Quality Improvement Implementation Research Articles

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit.

Infants with congenital heart disease (CHD) are at high risk for developmental differences which can be explained by the cumulative effect of medical complications along with sequelae related to the hospital and environmental challenges. The intervention of individualized developmental care (IDC) minimizes the mismatch between the fragile newborn brain's expectations and the experiences of stress and pain inherent in the intensive care unit (ICU) environment. A multidisciplinary group of experts was assembled to implement quality improvement (QI) to increase the amount of IDC provided, using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), to newborn infants in the cardiac ICU. A Key Driver Diagram was created, PDSA cycles were implemented, baseline and ongoing measurements of IDC were collected, and interventions were provided. We collected 357 NIDCAP audits of bedside IDC. Improvement over time was noted in the amount of IDC including use of appropriate lighting, sound management, and developmentally supportive infant bedding and clothing, as well as in promoting self-regulation, therapeutic positioning, and caregiving facilitation. The area of family participation and holding of infants in the CICU was the hardest to support change over time, especially with the most ill infants. Infants with increased medical complexity were less likely to receive IDC. This multidisciplinary, evidence-based QI intervention demonstrated that the implementation of IDC in the NIDCAP model improved over time using bedside auditing of IDC.

Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study

BackgroundThe devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based...

Outcomes of a Multisite Mentored Implementation Approach to Promoting Goals of Care Conversations

ContextThe Preference-Aligned Communication and Treatment (PACT) Project is a multisite quality improvement effort that has been shown to increase the frequency of goals of care (GOC) conversations in hospitalized patients with serious illness. ObjectivesTo evaluate the effect of PACT on goal-discordant care and resource utilization. MethodsHospitals enrolled in a multiyear mentored implementation quality improvement initiative to facilitate GOC conversations for seriously ill hospitalized patients. The primary outcome was the percentage of patients with care discordant with stated preferences, assessed by comparing documented wishes to Medicare claims data for patients who were admitted to intervention units and died over the study period. Secondary outcomes evaluated end-of-life resource utilization by comparing Medicare claims data for intervention patients with propensity score-matched controls. ResultsIn the 9 hospitals included in the study, 1347 intervention group patients were compared to 4019 in the control group. Rates of discordance between wishes and care were generally low in the intervention group. Compared to the control group, patients in the intervention group had lower costs (−976.05 dollars, P = 0.010), were less likely to be admitted to the ICU (OR 0.9, P = 0.005), less likely to be on a ventilator or undergo CPR or cardioversion, more likely to enroll in hospice (OR 1.81, P < 0.001) and had a longer hospice stay (3.35 more days, P = 0.041). ConclusionA multisite mentored implementation quality improvement intervention for seriously ill hospitalized patients resulted in care aligned with goals and decreased resource utilization at the end of life.

Receipt of seasonal malaria chemoprevention by age-ineligible children and associated factors in nine implementation states in Nigeria

BackgroundAs part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3–59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round.MethodsThis analysis was based on data from representative end-of-round SMC household surveys conducted in nine SMC-implementing states in Nigeria. Data of 3299 age-ineligible children aged > 5 years and their caregivers were extracted from the survey dataset. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with ineligible receipt of SMC medicines.Results30.30% (95% CI 27.80–32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5–6 years while the rest were aged 7–10 years. There were lower odds of an age-ineligible child receiving SMC medicines among caregivers who were knowledgeable of SMC age eligibility (OR: 0.53, 95% CI 0.37–0.77, p < 0.001), compared with those who were not knowledgeable of age eligibility. Higher odds of receipt of SMC were found among age-ineligible children whose caregivers had higher confidence in the protective effect of SMC against malaria (OR: 2.01, 95% CI 1.07–3.72, p = 0.030), compared with those whose caregivers were less confident. Compared with ineligible children of younger caregivers (aged < 20 years), those whose caregivers were older had lower odds of receiving SMC than those whose caregivers were younger; with lower odds among children of caregivers aged 20–39 years (OR: 0.50, 95% CI 0.30–0.82, p = 0.006).ConclusionsThis study contributes important evidence on the magnitude of the receipt of SMC medicines by age-ineligible children, while identifying individual and contextual factors associated with it. The findings provide potentially useful insights that can help inform and guide context-specific SMC implementation quality improvement efforts.

