a consensus among expert opinions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].This study established a quality evaluation index system for the management of operating room sub-specialties, comprising three first-level indicators, eight second-level indicators, and thirty third-level indicators. The structural indicators, which include two secondary indicators and eight tertiary indicators, account for a combined weight of 0.327. The process indicators, consisting of three secondary indicators and eleven tertiary indicators, have a combined weight of 0.5640. Lastly, the outcome indicators, which include three secondary indicators and eleven tertiary indicators, contribute a combined weight of 0.1086. The weights of these indicators were determined using the Analytic Hierarchy Process (AHP), with consistency ratio (CR) values all less than 0.1, indicating that the weight distribution is reasonable, scientific, and objective. This evaluation index is both scientific and reliable [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnalysis of the Content of the Management Quality Evaluation System for the Operating Room Sub-specialty This study examines the operating room sub-specialty and provides insights into the qualifications of sub-specialty group leaders, assigning an importance score of 5 points and a full score rate of 100%. The leaders in this domain serve as a crucial link in advancing specialized practices, nursing quality, and team collaboration, thereby constituting the core of specialized nursing. Their contributions are vital for improving the overall nursing standards within specialized departments and enhancing patient satisfaction. Furthermore, \"sub-specialty nurses possess the emergency response capabilities to address sub-specialty emergencies,\" which is also rated with an importance score of 5 points and a full score rate of 100%.The subdivision of specialized fields within the operating room allows specialized nurses to effectively enhance the efficiency of the medical team during emergencies. The research indicators encompass not only the quality of sub-specialty nursing (0.3147) but also the scientific research innovation of sub-specialty nursing (0.0651) and the growth and development of sub-specialty nurses (0.0125) as secondary evaluation metrics. Studies indicate a positive correlation between nurses' professional identity and their scientific research capabilities; specifically, an enhancement in professional identity corresponds with an improvement in scientific research ability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The advancement of nursing research will augment nurses' knowledge of clinical services [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and foster the ongoing development of the nursing profession. Nurse growth serves as a measure of an individual's career progression within a department and plays a crucial role in reducing turnover intention among nurses, stimulating their work enthusiasm, enhancing core competitiveness, and improving the quality and safety of nursing care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].Emphasizing the development of nurses can enhance departmental cohesion and centripetal force. The assessment of the third-level indicator, the achievements of the Central Asia Specialized Team (0.0022), evaluates the overall strength and teamwork capabilities of the operating room sub-specialty. This evaluation serves to stimulate the enthusiasm and creativity of team members, thereby providing robust support for the department's continuous development [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The quality evaluation system for sub-specialty management in the operating room, constructed in this study, offers a comprehensive assessment based on indicators such as nursing quality, nursing education, nursing research, nurse development, and team achievements. This system provides a scientific foundation for optimizing the management of the operating room sub-specialty.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study developed a management quality evaluation system for the operating room sub-specialty, utilizing a three-dimensional model encompassing structure, process, and result. The scientific rigor of the constructed index system was ensured through the Delphi expert consultation method and the Analytic Hierarchy Process. This evaluation system serves as a tool for operating room managers to assess the quality of sub-specialty management, allowing nursing staff to clearly comprehend the orientation and quality standards of their work. Such clarity fosters the advancement of sub-specialties within the operating room and permits adjustments based on actual conditions during implementation. In the future, we aim to further establish quality evaluation standards tailored to the unique characteristics of different sub-specialties.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eThis study acknowledges several limitations. While progress has been made in developing the quality evaluation index system for sub-specialty management of operating rooms in China, notable constraints remain. First, there are sample limitations: the Delphi method consultation involved only 22 experts, resulting in a relatively small sample size. Additionally, the geographical distribution of these experts may not adequately reflect the diverse realities of operating room management across various regions and hospital tiers in the country, potentially affecting the generalizability of the index system.Secondly, there are methodological limitations: The research primarily depends on literature retrieval, semi-structured interviews, and the Delphi method to develop an index system. While these methods possess a degree of scientific rigor and reliability, they lack empirical validation. Furthermore, the index system has not been applied or tested in actual sub-specialty management scenarios within the operating room, rendering it impossible to assess its operability and effectiveness in practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their heartfelt gratitude to all participants for their invaluable involvement and contributions to this study, with special thanks for their essential role in the data collection process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWang W. completed data statistics and manuscript writing, Gong R. summarized data, Ma Y. designed a questionnaire, Shen J. reviewed and analyzed literature, Qian Q. guided and reviewed the paper, and Sun Y. designed and reviewed the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpecial Research on Perioperative Nursing Quality Management of the Institute of Hospital Management, National Health Commission, Project Number NHAHL2522\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the institutional reviewboard of China-Japan Friendship Hospital. Informed consent was obtained from all participants in the online survey bypresenting a consent form. All methods were performed in accordance withthe relevant guidelines and regulations.Research was performed in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Nursing Department of Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai ,China;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2 Nursing Department of Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China; 3 Nursing Department of China-Japan Friendship Hospital, Beijing, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Health Commission, National Administration of Traditional Chinese Medicine. 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BMC Nurs. 2023;22(1):163. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12912-023-01311-y\u003c/span\u003e\u003cspan address=\"10.1186/s12912-023-01311-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Structure - Process - Result, Operating Room Sub-specialty, Quality Evaluation, Indicator System, Delphi, Analytic Hierarchy Process","lastPublishedDoi":"10.21203/rs.3.rs-8371689/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8371689/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo develop an evaluation index system for assessing the management quality of sub-specialties in operating rooms across China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed a combination of literature review, semi-structured interviews, and the formulation of an initial version of the index system. The Delphi method was utilized to consult 22 Chinese experts, and the analytic hierarchy process was conducted using Yaahp 11.0 software to determine the weights of the indices.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe effective recovery rates for the first and second rounds of expert consultation were 100% and 90.90%, respectively. The expert authority coefficients were 0.975 and 0.978, while the coefficient of variation (CV) values ranged from 0.00 to 0.30 and from 0.00 to 0.13. The Kendall harmony coefficients were 0.122 and 0.229, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Ultimately, the management quality evaluation index system for the operating room sub-specialty comprises three first-level indicators, eight second-level indicators, and thirty third-level indicators, all exhibiting consistency coefficients (CR) of less than 0.1.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe developed quality evaluation index system for the sub-specialty management of operating rooms in China is highly scientific and reliable, serving as a reference for the standardized and refined management of operating room sub-specialties.\u003c/p\u003e","manuscriptTitle":"A quality evaluation index system for sub-specialty management of operating rooms in China: based on the three-dimensional quality structure model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 18:29:18","doi":"10.21203/rs.3.rs-8371689/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-13T18:45:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268673554737909497443043043792024239287","date":"2026-01-22T16:59:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-16T10:51:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T02:24:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-22T07:33:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-20T09:53:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-20T09:47:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bfd9caf4-7268-4027-a35c-69bb1e74241a","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-20T18:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 18:29:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8371689","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8371689","identity":"rs-8371689","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}