Influence Quality Improvement Research Articles

Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment

Background and objectivesThe EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia.MethodsIn 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes.ResultsImplementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative.ConclusionsThis study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care.Trial registrationThis project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.

The Impact of Technological Challenges on Perceived Ageism: A Literature Study on the Antecedents of Intergenerational Cooperation in the Workplace

The rise in discrimination numbers due to ageing in the workplace has increased research on ageism and intergenerational cooperation. This rise is because ageism is considered one of the most common forms of discrimination experienced in the work environment. It is more damaging than racism and sexism because it is more institutionalized and harder to recognize. One way to prevent or reduce ageism in the workplace is to build intergenerational interactions or collaborations. This study aims to build a comprehensive model of the antecedents or factors that influence quality improvement in intergenerational cooperation. By conducting some literature reviews, this study found three critical factors that might affect intergenerational cooperation. Those three factors are technological challenges, an organizational culture that supports intergenerational cooperation, and leadership. Further discussions and research design models are also presented in this study.

Hospital accreditation: an umbrella review.

Hospital accreditation is an established quality improvement intervention. Despite a growing body of research, the evidence of effect remains contested. This umbrella review synthesizes reviews that examine the impacts of hospital accreditation with regard to health-care quality, highlighting research trends and knowledge gaps. Terms specific to the population: 'hospital' and the intervention: 'accreditation' were used to search seven databases: CINAHL (via EBSCOhost), Embase, Medline (via EBSCOhost), PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) EBP Database (via Ovid). 2545 references were exported to endnote. After completing a systematic screening process and chain-referencing, 33 reviews were included. Following quality assessment and data extraction, key findings were thematically grouped into the seven health-care quality dimensions. Hospital accreditation has a range of associations with health system and organizational outcomes. Effectiveness, efficiency, patient-centredness, and safety were the most researched quality dimensions. Access, equity, and timeliness were examined in only three reviews. Barriers to robust original studies were reported to have impeded conclusive evidence. The body of research was largely atheoretical, incapable of precisely explaining how or why hospital accreditation may actually influence quality improvement. The impact of hospital accreditation remains poorly understood. Future research should control for all possible variables. Research and accreditation program development should integrate concepts of implementation and behavioural science to investigate the mechanisms through which hospital accreditation may enable quality improvement.

Pengaruh Model Pembelajaran Problem Based Learning (PBL) Berbantuan LKPD terhadap Kemampuan Berpikir Kritis Peserta Didik

The teacher is a factor that can directly influence quality improvement in improving the quality of education and students' critical thinking skills. Teachers are responsible for encouraging and guiding students to become proficient in active critical thinking and enjoy learning. The teacher is also responsible for all things in the class and provides assistance such as supporting the stages so that students can develop. A process so that teaching and learning activities in the classroom turn interactive and achieve the objectives of the teaching and learning activities is to use a learning model. An example of a learning model in order to improve students' critical thinking skills is a problem-based learning model. This research methodology is based on seven steps of literature search: determining the purpose of writing, selecting database sources, selecting keywords at the stage of searching a database, carrying out the stages of searching for literature, and determining the inclusion criteria for the articles used. selected according to inclusion characteristics and synthesis results in 20 national and international journals. The purpose of this study was to test the effect of the problem-based learning model (PBL) assisted by worksheets on students' thinking skills. The results of the study found that the problem-based learning model supported by LKPD was effective in increasing students' critical thinking skills.

Structures and systems influencing quality improvement in Australian early childhood education and care centres.

This study assessed the impact of structural characteristics on quality rating and improvement systems (QRIS) outcomes in an Australian national study. Data from the Australian Children's Education and Care Quality Authority (ACECQA) repository of National Quality Standard (NQS) ratings were used to identify long day care services that had improved from Working Towards NQS to Meeting or Exceeding NQS or had no change over two assessments. QRIS outcomes were examined for state/territory jurisdiction, urban-rural location, community socio-economic status, type and size of provider organisation, centre size and stability of centre owner/provider using multinomial logistic regression analyses. Controlling for jurisdiction, results showed that improvement to Meeting NQS was more likely for not-for-profit versus for-profit providers and for large multi-site provider organisations versus small, stand-alone providers. Improvement to Exceeding NQS was also associated with not-for-profit and larger provider organisations, as well as larger versus smaller centres, and centres that had stable ownership.

Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations.

Introduction Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of 'Clan' and 'Adhocracy' typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success.

Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice.

Introduction The impact of contextual factors on primary health-care quality improvement is significant. In-depth research is required to identify the key contextual factors that influence quality improvement initiatives to develop high-performing primary health-care systems. Aim This research seeks to answer two questions; what are the contextual factors influencing primary care improvement initiatives?; and how do contextual factors, the quality improvement initiative and the implementation process influence one another and the overall improvement outcomes? Methods A multi-case study methodology was used to explore the complexities of the phenomena in situ . Three sites where successful quality improvement had occurred were selected by purposeful theoretical sampling to provide a sample of rural, urban and Kaupapa Māori general practice settings typical of the New Zealand environment. Semi-structured interviews were conducted with team members and triangulated with secondary data provided by the organisations. Results The quality improvement topic and the approach taken were intrinsically linked to context. Sites reported success in achieving the desired outcomes benefitting the patients, practice and staff. Teams did not use formal improvement methods, instead relying on established relationships and elements of change management methods. The culture in all three cases was a large component of why and how these initiatives were successful. Discussion Intrinsic motivation was generated by community connections and networks. This combined with a learning climate generated by distributed leadership and teamwork enabled success. Iterative reflection and sensemaking processes were able to deliver quality improvement success in primary care without the use of formal improvement methods.

Nurses’ attitudes toward quality improvement in hospitals: Implications for nursing management systems

Background & Aim: Quality improvement in hospitals is a systematically widely used framework that improves patient care quality delivered by health care professionals. This study assessed the attitude of nurses toward Quality Improvement. Methods & Materials: A quantitative research approach was used. A total of 361 nurses working in two government hospitals and two private hospitals in the Philippines were selected using convenience sampling. The data collected using a self-administered questionnaire was started in March-April 2019. To identify the association between nurse demographic characteristics and perceived quality improvement, an independent sample t-test, a one-way analysis of variance with a post-hoc Tukey HSD test, and a Pearson’s product-moment correlation were conducted using SPSS. Results: Nurses have high positive quality improvement attitude scores. The age, salary, and hospital type, influence quality improvement attitude scores. Conclusion: Nurses have a positive attitude towards qualitative improvement. In addition, nurses’ age, salary, and public hospitals' work have a positive qualitative improvement than nurses working in private hospitals.

Understanding Factors Influencing Quality Improvement Capacity Among Ambulatory Care Practices Across the MidSouth Region: An Exploratory Qualitative Study.

Success in choosing and implementing quality metrics, necessary in a value-based care model, depends on quality improvement (QI) capacity-the shared knowledge, understanding, and commitment to continuous improvement. We set out to explore factors influencing QI capacity among ambulatory care practices in the MidSouth Practice Transformation Network. As part of network participation, 82 practices submitted a plan for implementing self-selected quality metrics. This plan asked practices to identify factors that would assist or impede successful implementation of interventions to meet metric targets. We used a qualitative thematic analysis approach to explore barriers and facilitators to developing QI capacity among ambulatory care practices. Recurrent facilitators included external change agents, protected time for QI, a framework for improvement, and infrastructure including electronic health record (EHR) capabilities. Frequent barriers included lack of QI knowledge, lack of time, frequent staff turnover, inadequate EHR capabilities, lack of an internal change agent, and a belief that performance was outside of the practice's control. These findings provide insight into factors influencing the adoption and implementation of QI metrics across a diverse group of ambulatory care practices and suggest that targeting the Inner Setting of practices may be an appropriate approach for developing practice-level QI capacity, which is necessary for success in a value-based care model.