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada

BackgroundThe fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity.MethodsAn audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt.ResultsFidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly.ConclusionsWe describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions.Trial registrationClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Impact of a quality improvement initiative and monthly multidisciplinary meetings on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis.

Several studies have demonstrated the benefits of enhanced recovery after surgery (ERAS) protocols for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumented fusion (PSIF). However, there are relatively few studies investigating the effect of regular multidisciplinary team meetings on level selection, surgical performance parameters, and patient outcomes after PSIF for AIS. The aim of this study was to assess changes in intra- and postoperative outcomes following multidisciplinary team meeting implementation for patients undergoing PSIF for AIS. The medical records of 96 adolescents (10 to 18years old) diagnosed with AIS and undergoing PSIF at a major academic institution from 2017 to 2022 were retrospectively reviewed. A quality improvement (QI) initiative was implemented in February 2020, including institution of monthly multidisciplinary conferences focusing on preoperative indications, level selection, postoperative review of surgical performance parameters for previous cases, and discussion and optimization of postoperative ambulation and pain control protocols. Patients were placed into "Pre-QI" (treated pre-February 2020) and "Post-QI" (treated post-February 2020) cohorts. Patient demographics, comorbidities, deformity characteristics, intraoperative variables, ambulation status, postoperative complications, length of stay (LOS), and unplanned readmission rates were assessed. Of the 96 study patients, 44 (45.8%) were in the Pre-QI cohort, and 52 (54.2%) were in the Post-QI cohort. Mean major curve was not significantly different between the two cohorts (Pre-QI: 58.0 ± 7.3° vs Post-QI: 57.9 ± 14.5°, p = 0.169). The Pre-QI cohort had a greater mean minor curve degree (Pre-QI: 42.7 ± 11.8° vs Post-QI: 36.8 ± 12.4, p = 0.008). The Pre-QI cohort had significantly greater mean spinal levels fused (Pre-QI: 11.7 ± 1.7 vs Post-QI: 10.4 ± 2.6, p = 0.009), significantly greater mean estimated blood loss (Pre-QI: 1063.6 ± 631.5ml vs. Post-QI: 415.8 ± 189.9ml, p < 0.001), significantly greater mean operative time normalized to levels fused (Pre-QI: 0.6 ± 0.1h/level fused vs Post-QI: 0.4 ± 0.1h/level fused, p < 0.001), and a significantly greater proportion of patients with intraoperative drain placement (Pre-QI: 93.2% vs Post-QI: 5.8%, p < 0.001). The Post-QI cohort had significantly shorter time to postoperative ambulation (Pre-QI: 2.1 ± 0.9days vs Post-QI: 1.3 ± 0.5days, p < 0.001). A significantly greater proportion of patients in the Pre-QI cohort developed any postoperative complication (Pre-QI: 72.7% vs Post-QI: 34.6%, p < 0.001), and mean LOS was significantly greater among Pre-QI patients (Pre-QI: 4.5 ± 1.1days vs Post-QI: 3.2 ± 0.8days, p < 0.001). Discharge disposition (p = 0.758) and 30-day unplanned readmissions (p = 0.207) were similar between the cohorts. Our findings suggest that monthly multidisciplinary pediatric spine team meetings may improve patient care. Further studies exploring the incorporation of QI implementation with frequent multidisciplinary team meetings into existing ERAS protocols are merited.

Implementasi Sistem Penjaminan Mutu Internal dalam Meningkatkan Mutu Pendidikan di MIN 1 Rejang Lebong

ABSTRACTInternal quality assurance is carried out with reference to national educational standards in order to realize the educational goals of the country. Internal quality is currently used in basic and secondary education in addition to universities. This study aims to identify and explain the internal quality system cycle's implementation. Data collecting methods include observations, interviews, and documentary research. According to the findings of this study, Darul Farah Cihampelas Secondary School has implemented the following quality improvement activities in accordance with the stages of the SPMI cycle: first, a school self-evaluation based on the education quality report; second, quality improvement planning through the creation of a quality assurance committee and a re-analysis of the results of the school self-evaluation; third, implementation of quality improvement; and fourth. The evaluation of educational quality comes in second. Quality strategy for the fifth fiscal year, evaluation following quality improvement, and quality improvement results. Implementing internal quality assurance will have an influence on the development of more creative teaching methods, student and school performance, internal and external customer happiness, and the fulfillment of the eight National Education Standards.

