Implementation Of Continuous Quality Improvement Research Articles

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

BackgroundThe growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.MethodsThis qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.ResultsA total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.ConclusionsImplementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.

Standardization of Sample Handling Methods to Reduce the Rate of Inadequate Sampling

Purpose: The predominant approach for mitigating inadequate sampling rates has primarily involved bolstering the volume of education. This study aimed to curtail inadequate sampling rates through the implementation of continuous quality improvement (CQI) activities, tailoring effective methods to the unique needs of each institution.Methods: We developed a sample handling guidebook and implemented QI activities to address this issue.Results: These measures resulted in a 4.7% decrease in inadequate sampling rates, concurrently improving knowledge of sample handling and overall nurse satisfaction. We addressed the root causes of inadequate sampling before laboratory pre-processing by: 1) focusing on systematic rather than erratic errors through CQI activities, 2) revising the sample handling guide, and 3) delivering face-to-face education based on the specific needs of the nursing department. These changes resulted in an additional 0.6% decrease in the inadequate sampling rate.Conclusion: This study demonstrates that the implementation of CQI activities based on evidence derived from a multifaceted causal analysis significantly reduced the inadequate sampling rate compared to previous studies.

Effect of modified gastrointestinal decompression under abdominal CT in patients with intestinal obstruction.

We aimed to evaluate the effect of continuous quality improvement on modified gastrointestinal decompression under abdominal computed tomography (CT) in patients with intestinal obstruction. The CT images of 74 patients with intestinal obstruction who underwent gastrointestinal decompression in our hospital from 1 January 2018 to 31 December 2019 were analysed retrospectively (Control group). Factors influencing unsatisfactory decompression effects were analysed, and corresponding improvement measures were formulated and implemented. A total of 77 patients from 1 January 2020 to 31 March 2022 were enrolled prospectively (Study group). The position of the nasogastric tube end, the amount of gastric drainage within 24h and the degree of abdominal distension relief were compared before and after the improvement. After implementation of continuous quality improvement, the proportion of the end of the nasogastric tube reaching the antrum, the amount of gastric fluid drainage within 24h and the degree of abdominal distension relief were better than those before improvement (p<0.001, respectively). The execution rate and accuracy rate of CT interpretations by nurses reached 100% and 82%, respectively. Modified gastrointestinal decompression based on abdominal CT scans can increase the success of gastrointestinal decompression and effectively reduce the discomfort of patients.

Quality of service and continuous quality improvement in voluntary medical male circumcision programme across four provinces in South Africa: Longitudinal and cross-sectional programme data.

BackgroundRecent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa.MethodThis was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard.ResultsA total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 12% for infection prevention (95%CI: 7–17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3–13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7–20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3–14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28–42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22–35; p<0.001), leadership and planning 23%, (95%CI: 13–34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1–9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14–21; p<0.001).ConclusionThe overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards.

CONTINUOUS QUALITY IMPROVEMENT (CQI) PRACTICE IN VOCATIONAL COLLEGES

Continuous quality improvement (CQI) is an important element in quality management. This is because CQI is a key factor in improving the quality of education and ensuring that improvements in teaching and learning activities are continuously implemented. The implementation of CQI in Vocational Colleges (VCs) is increasingly being carried out in line with the application of the outcome-based learning (OBE) approach. However, reports from the board of accreditation showed differences in CQI practices for several programs under the same institution. Thus, this study can give a clear picture of CQI practice in VCs. This study was conducted to identify CQI practices in VCs and make comparisons of practice based on demographic factors namely gender, age, and teaching field. This survey-based study used questionnaires as a research instrument. The respondents of the study consisted of 87 VCs lecturers in the states of Selangor and Kuala Lumpur. Descriptive and inferential statistical analysis was used to attain the practice level and make comparisons on demographic factors. The findings of the study found that the practice of CQI in VCs was at a high level. However, there were significant differences based on demographic factors for the age group in the dimensions of customer focus and teamwork. This study could provide input to the Vocational Educational and Training Department (BPLTV) on the practice of CQI in VCs. With this input, actions and improvement measures can be planned and implemented to improve VCs. Therefore, it is hoped that this study could be a platform for improvement in VCs quality management.