Healthcare middle managers’ capacity and capability to quality improvement

PurposeThe purpose of this study was to identify and critically discuss how healthcare middle managers’ (HMMs) development of the capacity and capability for leadership are experienced to influence quality improvement (QI) in nursing homes.Design/methodology/approachThis study had a critical hermeneutic perspective with data gathered using focus groups, one individual interview and participative observations. Analysis was guided by a qualitative interpretive approach.FindingsThe results show how HMMs’ development of the capacity and capability for leadership are experienced to influence QI in nursing homes through grasping complexity in a conflicting practice. This involves continuous knowledge development and compensating contrasted by resource shortages, role conflicts and the lack of trust and cooperation.Originality/valueHMMs have a key role in implementing QIs in healthcare. There are few studies on how HMMs develop the capacity and capability for leadership and it is unclear how clinical contexts are influenced by HMMs’ development. This study provides new knowledge supporting a change facilitating HMMs’ developmental processes targeting practical influence; it emphasizes continuity, coherence, presence and trust.

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

BackgroundRecognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare?MethodsA realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework.ResultsThirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings.ConclusionsThis is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.Systematic review registrationPROSPERO CRD42017062135

Organizaciona kultura i unapređenje kvaliteta - razlike između kontinenata

Previous research shows that organizational factors influence quality improvement programs, and when there is a fit, it is leading to better business performances. Accordingly, the purpose of this paper is an analysis of interdependence between organizational culture and quality improvement via testing the differences between dimensions and types of organizational cultures and applied procedures for quality improvement techniques on companies from 32 countries worldwide. Following detailed exploration of the available literature, data collection is conducted on 200 production enterprises in multinational supply chain. Upon this, further statistical examination is conducted by comparison of the companies in dependence of its locations - continents. Results show that there are significant differences on dimensions of organizational culture and applied quality improvement procedures depending of geographical location of companies. Accordingly, results of this paper prove that contextual approach promoted in ISO 9001:2015 has to be applied and organizations that operate in different countries and continents must decide how much to localize their organizational culture and related management practices to fit within the host country context.

Orofacial cleft patient referral to a university orthodontic clinic over a 20-year period in Ghana

Context: After the first orofacial cleft (OFC) patient was referred to the orthodontic clinic of the University of Ghana School of Medicine and dentistry in 1998, a multidisciplinary clinic at the Korle-Bu teaching hospital (KBTH) was inaugurated and partnered by non-governmental organization, Transforming Faces from 2003 to 2014 and Smile Train from 2014 to date. Aims: The aim of this study was to review and document presentations, management, and associated care influences of OFC patients referred for orthodontic care to influence quality improvement policy. Settings: This study was conducted at the Orthodontic Clinic of the University of Ghana School of Medicine and Dentistry. Design: This was a retrospective design, in which data from patient records were obtained and analyzed. Subjects and Methods: Review of records of all OFC patients who assessed the orthodontic clinic from 1998 to 2018. Statistical Analysis Used: The statistical analysis was done using Microsoft Excel. Results: Thirty-four patients were referred to the orthodontic clinic from 1998 to 2018. The majority (67.65%) was referred from the KBTH multidisciplinary clinic and smaller number (32.35%) from other hospitals and clinics. Their ages ranged from 2 weeks old to 20 years old. The majority of the referred patients were in the 5–9-year-old age group (35.29%). Of the 26 patients who underwent treatment, the majority 38.46% were treated using the less expensive fixed upper-only appliance option and obturators were not routinely used (15.38%). The majority of patients were self-funded (47.8%) and (34.8%) were pro bono cases of which over 50% of discontinued treatment. Conclusions: The multidisciplinary OFC clinic was beneficial as the major source of orthodontic referrals. More stringent criteria for the selection of pro bono cases could decrease loss from care and inclusion of complete OFC care in the National Health Insurance Scheme may remove financial barriers.