How social networks influence the local implementation of initiatives developed in quality improvement collaboratives in health care: A qualitative process study.

Quality improvement collaboratives (QICs) have facilitated cross-organizational knowledge exchange in health care. However, the local implementation of many quality improvement (QI) initiatives continues to fail, signaling a need to better understand the contributing factors. Organizational context, particularly the role of social networks in facilitating or hindering implementation within organizations, remains a potentially critical yet underexplored area to addressing this gap. We took a dynamic process perspective to understand how QI project managers' social networks influence the local implementation of QI initiatives developed through QICs. We explored the case of a QIC by triangulating data from an online survey, semistructured interviews, and archival documents from 10 organizations. We divided implementation into four stages and employed qualitative text analysis to examine the relationship between three characteristics of network structure (degree centrality, network density, and betweenness centrality) and the progress of each QI initiative. The progress of QI initiatives varied considerably among organizations. The transition between stages was influenced by all three network characteristics to varying degrees, depending on the stage. Project managers whose QI initiatives progressed to advanced stages of implementation had formed ad hoc clusters of colleagues passionate about the initiatives. Implementing QI initiatives appears to be facilitated by the formation of clusters of supportive individuals within organizations; this formation requires high betweenness centrality and high network density. Flexibly modifying specific network characteristics depending on the stage of implementation may help project managers advance their QI initiatives, achieving more uniform results from QICs.

Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India

IntroductionThe primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges,...

Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Background and Issue: Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes. Purpose: The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke. Method: An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023. Results: A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation. Conclusion: Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.

Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative.

To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP). A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis. Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022. Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.

Strengthening the policy, implementation, and accountability environment for quality care: experiences from quality of care network countries.

Despite global commitment to universal health coverage with quality, poor quality of care (QOC) continues to impact health outcomes for mothers and newborns, especially in low-and-middle income countries. Although there is much experience from small-scale projects, without a long-term perspective it is unclear how to implement quality of care effectively and consistently for impact. In 2017, ten countries together with the WHO and a coalition of partners established the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network). The Network agreed to pursue four strategic objectives-Leadership, Action, Learning and Accountability (LALA) for QOC. This paper describes, analyses and reflects on what has worked and some of the challenges faced in implementation of the LALA framework. The implementation of the LALA framework has served as a catalyst to develop an enabling environment for QOC in the Network countries through strengthening the policy, implementation, accountability and community engagement for quality care. Developing an enabling health system environment takes time, but it is possible and shows results. The implementation shows that health systems continue to face persistent challenges such as capacities to quickly scale up changes across subnational levels, limited workforce capability to implement quality improvement consistently and gaps in quality of relevant data. The implementation has also highlighted the need to develop new mechanisms for community engagement and learning systems that inform scaling up of good QOC practices across programmes and levels of care. Moving forward, the Network countries will build on the experiences and lessons learned and continue to strengthen the implementation of LALA strategic objectives for impact. We hope the Network experience will encourage other countries and partners to adopt the Network implementation model to enable delivery of quality care for everyone, everywhere, and actively collaborate and contribute to the QOC global learning network.

Experiences regarding Home Care for Older Adults from the Viewpoint of Family, Paid Caregivers, Nurses, and Experts: A Qualitative Study