Advancing Quality Improvement in Public Health by Exploring CQI in Alabama's Home Visiting Program.

Continuous Quality Improvement (CQI) is the use of a deliberate and defined improvement process to advance organizational systems. Quality improvement in public health is increasingly widespread, but there are still limited examples of success or descriptions of developmental trajectories for building CQI capacity. The goal of this article is to add to the extant knowledge on the topic by describing one state's implementation of evidence-based CQI in the Maternal, Infant, and Early Childhood Home Visiting program between 2014 and 2019. On the basis of a systematic review of Annual Yearly Progress reports and semistructured key informant interviews, analysis yielded 3 themes that facilitated successful implementation of CQI in Alabama: starting small and building capacity; engaging in continuous and supported learning; and establishing and maintaining a culture of quality. This project demonstrates that CQI can help public health practitioners refine processes and grow capacity to best serve clients' diverse needs.

Continuous quality improvement as a tool to implement evidence-informed problem solving: experiences from the district and health facility level in Uganda

BackgroundContinuous quality improvement processes in health care were developed for use at health facility level, and that is where they have been used the most, often addressing defined care processes. However, in different settings different factors have been important to support institutionalization. This study explores how continuous quality improvement processes were institutionalized at the district level and at the health facility level in Uganda.MethodsThis qualitative study was carried out in seven districts in Uganda. Semi-structured interviews with key informants from the district health management teams and document review were conducted. Thematic analysis was used to analyze the data.ResultsAll districts that participated in the study formed Continuous Quality Improvement (CQI) teams both at the district level and at the health facilities. The district CQI teams comprised of members from different departments within the district health office. District level CQI teams were mandated to take the lead in addressing management gaps and follow up CQI activities at the health facility level. Acceptability of quality improvement processes by the district leadership was identified across districts as supporting the successful implementation of CQI. However, high turnover of staff at health facility level was also reported as a detrimental to the successful implementation of quality improvement processes. Also the district health management teams did not engage much in addressing their own roles using continuous quality improvement.ConclusionThe leadership and management provided by the district health management team was an important factor for the use of Continuous Quality Improvement principles within the district. The key roles of the district health team revolved around the institutionalisation of CQI at different levels of the health system, monitoring results of continuous quality improvement implementation, mobilising resources and health care delivery hence promoting the culture of quality, direct implementation of CQI, and creating an enabling environment for the lower-level health facilities to engage in CQI. High turnover of staff at health facility level was also reported as one of the challenges to the successful implementation of continuous quality improvement. The DHT did not engage much in addressing gaps in their own roles using continuous quality improvement.

Factors Affecting the Implementation of Continuous Quality Improvement in Health Facilities in Southern Nation and Nationalities Peoples Region (SNNPR), Ethiopia.

BackgroundContinuous quality improvement (CQI) has become an important aspect of healthcare organizations. The objective of this study was to identify contributing factors for implementing continuous quality improvement projects in health facilities for the better delivery of healthcare service in the region of South Nation and Nationalities Peoples Region (SNNPR), Ethiopia.MethodsA cross-sectional study was conducted from April to May 2018 in health facilities within two districts (woredas) located in SNNPR. Descriptive, bivariate, and multivariate analyses were used. During the analysis, a P-value less than 0.05 and 95% confidence interval (CI) were used to assess the significance of the associations.ResultsA total of 144 health professionals participated in the study. The majority of the respondents (75%) were male and 35% reported that their respective health facilities have implemented continuous quality improvement projects. More than half of the leaders (51.4%) were not receptive to new ideas and the majority of leaders were not encouraging learning (62.5%) or engaged in the quality improvement project implementation process (66%). Multivariate logistic regression analysis revealed that 84% of the health facilities were implementing a continuous quality improvement project (AOR=0.138 (0.029−0.652)). Similarly, client satisfaction was 90% (AOR=0.101 (0.019−0.522)) and the percentage of staff who believe that the quality improvement project contributed to the improvement of work at their respective health facility was 80% (AOR=0.181 (0.047−0.696)).ConclusionThe following variables, “Leaders receptiveness to new ideas”, “Leaders share information/data about health facility service delivery status”, “Health facility has a quality improvement project plan”, “Staff know using indicators to tell progress about service delivery”, and “Health facility assess client satisfaction level” were found to be independent predictors of continuous quality improvement (CQI) project implementation.

Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies - An implementation method.

Community pharmacists' optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties. To build community pharmacies' capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting. Community pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process. To assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.

Integration of Continuous Quality Improvement Methods Into Annual Program and Institutional Evaluation.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires continuous program improvement as part of program evaluation for residency training institutions and programs. To improve the institutional- and program-level evaluation processes, to operationalize a culture of continuous quality improvement (CQI), and to increase the quality and achievement of action items, the Wayne State University Office of Graduate Medical Education (WSU GME) incorporated CQI elements into its program evaluation process. Across 4 academic years, WSU GME phased the following 4 CQI elements into the evaluation process at the program and institutional levels, including the annual program evaluation (APE) and the annual institutional review: (1) An APE template; (2) SMART (specific, measurable, accountable, realistic, timely) format for program and institutional goals; (3) Dashboard program and institutional metrics; and (4) Plan-do-study-act cycles for each action item. Action item goals improved in adherence to the SMART format. In 2014, 38% (18 of 48) omitted at least 1 field, compared with 0% omitting any fields in 2018. More complete action items took less time to resolve: 1.7 years compared with 2.4 years (t (43.3) = 2.87, P = .003). The implementation of CQI in the APE was well received by program leadership. After leveraging CQI methods, both descriptions of institutional- and program-level goals and the time required for their achievement improved, with overall program director and program coordinator satisfaction.

Influence of continuous quality improvement on patients’ satisfaction within hospitals in Nairobi, Kenya

The study examined the influence of implementation of continuous quality improvement (CQI) on patient satisfaction in hospitals within Nairobi. Literature from developed countries indicates that the application of continuous quality improvement has a significant influence on customer satisfaction. However, there is limited literature originating from developing countries. This study aimed at understanding the influence of continuous quality improvements such as Innovativeness, Quality Indicators, Information sharing and Risk management on customer (patient) satisfaction. To reinforce the study, theoretical and empirical review on the CQI and customer (patient) satisfaction was conducted from current and classical literature adopting the total quality management theory of profound knowledge, and the expectation confirmation theory. The mixed research design was used to target employees and patients of hospitals within Nairobi, from whom data was collected through a self-administered questionnaire. Simple random sampling was used to select hospital employees while stratified random sampling was used to select the patients. The questions were placed on a five-point Likert scale. The results of this study showed that innovativeness, information sharing, and risk management significantly influenced patients’ satisfaction, while quality indicators had no significant influence on patients’ satisfaction. This study, therefore, concluded that continuous quality improvement positively and significantly predicted patients’ satisfaction within the hospitals in Nairobi. The study findings guided the researcher to recommend among other things, leaders in the healthcare industry to draw customer satisfaction through the CQI application. Achieved through feedback from the patients and utilizing such information to improve the patient experiences. The researcher proposes that future studies be carried to cut across other industries that were not captured.

‘At the grass roots level it’s about sitting down and talking’: exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services

ObjectivesImproving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a...

The application effect of continuous quality improvement in the management of the communication of central sterile supply department and clinical department

