Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice?

Mandel, Keith E; Cady, Steven H.

doi:10.1136/bmjqs-2021-014447

Cited by 6 publications

(9 citation statements)

References 39 publications

(74 reference statements)

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“… 9 Improvement initiatives are not without costs – the addition of extra tasks for staff without clear rationale and obvious benefit, may further contribute to staff burden at a time in which burnout is prevalent across the workforce. 10 The need to provide enhanced performance data whilst within the programme, uses up further resources especially when the organisation has limited power and capacity to change the drivers of key performance indicators. Entering an improvement regime has wide-ranging impacts for NHS organisations.…”

Section: Why Do National Improvement Programmes Struggle To Deliver I...mentioning

confidence: 99%

The Evolution of External Healthcare Regulation in England; From Performance Oversight to Supporting Improvement; Comment on "The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations"

Lalani

Hogan

2023

Int J Health Policy Manag

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The Special Measures and Challenged Provider (SMCP) Regime introduced for struggling healthcare organisations in England represents a subtle shift to the scope of external regulation from performance oversight to include supporting internal service improvement. External regulation alone has a had a mixed impact on the quality of care and Vindrola-Padros et al’s study highlights that externally driven improvement initiatives may also struggle to succeed in turning around performance. Principally, this is due to a failure in acknowledgment that poor performance results from a myriad of external and internal factors which coalesce to impede organisational performance. A struggling organisation may be indicative of wider issues in the local health and care system. Whole systems approaches to improvement with collaboration across providers and the effective use of data may support struggling organisations but their role maybe tempered with the increased centralisation of the delivery of improvement regimes such as SMCP.

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Section: Why Do National Improvement Programmes Struggle To Deliver I...mentioning

confidence: 99%

The Evolution of External Healthcare Regulation in England; From Performance Oversight to Supporting Improvement; Comment on "The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations"

Lalani

Hogan

2023

Int J Health Policy Manag

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“…In this month's edition, Mandel and Cady draw on organisational change theories to argue that quality improvement (QI), as currently deployed, is self-limiting. 1 In other words, if left untamed it will fail to produce valuable change and may have a raft of negative consequences, including stress, reduced engagement and burnout among healthcare staff. While acknowledging that some improvement methods (eg, appreciative inquiry, positive deviance) do address the emotional experience of staff as well as their performance, and focus on socio-behavioural (teamwork, cultures, etc) as well as processtechnical design elements, Mandel and Cady call for these to be explicit elements of all healthcare QI initiatives.…”

mentioning

confidence: 99%

“…We argue here that this article represents a theoretical framing for messages that ring loud throughout the QI and safety literature. These linked messages are (1) additive change means asking staff to do more and more, potentially creating safety clutter, and (2) improvement initiatives can have negative as well as positive consequences, including for staff. Unless we address 1 and 2, QI might inadvertently increase staff burnout.…”

mentioning

confidence: 99%

“…In this month’s edition, Mandel and Cady draw on organisational change theories to argue that quality improvement (QI), as currently deployed, is self-limiting 1. In other words, if left untamed it will fail to produce valuable change and may have a raft of negative consequences, including stress, reduced engagement and burnout among healthcare staff.…”

mentioning

confidence: 99%

“…As noted by Mandel and Cady,1 leaders must pay attention to the impact of QI projects on staff well-being to prevent burnout and turnover, and to maintain and improve quality and safety.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff?

Lawton

Thomas

2022

BMJ Qual Saf

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Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals’ experiences after 3 years, including the COVID-19 pandemic period

et al. 2023

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ObjectivesUnsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross (GC) method is a user-friendly incident reporting method that incorporates daily safety briefings to support healthcare professionals in their daily patient safety work. Thus, this study aimed to describe healthcare professionals’ experiences with the GC method in a PACU setting 3 years after its implementation, including the period of the coronavirus disease 2019 pandemic’s three waves.DesignAn inductive, descriptive qualitative study was conducted. The data were analysed using qualitative content analysis.SettingThe study was conducted at a PACU of a university hospital in South-Eastern Norway.ParticipantsFive semistructured focus group interviews were conducted in March and April 2022. The informants (n=23) were PACU nurses (n=18) and collaborative healthcare professionals (n=5) including physicians, nurses and a pharmacist.ResultsThe theme ‘still active, but in need of revitalisation’ was created, describing the healthcare professionals’ experiences with the GC method, 3 years post implementation. The following five categories were found: ‘continuing to facilitate open communication’, ‘expressing a desire for more interprofessional collaboration regarding improvements’, ‘increasing reluctance to report’, ‘downscaling due to the pandemic’ and ‘expressing a desire to share more of what went well’.ConclusionsThis study offers information regarding the healthcare professionals’ experiences with the GC method in a PACU setting; further, it deepens the understanding of the daily patient safety work using this incident reporting method.

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Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice?

Cited by 6 publications

References 39 publications

Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff?

Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals’ experiences after 3 years, including the COVID-19 pandemic period

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