Home care (HC) is recommended for older adults who want to live at home as long as possible despite life-limiting conditions. It is more convenient and cost-effective than institutionalization and hospitalization. However, HC for older adults in Iran faces many challenges. The purpose of this study was to explore the perspectives of different stakeholders involved in HC for older adults about their experiences and suggestions for HC improvement. This qualitative study was conducted based on the explorative content analysis approach between 2021 and 2022 in Tabriz, Iran. The participants were selected using the purposeful sampling method, and the data were collected through in-depth semistructured personal interviews. A total of 27 individuals who participated in individual interviews were family members, HC workers (including nurses and unqualified paid caregivers), heads of counseling and nursing care at home centers, and experts who had clinical or research experience in the field of geriatric care. Collected data were categorized into three main themes: defects in home care governance, concern about the efficiency of home care, and caregivers’ job security concerns. These themes reflected the problems of HC, such as conflicts between multiple trustees, lack of evaluation and monitoring, inadequate competence and financial barriers of families and caregivers, and poor integration and coordination of services. Therefore, it is recommended to develop a national model for HC for Iranian older adults and allocation of different financial resources for HC, implementing quality improvement and evaluation tools, enhancing the training of caregivers, providing them with adequate compensation and benefits, and ensuring the safety and quality of services. These findings can inform the policymakers and planners of care services about the needs and challenges of this population and facilitate the collaboration among different stakeholders to provide better HC for older adults.

Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives.

Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap. This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process. We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories. The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales. This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.

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.

IMPLEMENTASI SISTEM MUTU INTERNAL UNTUK MENINGKATKAN MUTU PENDIDIKAN DASAR

To implement state education goals, internal quality assurance is carried out in relation to national education standards. Internal quality is now applied not only to higher education, but also to primary and secondary education. We continue to ensure and lead educational quality assurance and compliance in primary and secondary school units. The aim of this research is to determine and describe the implementation of the internal quality system cycle. The techniques used in data collection are: Observation, interviews, documentary research. The results of the research show that the quality improvement steps implemented at Bawamai Pontianak Elementary School are in accordance with the SPMI cycle steps including: First, school self-evaluation based on education quality certificates; second, a plan to improve quality through the formation of a quality committee and analysis of the results of the Kermbali School self-evaluation; Implementation of quality improvement, fourth, evaluation of follow-up and results of quality improvement after quality improvement, and fifth, return to next year's quality plan. The results of implementing internal quality assurance influence a more innovative learning process, student and school performance, satisfaction and success of internal and external customers. Eight national education standards.

PERBAIKAN KUALITAS PRODUK MENGGUNAKAN METODE QUALITY CONTROL CIRCLE (QCC) DI PT. PUDAK ORIENTAL INDONESIA

PT. Pudak Oriental Indonesia is one of the companies that emphasize the importance of product quality. The common issue faced in the quality inspection process is the presence of numerous defective products that fail quality testing. The objective of this research is to identify the types of defects that frequently occur, identify their root causes, and reduce the defect rate using the Quality Control Circle (QCC) method, employing PDCA (Plan, Do, Check, Act), and Control Charts. QCC is a method aimed at reducing defects and improving product quality. The research findings indicate that the most frequent type of defect is white body defects, with a total of 309 pieces. The root cause analysis reveals that the most influential factors are human error and material factors. The results of the quality improvement implementation initially started at 18% and have reduced to 11%. Specifically for the white body defect type, after the defect mitigation efforts, the defect rate has been reduced from the initial 309 pieces to 54 pieces.

Critical Success Factors For Quality Improvement Projects In Pasuruan, East Java, Indonesia

Purpose: This study aims to determine the factors influencing the successful implementation of quality improvement projects. Theoretical framework: This research will focus on finding critical success factors for quality improvement projects and prioritizing improvements to improve the performance and success of quality improvement project implementation. Design, Methodology and Approach: The research used Smart PLS-SEM and Importance Performance Analysis (IPA). Smart PLS-SEM was first used to determine critical success factors for Quality Improvement Projects (QIPs). Furthermore, IPA was used to determine the position of each factor based on its importance and achievements. Findings: The result showed all dimensions and indicators significantly affect the success of quality improvement projects. The dimension with the highest outer loading value is the quality performance measurement dimension. The next step is measured using the IPA method to determine the critical factors for project success. The results of the IPA analysis show that quality control and leadership are crucial factors in the success of quality improvement projects in the second quadrant. At the same time, the factor that prioritizes improvement is quality assurance (first quadrant). Research, Practical &amp; Social implications: Research, Practical, and Social Implications: The research implies that quality control and leadership are critical success factors for quality improvement projects. Leadership plays an essential role in implementing quality improvement projects, and leadership commitment is an important key to the success of these projects. In addition, there is a requirement for support from leadership regarding resource allocation. This resource allocation includes labor, costs, information systems, machines, and tools. Another factor that is critical to the success of these projects is quality control. Implementation of quality control has a vital role during the quality improvement project process and after the project. With quality control, the product suits the specifications and standards and meets the targets and standards set. Products that track the results of the implementation of quality control can ensure that the product's quality is guaranteed and follows the target set. Originality/Value: This research combines two methods to determine the critical success factors in implementing quality improvement projects. Previous research, using SEM-PLS and IPA method measurements, was carried out separately, measuring the importance and performance levels. In this study, the outer loading results in the original sample measurement with SEM-PLS for importance value in the IPA method.

