Participation In Quality Improvement Research Articles

Interventions to improve system-level coproduction in the Cystic Fibrosis Learning Network

BackgroundCoproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide...

Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review.

Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

Commitment to Excellence, Innovation in Health Care: Journey to Enhance Healthcare Quality and Patient Safety at Shuang Ho Hospital

<p>雙和醫院自2008年開院以來一直秉持以病人及員工為中心的服務理念，持續提升醫療品質和病人安全。醫療品質部結合醫院理念，推動卓越服務，包括健全品質與安全管理、人才培育、競賽活動以及創新特色發展。在醫療品質推動方面，醫院重視病人安全，鼓勵異常事件通報文化，並進行指標管理以及人才培育。此外，醫院積極參與各項競賽活動，鼓勵全院參與品質改善，並提供完善獎勵。在創新特色發展方面，推動智慧醫療、醫病共享決策和明智選擇等服務，以提供更加有效的醫療照護。未來，醫院將持續與其他醫療機構合作，建立共享交流平台，推動醫療品質和病人安全，以提供高品質的國際一流醫療服務為目標。</p> <p> </p><p>Since its opening in 2008, Shuang Ho Hospital has upheld the concept of patient- and staff- centered service to continuously enhance health-care quality and patient safety. The Department of Healthcare Quality promotes service excellence in alignment with the hospital’s philosophy, which encompasses robust quality and safety management, talent cultivation, competition activities, and the development of innovative features. In promoting health-care quality, the hospital emphasizes patient safety, encourages a culture of reporting abnormal events, conducts benchmarking tests, and fosters talent development. In addition, Shuang Ho Hospital actively participates in various competitions, encourages hospital-wide participation in quality improvement, and provides comprehensive rewards. Regarding innovative feature development, the hospital promotes intelligent health care, shared decision-making, and Choosing Wisely initiatives to enhance the effectiveness of health-care services. In the future, Shuang Ho Hospital will continue to collaborate with other health- care organizations to establish a platform for sharing and exchanging ideas to promote health-care quality and patient safety, with the goal of providing high-quality, world-class health care services.</p> <p> </p>

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

BackgroundPublic–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.MethodsWe searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.ResultsWe identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change.ConclusionsMany of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.

Centering Equity and Fostering Stakeholder Collaboration and Trust-Pillars of the Maternal Health Innovation Program in Maryland.

To describe two main pillars of the Maryland Maternal Health Innovation Program (MDMOM): (1) centering equity and (2) fostering broad stakeholder collaboration and trust. We summarized MDMOM's key activities and used severe maternal morbidity (SMM) surveillance and program monitoring data to quantify MDMOM's work on the two pillars. We developed measures of hospital engagement with MDMOM (participation in quality improvement [QI] activities, participation in check-in meetings, staff involvement) and with other partners (participation in QI activities, representation in state-level groups). We examined Bonferroni-adjusted correlations between these hospital engagement measures and with key hospital characteristics: level of maternity care, annual delivery volume, and SMM rate. Over 100 national and state organizations and individual stakeholders contributed to our building the MDMOM program and implementing key activities centering equity: hospital-based SMM surveillance in 20 of Maryland's 32 hospitals; almost 5,000 trainings offered to perinatal health care providers; two telemedicine/telehealth interventions; training of home visitors and community-based organization staff. Birthing hospitals represent MDMOM's main implementation partners. The strength of their participation in MDMOM QI activities is positively correlated to their participation in check-in meetings and with the degree of involvement by physicians in such activities. Higher engagement in MDMOM QI activities is also positively correlated to hospitals' participation in other state-level maternal health initiatives or groups. Our experience with the MDMOM program demonstrates that an equity focus and broad stakeholder collaboration building strong relationships and providing implementation support can lead to high levels of engagement in innovative maternal health interventions.

Improving Radiation Oncology Staff Engagement with Quality Improvement and Safety through a QI Committee Visiting Staff Initiative.

