Sustaining improvement of hospital-wide initiative for patient safety and quality: a systematic scoping review

Abstract

BackgroundLong-term sustained improvement following implementation of hospital-wide quality and safety initiatives is not easily achieved. Comprehensive theoretical and practical understanding of how gained improvements can be sustained to benefit safe and high-quality care is needed. This review aimed to identify enabling and hindering factors and their contributions to improvement sustainability from hospital-wide change to enhance patient safety and quality.MethodsA systematic scoping review method was used. Searched were peer-reviewed published records on PubMed, Scopus, World of Science, CINAHL, Health Business Elite, Health Policy Reference Centre and Cochrane Library and grey literature. Review inclusion criteria included contemporary (2010 and onwards), empirical factors to improvement sustainability evaluated after the active implementation, hospital(s) based in the western Organisation for Economic Co-operation and Development countries. Numerical and thematic analyses were undertaken.Results17 peer-reviewed papers were reviewed. Improvement and implementation approaches were predominantly adopted to guide change. Less than 6 in 10 (53%) of reviewed papers included a guiding framework/model, none with a demonstrated focus on improvement sustainability. With an evaluation time point of 4.3 years on average, 62 factors to improvement sustainability were identified and emerged into three overarching themes: People, Process and Organisational Environment. These entailed, as subthemes, actors and their roles; planning, execution and maintenance of change; and internal contexts that enabled sustainability. Well-coordinated change delivery, customised local integration and continued change effort were three most critical elements. Mechanisms between identified factors emerged in the forms of Influence and Action towards sustained improvement.ConclusionsThe findings map contemporary empirical factors and their mechanisms towards change sustainability from a hospital-wide initiative to improve patient safety and quality. The identified factors and mechanisms extend current theoretical and empirical knowledgebases of sustaining improvement particularly with those beyond the active implementation. The provided conceptual framework offers an empirically evidenced and actionable guide to assist sustainable organisational change in hospital settings.

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography

“…Despite the progress reported in academic research ( Moon et al, 2022 ), patient safety is less than ideal, particularly for people experiencing dementia in hospital ( Smyth et al, 2021 ; Wright & Singh, 2022 ). Patient safety continues to be hindered by myriad factors ( Emanuel et al, 2005 ; Gandhi et al, 2018 ).…”

Looking Back, Looking Forward: A Study Protocol for a Mixed-Methods Multiple-Case Study to Examine Improvement Sustainability of Large-Scale Initiatives in Tertiary Hospitals

“…Therefore, we will stratify participants into homogenous role groups to allow exploration of unique perspectives on initiative implementation and improvement sustainability across role variations (Table 2). Role stratification helps to capture the distinctive roles of the healthcare workforce at different levels of hierarchy to achieve and sustain improvement [4,39,55]. The total number of interview participants will be between 32 and 36 (Table 2).…”

“…Interviews will explore staff experience of the implementation of the initiatives across three main domains-people, process, and organizational environment-and 11 subdomains, empirically evidenced as the factors to sustaining improvement [39]. Examples of subdomains that will inform the interview discussion are leadership, change management and perceived hospital culture supported for embedding the initiatives (Figure 2).…”

“…Such a structured approach will allow examining different perspectives through similarities and differences captured in the data [59]. A coding framework will be developed and aligned with the interview question themes [39]. The stratified participants will be assigned a unique code to be indirectly identified in separate groups (Table 3).…”

“…A recent review [39] of empirical evidence has identified that sustained improvement from hospital-wide quality initiatives requires concerted efforts across hospital hierarchies (i.e., change actors) before, during, and after the active implementation phase. The review provides a comprehensive framework of interrelationships among the identified factors for improvement sustainability.…”