Implementing Quality Improvement to Morbidity and Mortality Conferences: Focusing on Action Plans By Closing the Loops with Timely Follow Ups

Introduction Morbidity and Mortality (M&amp;M) meetings are often part of the medical curriculum for doctors in training where junior doctors present cases for reflection on diagnostic or treatment decision-making, and in return they attain clinicopathological wisdom. Studies have shown that for M&amp;M meetings to facilitate improvement, they need to be structured and systematic in reviewing and discussing sentinel events, directing discussions towards improving system and process variations. Often, the structure of M&amp;M meetings led to a lack of organizational learning and accountability. We sought to restructure the traditional M&amp;M process in our department and utilize this process as a Quality Improvement initiative. Using a structured follow up process as a “closing the loop” mechanism, we wanted to assess what impact this would have on the original emphasis of the meetings and on professional learning. Setting and Objective M&amp;M conferences are held at monthly Hematology &amp; Oncology division meeting attended by fellows, senior staff physicians, advanced practice providers, nurses, pharmacists, and administration members. A case is curated and presented to the group by one of the Hematology and Oncology Fellows on a rotational basis. Guests from other divisions are invited depending on the cases being discussed. The hospital's peer review coordinator facilitates the coordination among stakeholders before and after the conference. Typically, these discussions result in fruitful proposals, however there was no formal process in place to implement changes and report follow up back at the M&amp;M conferences. There were incidents where multiple similar issues were brought up in a repeated fashion creating frustration and mistrust in the system among team members. Subajects and Methods Consequently, an intervention was planned to streamline proposed action plans, implement them and provide updates at future M&amp;M conferences on cases previously discussed. The process involved creating a tracking spreadsheet, each case culminated with proposed action plans. The outcome was reported three months later at the beginning of the M&amp;M conference. This redesigning of the M&amp;M process was carried out in a PDSA cycle fashion. This quality improvement study design was a prospective cohort study. In July 2022, a pre-intervention survey was sent to all stake holders and the same survey was sent 10 months later after completion of 10 M&amp;M conferences in the redesigned format. The survey covered the following 5 questions: Rate the overall educational value of past M&amp;M conferences that you have attended in this department.On average, how engaged or involved did you feel during past M&amp;M conferences in this department?To what extent have prior M&amp;M conferences in this department contributed to your ability to prevent or handle similar complications to those that were presented?How satisfied were you with the action plan being proposed by the end of the meeting?How assured were you that the proposed action plan will be followed up on after the meeting is over? Results and Discussion Follow-up action plans included improving access to outpatient oncology care, coordinating transition of care between inpatient &amp; outpatient teams, providing education regarding hospital policies, communications with multiple inpatient consult services as well as outpatient affiliated infusion centers, treatment coordination with blood bank and stem cell transplant teams, feedback suggestions to improve on existing departmental policies covering anti-neoplastic chemotherapy administration. Due to anonymity of survey, there was no way to link or know if the same person took the pre survey and then completed the post survey, so we were limited in the types of analyses that we could do with the data. Nonetheless, there was a positive trend in answers to all the questions asked. Statistical significance was reached in the third question of survey as illustrated. Conclusion This quality improvement initiative reinforces the importance on follow through on action plans after the conference as well as the need to close the loop with follow up reporting back to the group on previously discussed cases. The hematology and oncology fellowship program at Henry Ford Hospital will implement this action plan in future conferences and will continue to address areas of improvement with regards to peer review and M &amp; M case discussions.