An interdisciplinary, team-based approach to safety and quality is a critical value of radiation oncology. Quality Improvement (QI) programs can be meaningful contributors. A visiting staff initiative to the monthly QI meeting was developed, with goals of broadening staff engagement with QI activities, providing transparency, encouraging a culture of reporting, and offering additional perspectives to the standing QI Committee (QIC). From 5/2021 - 1/2023, 24 staff, including physicians (n = 11), radiation therapists (n = 6), dosimetrists (n = 4), and administrative staff (n = 3) from 4 community-based radiation oncology clinics rotated through the monthly QI meeting as visitors. The meeting was held virtually. Prior to the meeting, visitors were provided with a background on QI operations and encouraged to be active participants. The QIC has 30 standing members including physicians (n = 2), physicists (n = 8), dosimetrists (n = 2), nursing (n = 3), radiation therapists (n = 4), IT (n = 2), administrative staff (n = 4), and QIC support staff (n = 2), out of a total of 115 staff members. Visitors filled out pre- and post-attendance surveys. A survey of the QIC (n = 14) was conducted to assess the value of the program to the committee. Survey responses were on a Likert scale (1 = Strongly Disagree; 5 = Strongly Agree). A 2-tail t-test was used for statistical analysis. Nearly all visitors stated that they learned something new through participation in the QI meeting (92%), and most said they were interested in future QI participation (63%). Most visitors were familiar with the process of submitting a safety report (75%), and nearly half submitted one in the past year (46%). After the first 10 visitors participated in QIC, the standing QIC was surveyed and agreed that visitors offered new perspective (4.3), and that the visitor program enhanced quality and safety in the department (4.2). The QIC visiting staff initiative was significantly effective in educating interdisciplinary staff members, establishing a safety culture, increasing transparency around QI functions, and providing new perspectives. At baseline, there was appreciation for the role of QI and safety. Implementing a QI visiting staff initiative is feasible and beneficial and may be of even higher impact in less established QI programs.

Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study.

The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry. In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods. We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results. Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.

Participation in a multidisciplinary institutional committee, “RQUEST,” to enhance quality improvement education, project design, and implementation for hematology/oncology fellows.

e18733 Background: Participation in quality improvement (QI) projects allows medical trainees to develop an essential skillset to systematically analyze practice and implement changes with the goal of practice improvement. The ACGME designates QI education and participation as a core competency for all fellows. Training programs and institutions can vary significantly in QI educational format, participation, and direct support for project design and implementation. Here we present a description of the Resident Quality, Experience, and Safety Team (RQUEST) committee, which is being utilized by Hematology and Oncology fellows for QI project design and implementation at our institution. Methods: The first RQUEST committee was convened in August of 2021. RQUEST holds formal monthly meetings from August to June of each academic year. At the initial meetings, committee members are introduced to quality, safety, and patient experience structures and receive introductory training in QI tools and techniques. RQUEST members are then split into smaller project groups and work to select a QI project, perform current state analysis and baseline data collection, design and implement improvement interventions, and re-measure to determine the impact of the chosen interventions. The year concludes with each team presenting their project at a joint session to a larger audience of program directors, quality officers, service line directors, department chairs, graduate medical education staff, and hospital leadership RQUEST participation provides fellows with direct access to a multidisciplinary team and resources throughout project design and implementation. The timeline of monthly meetings provides both accountability and productive feedback. This facilitates the identification of system-specific opportunities for improvement and the most practical points of contact within the hospital, clinic, or EMR to design and apply quality interventions promptly and effectively. Results: We sent a voluntary survey to RQUEST participants, and 40% of participants responded to the survey. 100% of those who responded said participating in RQUEST has been beneficial in developing and implementing a QI project, and 100% said they would recommend participating in RQUEST to other medical trainees. The most common benefits listed were: · Structured approach/guidance · Institutional support and resources · A collaborative environment with a team of members from various departments, including IT. Conclusions: Fellow participation in a multidisciplinary QI committee at our institution has improved fellow QI education, participation, and project implementation. This engagement model has proven valuable to fellows and faculty in enhancing QI competency and clinical practice.

