Effectiveness of quality improvement collaboratives in UK surgical settings and barriers and facilitators influencing their implementation: a systematic review and evidence synthesis

Abstract

BackgroundHigh-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear. This review assessed effectiveness of QICs in National Health Service (NHS) surgical settings, and identified factors that influenced implementation.MethodsA systematic search of MEDLINE and EMBASE, as well as grey literature, was conducted in January 2022 to identify evaluations of QICs in NHS surgical settings. Data were extracted on the intervention, setting, study results and factors that were identified as facilitators or barriers. These were coded using the Consolidated Framework for Implementation Research (CFIR). The quality of study reports was assessed using Quality Improvement Minimum Criteria Set.ResultsFifteen reports on 10 QICs met inclusion criteria. The evaluations used study designs of different strength, with one using a stepped-wedge randomised controlled trial (RCT). Eight studies reported the QIC had been successful in achieving their principal aims, which covered a mix of patient outcomes and process indicators. The study based on the RCT found the QIC was not successful (no improvement in patient outcomes). Each article reported a range of facilitators and barriers to effectiveness of implementation of the QIC, which were spread across the CFIR domains (intervention, outer setting, inner setting, individuals and process). There were few barriers reported in the intervention domain that related to the QIC. There was no clear relationship between numbers of facilitators and barriers reported and effectiveness.ConclusionsStudies have reported QICs to be effective in increasingly complex contexts, but their results must be treated with caution. The evaluations often used weak study designs and the quality of reports was variable. Evaluation with strong study design should be integral to future QICs.PROSPERO registration numberCRD42022324970.

Barriers and Facilitators to High-Volume Evidence-Based Innovation and Implementation in a Large, Community-Based Learning Health System

“…18 CFIR is a widely accepted framework for assessing barriers and facilitators of implementation. 7,10,[19][20][21][22][23][24][25][26] Its creation involved reviews of several hundred publications across multiple scienti c disciplines followed by the combination of different constructs into a single framework. 26 The current project utilized the full core CFIR framework, without a recently proposed six-element addendum regarding anticipated vs. actual outcomes.…”

“…34 However, most current implementation literature evaluates a single topic, a certain medical specialty setting, or, when characterizing multiple projects, may summarize disparate already-published single-topic data collected using different methods. 35,36,37,38,20,25,39 While useful for speci c efforts, this approach may not identify the common and generalizable domains attainable from using a consistent, prospective approach to data collection and mapping across multiple projects. In contrast, identifying common potentially modi able implementation facilitators and barriers across many project topics can enumerate the likely highest-yield systems-level topic areas relevant for strategic development of learning health systems.…”