Abstract
BackgroundIt is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors.MethodsWe conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool.ResultsWe included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences.ConclusionsContextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0906-0) contains supplementary material, which is available to authorized users.
Highlights
It is widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented
The search focused on Quality improvement (QI) strategies included in the Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy, which include various forms of continuing medical education (CME), quality assurance projects, financial, organizational, or regulatory interventions that can affect the ability of health care professionals to deliver services more effectively and efficiently [13]
The final list of included studies was evaluated for their completeness by a panel of quality management experts from European countries, comprised of mostly senior researchers and medical professionals who participated in a European Commission (EC) funded research project (Deeping our understanding of quality improvement in Europe (DUQuE), see www.duque.eu and acknowledgment section)
Summary
It is widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. It is accepted that the mixed effect and success rates of QI strategies are in part due to the different contexts in which the interventions are planned and implemented [6,7,8]. ‘Context’ for quality improvement has been defined to include those factors that potentially mediate the effect of the intervention, such as leadership, personal skills, organizational resources or data availability [8]. Having a thorough understanding of the underlying mechanisms that make an intervention work, will allow for successful application of the intervention in other settings and help improving its effectiveness
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