Demonstrating Clinician Educator Value.

Clinician educators (CEs) can feel pressured by multiple institutional forces: compliance with frequently changing Accreditation Council for Graduate Medical Education (ACGME) requirements; the dynamic operational and fiscal strains of sponsoring institutions (SIs); and personal pressures for career advancement, in both academic and community settings. The value of demonstrating contributions as a CE for academic promotion via an annotated curriculum vitae and/or portfolio is well documented.1,2 However, CEs must also find ways to continuously demonstrate value to program, clinical, and organizational leadership, regardless of the type of SI.CEs should strive to align their educational priorities with the SI's clinical priorities. Two examples of aligned CE-SI goals are achieving a reputation for being a high reliability organization and providing value-based care.3 High reliability organizations strive to provide care with zero harm, and value-based systems provide high-quality patient care focused on improved outcomes, positive patient experiences, and lower use of resources.4To accomplish these goals, most SIs develop quality improvement (QI) and patient safety (PS) programs that often operate independently from the sponsored educational programs.5 The ACGME's Common Program Requirements mandate trainee skill development to provide reliable, safe, and high-quality care. At the same time, trainee involvement in QI and PS programs often goes underrecognized by SI leadership, despite program directors reporting that resident participation in QI led to institutional-level changes.5How can CEs make their SI's and program's leadership aware of their contributions to aligned priorities? Using a framework such as mattering can help. Mattering is a psychological construct which recognizes that we all want to be valued and to add value. When someone matters, they are more engaged, are less stressed and depressed, and feel like they belong. There are 4 accepted components for CEs to incorporate when creating an environment of mattering: awareness, importance, reliance, and ego extension.6 As a CE, demonstrating how your clinical and educational work adds value to the shared goals of high reliability and value-based patient care is vital.By using the 4-part mattering framework, you can enhance how you and your program matter to your SI and program leadership. When you matter to others, they recognize your value as well as the value of your programs and activities in achieving shared goals.

Quality Improvement of Quality Improvement (P13-2.005)

<h3>Objective:</h3> To increase resident participation in quality improvement (QI) in a large New York City neurology residency program within a one-year academic period. <h3>Background:</h3> The ACGME requires that neurology residents receive training and experience in quality improvement processes (QI). QI involves investigating root cause analysis and systems thinking. As part of preparing future clinical leaders, residency programs educate residents on ways to analyze the care they provide, investigate system process, and understand their roles within the larger health care system. There is a need to guide residency programs to further develop and improve resources to encourage resident involvement in QI. We present a possible solution to increase QI education and participation among our neurology residents. <h3>Design/Methods:</h3> Well-established QI tools including driver diagrams, cause and effect diagrams and GEMBA walks were utilized to identify barriers and tests of change. We then designed and implemented a multifaceted approach to achieve our objective including (1) creation of a database tracking ongoing projects, (2) establishment of a department mandate regarding resident participation in quality improvement, (3) administration of QI didactic lectures, and (4) increased visibility of QI projects through departmental social media and grand round QI presentations. Resident project participation was our primary outcome measure, and tracked through the database. <h3>Results:</h3> Second year neurology resident QI project participation increased from 36% to 100%, third year resident participation increased from 70% to 90%, and fourth year residents maintained their high level of participation with 88% participating in QI and two residents were exempt. <h3>Conclusions:</h3> Our approach to increasing neurology resident participation in quality improvement projects was successful. At our institution, QI has gained recognition as a critical component of our residents’ scholarly activity. <b>Disclosure:</b> Dr. Monohan has nothing to disclose. Dr. Angulo Castro has nothing to disclose. Dr. Sivakumar has nothing to disclose. Dr. Perk has nothing to disclose. Dr. O’Kula has nothing to disclose. Dr. Law has nothing to disclose.

