The care and keeping of clinicians in quality improvement

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Although frontline clinicians are crucial in implementing and spreading innovations, their engagement in quality improvement remains suboptimal. Our goal was to identify facilitators and barriers to the development and engagement of clinicians in quality improvement.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>A 25-item questionnaire informed by theoretical frameworks was developed, tested, and disseminated by email.</jats:p> </jats:sec> <jats:sec> <jats:title>Settings</jats:title> <jats:p>Members and fellows of the International Society for Quality in Healthcare.</jats:p> </jats:sec> <jats:sec> <jats:title>Participants</jats:title> <jats:p>1010 eligible participants (380 fellows and 647 members).</jats:p> </jats:sec> <jats:sec> <jats:title>Interventions</jats:title> <jats:p>None.</jats:p> </jats:sec> <jats:sec> <jats:title>Main Outcome Measures</jats:title> <jats:p>Self-efficacy and effectiveness in conducting and leading quality improvement activities.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We received 212 responses from 50 countries, a response rate of 21%. Dedicated time for quality improvement, mentorship and coaching, and a professional quality improvement network were significantly related to higher self-efficacy. Factors enhancing effectiveness were dedicated time for quality improvement, multidisciplinary improvement teams, professional development in quality improvement, ability to select areas for improvement, and organizational values and culture. Inadequate time, mentorship, organizational support, and access to professional development resources were key barriers. Personal strengths contributing to effectiveness were the ability to identify problems that need to be fixed, reflecting on and learning from experiences, and facilitating sharing of ideas. Key quality improvement implementation challenges were adopting new payment models, demonstrating the business case for quality and safety, and building a culture of accountability and transparency.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our findings highlight areas that organizations and professional development programs should focus on to promote clinician development and engagement in quality improvement. Barriers related to training, time, mentorship, organizational support, and implementation must be concurrently addressed to augment the effectiveness of other approaches.</jats:p> </jats:sec>

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

“…[18][19][20] Acknowledgement of the critical role of clinician and consumer engagement to create sustained change for quality improvement further supports the continued relevance of change management concepts of shared vision, stakeholder engagement and person-centred thinking. 21 Despite this, there has been limited exploration of the opportunities for change management concepts to support contemporary approaches to implementation and improvement methodologies. The Institute for Healthcare Improvement highlights that the Model for Improvement is not intended to replace change models but rather to accelerate improvement.…”

Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative

“…Based on this literature review, four central pillars of successful QI efforts were identified: 1) QI team structure, 2) QI foundation, 3) QI capacity, and 4) QI success. Establishing QI teams with clearly defined roles and training them as a team rather than as individuals promotes ongoing involvement in impactful QI activities (21)(22)(23)(24). QI foundation recognizes that achieving systemwide change requires establishing systemwide processes for the use of proven QI tools and data collection to support improvement efforts (22)(23)(24)(25).…”

“…Establishing QI teams with clearly defined roles and training them as a team rather than as individuals promotes ongoing involvement in impactful QI activities (21)(22)(23)(24). QI foundation recognizes that achieving systemwide change requires establishing systemwide processes for the use of proven QI tools and data collection to support improvement efforts (22)(23)(24)(25). QI capacity captures the use of QI tools, including Plan-Do-Study-Act (PDSA) cycles, run charts, and process mapping (21)(22)(23)26).…”

“…QI foundation recognizes that achieving systemwide change requires establishing systemwide processes for the use of proven QI tools and data collection to support improvement efforts (22)(23)(24)(25). QI capacity captures the use of QI tools, including Plan-Do-Study-Act (PDSA) cycles, run charts, and process mapping (21)(22)(23)26). Finally, QI successes are defined by a team's ability to scale up small tests of change though stakeholder engagement, prior QI successes, and ongoing institutional investments in QI efforts (23)(24)(25).…”

‘You can’t do quality between surgical cases and tea time’: barriers to surgeon engagement in quality improvement

“…In Taitz and colleagues’ 2011 seminal work, one interviewee alluded to the difficulties in engaging surgeons in quality improvement by opining that ‘you can’t do quality between surgical cases and tea time’ 1. There are several factors that may explain why surgeons have historically been difficult to engage in quality improvement work, including a lack of improvement culture, limited training and skills, inconvenience of timing of most daytime improvement work, lack of remuneration and inadequate feedback on surgeon performance on various quality metrics 2. Understanding and targeting these factors may improve the culture of quality improvement among surgeons.…”