Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations

Griffin, Ann; McKeown, Alex; Viney, Rowena; Rich, Antonia; Welland, Trevor; Gafson, Irene; Woolf, Katherine

doi:10.1136/bmjopen-2016-014121

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…Only one study used elements of the Model for Understanding Success in Quality (MUSIQ) framework within their description of context [49]. Within this definition the setting and environment are noted to be distinct features with leadership listed as an additional factor.…”

Section: Listing Contextual Factorsmentioning

confidence: 99%

Defining and assessing context in healthcare implementation studies: a systematic review

Rogers

Brún

McAuliffe

2020

BMC Health Serv Res

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Background: The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. Methods: Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. Results: Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). Conclusions: This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.

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Section: Listing Contextual Factorsmentioning

confidence: 99%

Defining and assessing context in healthcare implementation studies: a systematic review

Rogers

Brún

McAuliffe

2020

BMC Health Serv Res

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“…Moreover, the role of self-assessment24 posed a number of challenges in relation to purpose and autonomy. While institutional self-assessments can positively influence reactions to drive quality improvement, there are issues with validity, reliability and internal quality review 19 24–27…”

Section: Discussionmentioning

confidence: 99%

“…Prior to analysis, individual members completed a written reflexive exercise which highlighted prior dispositions towards the research, and were then discussed collectively. The team consisted of practitioners, academics and researchers from medical and social science background disciplines, with QA knowledge ranging novice-expert 19. Team members were vastly experienced in qualitative methods20 21 and had previously applied a realist lens to understand complex interventions in healthcare education 22…”

Section: Methodsmentioning

confidence: 99%

Realist evaluation of UK medical education quality assurance

Crampton

Mehdizadeh²,

Page³

et al. 2019

BMJ Open

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ObjectivesThe aim of the study was to explore what components of the General Medical Council’s (GMC) Quality Assurance Framework work, for whom, in what circumstances and how?SettingUK undergraduate and postgraduate medical education and training.ParticipantsWe conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine.InterventionThe GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis.ResultsAcross components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC’s framework was commended for being comprehensive and enabling a broad understanding of an organisation’s performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness.ConclusionsThis realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC’s approach to quality assurance which impacts on all medical students and doctors in training.

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“…It has been used in high-income settings to understand the context around QI projects in a paediatric hospital, a state QI collaborative, verification visits to healthcare organisations and an improvement advisor training programme. 35 36 …”

Section: Methodsmentioning

confidence: 99%

Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings

et al. 2021

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ObjectivesTo describe critical features of the Ethiopian Pediatric Society (EPS) Quality Improvement (QI) Initiative and to present formative research on mentor models.SettingGeneral and referral hospitals in the Addis Ababa area of Ethiopia.ParticipantsEighteen hospitals selected for proximity to the EPS headquarters, prior participation in a recent newborn care training cascade and minimal experience with QI.InterventionsEducation in QI in a 2-hour workshop setting followed by implementation of a facility-based QI project with the support of virtual mentorship or in-person mentorship.Primary and secondary outcome measuresPrimary outcome—QI progress, measured using an adapted Institute for Healthcare Improvement Scale; secondary outcome—contextual factors affecting QI success as measured by the Model for Understanding Success in Quality.ResultsThe dose and nature of mentoring encounters differed based on a virtual versus in-person mentoring approach. All QI teams conducted at least one large-scale change. Education of staff was the most common change implemented in both groups. We did not identify contextual factors that predicted greater QI progress.ConclusionsThe EPS QI Initiative demonstrates that education in QI paired with external mentorship can support implementation of QI in low-resource settings. This pragmatic approach to facility-based QI may be a scalable strategy for improving newborn care and outcomes. Further research is needed on the most appropriate instruments for measuring contextual factors in low/middle-income country settings.

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Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations

Cited by 8 publications

References 17 publications

Defining and assessing context in healthcare implementation studies: a systematic review

Defining and assessing context in healthcare implementation studies: a systematic review

Realist evaluation of UK medical education quality assurance

Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings

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