Changing disposition patterns in the era of COVID-19 after colon resections: A National Surgical Quality Improvement Program colectomy study

BackgroundThe COVID-19 pandemic severely impacted post-hospitalization care facilities in the United States and hindered their ability to accept new patients for various reasons. This study aimed to assess the impact of the pandemic on discharge disposition after colon surgery and associated postoperative outcomes. MethodsA retrospective cohort study was performed using the National Surgical Quality Improvement Participant Use File and targeted colectomy. Patients were divided into the following 2 cohorts: (1) pre-pandemic (2017–2019) and (2) pandemic (2020). The primary outcomes included discharge disposition—post-hospitalization facility versus home. The secondary outcomes were rates of 30-day readmissions and other postoperative outcomes. The multivariable analysis assessed for confounders and effect modification on discharge to home. ResultsDischarge to posthospitalization facilities decreased by 30% in 2020 compared to 2017 to 2019 (7% vs 10%, P < .001). This occurred despite an increase in emergency cases (15% vs 13%, P < .001) and open surgical approach (32% vs 31%, P < .001) in 2020. Multivariable analysis revealed that patients in 2020 had 38% lower odds of going to post-hospitalization facilities (odds ratio 0.62, P < .001) after adjusting for surgical indications and underlying comorbidities. This decrease in patients going to a post-hospitalization facility was not associated with an increased length of stay or an increase in 30-day readmissions or postoperative complications. ConclusionDuring the pandemic, patients undergoing colonic resection were less likely to be discharged to a post-hospitalization facility. This shift was not associated with an increase in 30-day complications. This should prompt further research to assess the reproducibility of these associations, especially in a setting without a global pandemic.

Survey of fellowship program directors in minimally invasive gynecologic surgery: fellow participation in quality improvement and patient safety initiatives

Survey of fellowship program directors in minimally invasive gynecologic surgery: fellow participation in quality improvement and patient safety initiatives

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering

BackgroundAttempts have been made to reduce excessive laboratory test ordering; however, the problem persists and barriers to physician involvement in quality improvement (QI) remain. We sought to understand physician participation...

Evaluating the impact of junior doctors in quality improvement - a 10-year review.

ObjectivesThe importance of engaging junior doctors in quality improvement (QI) initiatives is well recognised. Junior doctors bring fresh perspectives and engage closely with patients, consumers, families and the healthcare team. They are well positioned to recognise inefficiencies in the system that may compromise safe, timely and effective care. To promote QI participation by our junior doctors our organisation created a specific role; the Improvement House Medical Officer (IHMO). The objective of this study is to describe and evaluate the IHMO rotation at the Royal Melbourne Hospital, a large tertiary hospital in Australia.MethodsA mixed-methods study was performed that involved a survey of previous IHMOs since 2011, including a review of the major QI projects undertaken by IHMOs.ResultsTwenty-seven out of 40 IHMOs completed the survey. Doctors were attracted to the rotation to make an impact on the working conditions of junior doctors (selected by 20 respondents, 74%) and improve the quality of health care experienced by patients (18, 67%). Most respondents strongly agreed or agreed (22, 82%) that they used the skills gained in the rotation in their ongoing work. More than 40 QI projects have been led or co-led by IHMOs since 2011. Challenges of the role included the short timeframe of the rotation and the perceived slow pace of institutional change. Respondents found engaging other junior doctors with QI and understanding the hospital's organisational structure to be barriers.ConclusionsThe full engagement of junior doctors in QI upholds a healthcare culture that celebrates innovation and promotes patient safety. The IHMO rotation offers an immersive, experiential and impactful way to do so.