Context Matters for Nurses Leading Pain Improvement in U.S. Hospitals

Background: Pain continues to be a problem in hospitalized patients. Contextual factors contribute to the success of pain quality improvement efforts. Aims: This paper describes nurse team leaders’ perceptions of organizational context and factors perceived to help and hinder the process of leading a unit-based improvement effort focused on pain. Design: Qualitative descriptive design. Setting: Interviews took place over the telephone. Participants: Nurses from 106 hospitals across the United States. Methods: Investigators interviewed 125 nurses leading a unit-based pain quality improvement project in partnership with the National Database of Nursing Quality Indicators. Lewin’s Field Theory guided a thematic analysis. Results: Key contextual factors related to the amount of change in the health care environment and characteristics of the organization and providers. Helping forces included characteristics of nurses, teamwork, a culture of quality, opportunities for learning, pain management resources, and accountability for pain management. Hindering forces included: barriers to involvement, attitudes and relationships, lack of knowledge, and types of patients. Conclusions: Overcoming the pervasive barriers of constant change and lack of staff involvement while also capitalizing on the culture of quality and characteristics of the health care team may further enhance and sustain improvement efforts related to pain management of hospitalized patients. New models for influencing quality improvement could be strengthened with involving frontline staff in both planning and implementation of improvement efforts. Clinical Implications: Because of the diverse responses, it is recommended that each unit conduct a force-field analysis to guide successful implementation of improvement efforts.

A new typology for understanding context: qualitative exploration of the model for understanding success in quality (MUSIQ)

BackgroundThe importance of contextual factors in influencing quality improvement and implementation (QI&I) initiatives is broadly acknowledged. Existing treatments of context have primarily viewed it as static and distinct from interventions themselves. The objective of this study was to advance understanding of the complex and dynamic interaction between context, intervention, and implementation strategies. Using the Model for Understanding Success in Quality (MUSIQ), we aimed to better understand the roles of, and inter-relationships between, contextual factors within QI&I initiatives.MethodsSecondary analysis was performed on qualitative data collected as part of two studies: (1) an evaluation of a state-wide obstetrical quality improvement (QI) initiative, and (2) a study of the use of Plan-Do-Study-Act cycle method in QI projects. Electronic coding databases from each study were reviewed jointly. Data analysis was initiated deductively using MUSIQ as a template. Codes were added in an inductive manner.ResultsAll original factors in MUSIQ were observed to be important in the QI initiatives studied and new factors were identified. Three distinct types of context were identified; the setting(s) of care in which QI&I takes place (Type 1); the context of the team conducting a specific project (Type 2); and the wider context supporting general QI&I (Type 3). The picture of context emerging from this study is a dynamic one with multiple, closely-linked factors operating at different levels in a system that is constantly changing in response to QI&I initiatives. To capture this complexity, a revised model (MUSIQ v2.0) was created positioning use of structured QI&I approaches as the focal point and demonstrating how context influenced effective use of these approaches, and in turn, how these approaches supported teams in navigating context by adapting interventions to fit local settings.ConclusionsMUSIQ is a useful tool to explore the roles of, and inter-relationships between, contextual factors within QI&I initiatives. The revised model may help address some existing controversies about how context influences QI&I success and help ensure that future research efforts consider context not as static background, but as a complex system that is constantly changing, tightly-linked, and governed by feedback loops.

Assessing the organizational characteristics influencing quality improvement implementation in Saudi hospitals

Assessing the organizational characteristics influencing quality improvement implementation in Saudi hospitals

Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals.

Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels. The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff). We conducted semistructured interviews with 24 health care administrators, physician and nonphysician primary care providers, and administrative staff representing 10 primary care practices affiliated with one integrated delivery system. Participants across all roles identified similar organizational- and team-level factors that influence QI implementation including organizational capacity to take on new initiatives (e.g., time availability of physicians), technical capability for QI (e.g., data analysis skills), and team climate (e.g., how well staff work together). There was greater variation in terms of individual-level factors, particularly perceived meaning and purpose of QI. Perceptions about value of QI ranged from positive impacts on patient care and practice competitiveness to decreased efficiency and distractions from patient care, but differences did not appear attributable to role. Successful QI implementation requires effective collaboration within cross-functional teams. Additional research is needed to assess how best to employ implementation strategies that promote cross-understanding of QI among team members and, ultimately, effective implementation of QI programs. Health care managers in primary care settings should strive to create a strong teamwork climate, reinforced by opportunities for staff in various roles to discuss QI as a collective.

PENINGKATAN MUTU PENDIDIKAN DI MADRASAH IBTIDAIYAH NORRAHMAN KECAMATAN BANJARMASIN SELATAN KOTA BANJARMASIN

This study discusses the "educational enhancement in Norrahman Subdistrict of Bacolod MI South of the town of Banjarmasin". Formulation of the problem in this research is how the educational enhancement in Norrahman Subdistrict of Bacolod MI South of the town of Banjarmasin and what are the factors that influence quality improvement in education in MI Norrahman Kecamatan Banjarmasin South Of The City Of Banjarmasin. Based on the formulation of the problem, then the purpose of this research is to know the educational enhancement in Norrahman Subdistrict of Bacolod MI South of the town of Banjarmasin as well as factors that affect the educational enhancement in MI Norrahman Subdistrict Of Bacolod South Of The City Of Banjarmasin. The subject in this study is the teacher MI Norrahman Subdistrict of Bacolod South of the city of Banjarmasin, while being the object of research is educational enhancement in Norrahman Subdistrict of Bacolod MI South of the town of Banjarmasin and the factors that influence quality improvement in education in Norrahman Subdistrict of Bacolod MI South of the city of Banjarmasin. Data collection techniques used in this research is the observation, interviews, documentation. The data processing is done by editing techniques, data classification, and interpretation of data. While the data analysis techniques using qualitative descriptive analysis by way of describing and outlining any data obtained and to take the conclusions are deductive inferences in a way that is common, leading to the conclusion that is special. Based on the results of the research that has been done, it is noted that the effort to Increase the quality of education in the Norrahman Subdistrict of Bacolod MI South of the town of Banjarmasin has gone well, it is influenced by several factors including factor the teacher, a factor communication between teachers and students, economic factors, and supporting facilities and infrastructure so that the process of improving the quality of education in the Norrahman Subdistrict of Bacolod MI South of the city of Banjarmasin. Key Words: Improved, The Quality Of Education, The Madrasa.

How Patient Partners Influence Quality Improvement Efforts

There is growing acknowledgement that patients are key stakeholders in improving quality of medical care, yet a key barrier to integrating patients into quality improvement teams (QITs) as patient partners is the lack of evidence of their impact. This mixed-method study was conducted to identify the ways patient partners influence QITs and to document the extent of patient partners' impact. Focus groups and in-depth interviews were conducted with 17 patient partners and 11 staff at WellSpan Health and Aligning Forces for Quality-South Central Pennsylvania to identify the specific mechanisms through which patients influenced QIT efforts. Online surveys of 47 patient partners and 56 QIT leaders were conducted in summer 2016 to test the ways in which patient partners affected quality improvement (QI) and gauge respondents' perceptions of the impact of patient partners' contributions. Patient partners influenced QI through three key mechanisms: symbolism, providing feedback (on written material for patients and new policies), and making suggestions (on office communication, educational materials, physical space, and clinical care processes). Almost three quarters of the patient partners believed they had a moderate to very large impact on their QIT's QI efforts. Eight of the 10 QIT leaders reported that patient partners improved patient-centeredness of QI a "moderate amount" to a "great deal" through one of the three key mechanisms. Integrating patient partners into ambulatory care QITs was a largely positive experience for patient partners, QIT leaders, and administrators. The changes that patient partners prompted were meaningful and likely improved patients' experience with care.

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi hospitals. It appears that the most important contributing factors to the successful implementation of QI in Saudi hospitals are proper human resources utilization and effective quality management. Through careful planning, change management, proper utilization of human resources, supportive quality information systems, focus on processes and systems, structural support, and an organizational culture that is compatible with QI philosophy, Saudi hospitals will be more capable in achieving sustained measureable improvements in the quality and safety of patient care.