Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study.

Mathias Waelli,Philippe Lorino,Jean-Yves Bonnefond,Etienne Minvielle,Claude Sicotte,Marie-Léandre Gomez,Adrian Zicari

doi:10.1186/s12913-016-1794-7

Abstract

BackgroundSeveral countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice.MethodSeven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews.ResultsA significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department.ConclusionsPublic policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.

Highlights

Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs)
Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation
Effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors

Summary

Introduction

Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). A prerequisite to quality improvement is successful local QI implementation. Health authorities in many countries have launched public reporting campaigns to improve the quality of care based on validated quality indicators (QIs) QIs should be understood here as statistical measures that assess output or processes. The premise is that public disclosure of QI scores will increase transparency and Quality improvements necessitate the development of valid QI measures and the means to enable the introduction of corrective interventions that befit the local context [4]. The value of a QI depends on its adoption by HCO staff and in the changes in practice or work organization that will improve quality.

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