Strategies for enabling physician leadership and involvement in quality improvement: a scoping review

Abstract

Background: The importance of physician advocacy and leadership in quality improvement (QI) in health care is well recognized, but achieving physician involvement is challenging. The purpose of this scoping review was to describe strategies used in physician-led QI models/approaches that include learning about the science of improvement and may enable physician QI capability, participation, and leadership. Methods: Articles were identified through electronic searches of MEDLINE, Embase, CINAHL, and Scopus, and reference lists were reviewed. For each model/approach, descriptions of strategies were extracted and the frequency of each strategy was determined. Thematic analysis was conducted. Results: Eleven articles representing nine unique models/approaches were included. From these, 20 enabler strategies were identified, and eight themes emerged: dedicated support staff; operational alignment and leader support; evidence-informed care; sharing QI to encourage QI; financial investment; formal QI leader role and responsibility; physician mentorship; and QI capability. No model/approach included all the strategies, and the number of strategies aligned with each theme varied. Heterogeneity in reporting physician-led QI approaches and broad use of the term “physician-led” increased search complexity. Conclusion: Comprehensive models/approaches that encourage physicians to participate in and lead QI while learning the science of improvement have not yet been developed. Research on physician QI participation and strategy evaluation, including effectiveness, is required. This review offers a road map of enabler strategies that can be used to support future models.