RecutClub 2.0: Deployment of a Trainee-Led, Didactic-Centered Whole Slide Imaging Platform

Abstract Objectives The Houston Methodist Pathology training program encourages trainee participation in quality improvement (QI) projects for improving the didactics experience. One of these initiatives is RecutClub, a whole slide imaging (WSI) web-based platform for presenting surgical pathology unknown conference cases. With the evolving nature of pathology didactics in an ever-changing world where remote work plays an increasingly important role, several refinements were needed to ensure that the platform could continue to provide an unparalleled WSI experience for incoming trainees. Additionally, the burden of updating site content needed to be distributed from the site administrators to the end-users. Methods RecutClub is operated through Google Cloud via a Google App Engine instance. It connects to Google Cloud Databases to store persistent tabular data and Google Cloud Storage for pyramidal JPEG files used to display whole slide images in a web-browser. In the next generation platform (RecutClub 2.0), the largest change was to migrate case uploading from a developer-controlled solution to a decentralized, trainee-driven web portal. To ensure a superior user experience, the entire site as well as the upload form was migrated to Bootstrap 4. An AJAX-native, asynchronous uploader was built to interface the existing Google Cloud platform to a new upload portal that allows authorized trainees to build cases from scratch. Additionally, a tagging solution was implemented to allow for server-side persistent storage of trainee-selected cases, such as “interesting” cases or cases for further review. This tagging complements the existing region of interest (ROI) and case search functionalities. Results The deployment of RecutClub 2.0 involved multiple rounds of resident-led testing and feedback. Several regular testers offered ongoing user feedback and suggestions for visual layout and usability. The response from the general trainee population after deployment was overwhelming positive, with many trainees commenting on the “improved” visual aesthetics as well as the convenience of the upload functionality. Administrator involvement in case-upload time decreased from 2 hours/month to 0 hours/month due to enabling trainee-driven uploading. Conclusions The deployment of RecutClub 2.0 fulfilled the dual primary objectives of enabling straightforward trainee-led content updates, as well as decreasing administrator involvement in case-upload time. These and other changes ensure that RecutClub can continue to provide an unparalleled WSI experience for pathology trainees at Houston Methodist, while also providing fresh content in a landscape with several competing WSI platforms.

Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey

BackgroundLack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice.MethodsA cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019.ResultsThe response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians’ interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated.ConclusionsThis study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.

Promoters and inhibitors for quality improvement work in general practice: a qualitative analysis of 2715 free-text replies

BackgroundContinuous quality improvement (QI) is necessary to develop and maintain high quality general practice services. General Practitioners (GPs’) motivation is an important factor in the success of QI initiatives. We...

Development of a respiratory quality improvement faculty in an acute hospital using QI methodology

National Health Service (NHS) clinical staff are required to demonstrate involvement in quality improvement (QI) and patient safety. Clinicians are often best placed to identify problems and design solutions for...

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

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.

Increasing physician participation as subjects in scientific and quality improvement research

BackgroundThe twenty-first century has witnessed an exponential increase in healthcare quality research. As such activities become more prevalent, physicians are increasingly needed to participate as subjects in research and quality improvement (QI) projects. This raises an important ethical question: how should physicians be remunerated for participating as research and/or QI subjects?Financial versus non-monetary incentives for participationResearch suggests participation in research and QI is often driven by conditional altruism, the idea that although initial interest in enrolling in research is altruistic or prosocial, decisions to actually perform study tasks are cost–benefit driven. Thus, the three models commonly employed to appropriately compensate participants (in-kind compensation such as travel reimbursement, paying market rates for the subject’s time, and paying market rates for the activity asked of the participant) are a poor fit when the participant is a clinician, largely due to the asymmetry between cost and benefit or value to the participant. Non-monetary alternatives such as protected time for participation, continuing education or maintenance of certification credit, or professional development materials, can provide viable avenues for reducing this asymmetry.ConclusionResearch and QI are integral to the betterment of medicine and healthcare. To increase physician participation in these activities as the subject of study, new models are needed that clarify the physician’s role in research and QI as a subject. Non-monetary approaches are recommended to successfully and ethically encourage research and QI participation, and thus incorporate these activities as a normal part of the ethical clinician’s and successful learning healthcare system’s world view.