Objective To explore the effect of continuous quality improvement (CQI) in the communication management between central sterile supply department (CSSD)and clinical departments. Methods The communication management mechanism between CSSD and clinical departments should be established, and CQI measures should be carried out to strengthen the quality supervision and enhance communication between CSSD and clinical departments.The quality score, service efficiency and satisfaction of the clinical department to CSSD were compared before the implementation of CQI ( from January 2015 to December 2015 ) and after the implementation (from January 2016 to December 2016). Results After the implementation of the CQI, the recovery and cleaning, the quality of the packaging, the quality of sterilization and the quality of the sterile articles distribution were significantly higher than before the implementation(P<0.05). After the implementation of CQI, the job satisfaction of the clinical department to CSSD was 95.45%, which was significantly higher than that before the implementation of the 79.09% (P<0.05). The degree of knowledge mastery of the room and CSSD staff was 90.91% and 100.00% respectively, which was significantly higher than that before the implementation of 74.55% and 80.95%(P<0.05). The delivery time of the CSSD routine and the clinical needed items was significantly shorter than before the implementation (P<0.05). Conclusions The implementation of CQI measures in the communication management of the hospital CSSD and clinical department can effectively improve the work quality and service efficiency, and improve the job satisfaction of the medical staff in each department to the CSSD. Key words: Central sterile supply department; Communication; Continuous quality improvement; Degree of satisfaction

Implementation of continuous quality improvement in Aboriginal and Torres Strait Islander primary health care in Australia: a scoping systematic review

BackgroundContinuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation.MethodsSearches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature.Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers.ResultsSixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or improvement strategies implemented and only two applied a change theory.ConclusionInvestigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.

Quality Improvement (QI): A Splendid Driver for Achieving the Third 90 in Addis Ababa, Ethiopia

Background: Routine HIV viral load tests improve treatment quality and individual health outcomes for people living with HIV. Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services. Thus, the aim of this study was to assess the effect of Quality Improvement (QI) on achieving routine HIV viral load implementation in Addis Ababa, Ethiopia. Methods: Facility based prospective follow up study design approach was used from January 2016 to December 2016. Data was entered, cleaned using EPI-Data 3.1 and exported to SPSS version 20 software for further processing and analysis. The effect of QI was measured and monitored by test change using run chart. Results: At the end of the quality improvement, the monthly routine viral load performance samples using one analyzer were 3255 from less than 676 at baseline. The routine viral load feedback arrival within agreed turnaround time and regularly archival availability increase from 6 health facilities (7.2%) to 65% at 54 health facilities by December 2016, from the 83 ART monitoring health facilities sent their HIV viral load sample. Implementation of continuous quality improvement is a game changer in transforming laboratory quality and positively impact on meeting the third 90 in Addis Ababa, Ethiopia. Conclusion: The QI model which have implemented at Addis Ababa health research HIV viral load laboratory achieve and worth good experiences with a range of benefits. We strongly believe that healthcare has much to gain by successfully implementing Quality improvement principles within their routine programs.

Nurse managers’ experiences in continuous quality improvement in resource‐poor healthcare settings

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention.

Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation.

Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.

Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.

Application of continuous quality improvement in pediatric nursing quality management

Objective To investigate the clinical effect of continuous quality improvement in pediatric nursing quality management. Methods The implementation of continuous nursing quality improvement measures were carried out in 24 in-service nursing staffs from March 2012 to April 2015, and 82 hospitalized children in our hospital from March 2012 to March 2014 were selected as the control group before the nursing quality improvement was carried out.And another 82 hospitalized children in our hospital from April 2014 to April 2015 were selected as the experimental group after the nursing quality improvement was carried out.The improvement of nursing quality, children's adverse events and their families' satisfaction in the two groups before and after the implementation of nursing quality improvement were observed. Results The nursing score of the nursing staffs after the implementation of continuous quality improvement was significantly higher than that before the implementation, and the difference was statistically significant (P<0.05); the incidence of adverse events of the experimental group was just 1.22%, which was significantly lower than that of the 8.54% of the control group, and the difference was statistically significant (P<0.05); patients' families' satisfaction rate in the experimental group reached 96.34%, which was significantly higher than that of 87.80% of the control group, and the difference was statistically significant (P<0.05). Conclusions The implementation of continuous quality improvement in pediatric nursing management can significantly improve the quality of care, reduce the incidence of adverse events, and improve the family satisfaction, it is worth promoting. Key words: Pediatric nursing; Quality management; Continuous quality improvement; Effect

'There's only one enabler; come up, help us': staff perspectives of barriers and enablers to continuous quality improvement in Aboriginal primary health-care settings in South Australia.

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding.