Practice Quality Improvement Research Articles

Enhancing Knowledge and Attitudes Regarding Opioid Use Disorder Among Private Primary Care Clinics: A Quality Improvement Project.

Opioid use disorder (OUD) continues to impact communities worldwide. British Columbia specifically declared a public health emergency in April 2016. It is known that patients with OUD often experience barriers in access to care, including limited knowledge and training among providers, as well as persisting stigma in the medical community. The Doctor of Nursing Practice quality improvement project sought to provide barrier-targeted OUD education while using multiple effective teaching methods, such as test-enhanced learning, to family nurse practitioners (FNPs) working among private primary care clinics to assess the impact on knowledge and attitudes. In review of an experience survey, zero participants had received prior education on OUD (N = 7). The Drug and Drug Problems Perceptions Questionnaire was used to assess attitudes. In review of the data, attitudes before receiving education (Mdn = 74) improved after receiving barrier-targeted education (Mdn = 66), W = 0, p < .05. Knowledge was tested at three time points. After a review of unique identifiers, four participant tests were successfully linked. It was found that knowledge after receiving education (M = 7.75, Mdn = 7.5) improved in comparison with baseline knowledge (M = 6, Mdn = 6) and further improved after a 1-month time frame (M = 8.5, Mdn = 8.5). Although the project was limited by sample size, providing education to FNPs who have not received prior education on OUD, and using modalities such as test-enhanced learning, showed a favorable impact on knowledge and attitudes. In light of the opioid epidemic, nursing leaders must continue to actively engage practicing FNPs and students with OUD education. FNPs are well positioned to be champions in this area and may mobilize teams to overcome barriers among private primary care clinics and increase access to care.

Lessons learned from the development of a national registry on dementia care and support based on linked national health and administrative data.

This paper provides insight into the development of the Dutch Dementia Care and Support Registry and the lessons that can be learned from it. The aim of this Registry was to contribute to quality improvement in dementia care and support. This paper describes how the Registry was set up in four stages, reflecting the four FAIR principles: the selection of data sources (Findability); obtaining access to the selected data sources (Accessibility); data linkage (Interoperability); and the reuse of data (Reusability). The linkage of 16 different data sources, including national routine health and administrative data appeared to be technically and legally feasible. The linked data in the Registry offers rich information about (the use of) care for persons with dementia across various healthcare settings, including but not limited to primary care, secondary care, long-term care and medication use, that cannot be obtained from single data sources. A key lesson learned is that in order to reuse the data for quality improvement in practice, it is essential to involve healthcare professionals in setting up the Registry and to guide them in the interpretation of the data.

Optimizing Contraceptive Prescription in Smoking Women: A Quality Improvement Study.

Introduction Family planning is fundamental in primary care (PC), and informed counseling helps to guide contraceptive choices. Combined hormonal contraceptives (CHC) pose cardiovascular risks, particularly when combined with smoking. According to the World Health Organization, the recommended global clinical decision is to refrain from employing CHC in female smokers aged 35 or older. This study aimed to improve contraception prescriptionfor female smokers aged 35-54 in PC. Methods This study was conducted in a Portuguese Family Health Unit (FHU) from October 2021 to August 2022, and it followed theStandards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and the Plan-Do-Study-Act approach.Female smokers aged 35-54 were includedand evaluated in three moments: baseline evaluation (October 2021), intermediate evaluation (February 2022), and post-intervention evaluation (August 2022). Interventions involved educating medical staff, creating patient awareness campaigns,and evaluating contraceptive methods. The established quality-defining goal was to decrease the prevalence of female smokers aged 35 or above using CHC to ≤5%. Results CHC prevalence among smoking women aged 35-54 decreased from 16.4% to 8.5% after nine months of the initial intervention. There was an increase in progestogen-only methods usage over time, from 25.7% to 34.0%. Discussion Despite not fully achieving the predefined goal, interventions led to a substantial reduction ofCHC useamong smoking women aged 35-54. Collaborative efforts between healthcare professionals and patients played a pivotal role in optimizing care and reducing cardiovascular risk. This study underscores the importance of continuous quality improvement, collaborative interventions, and knowledge updates in Family Medicine practice. While conducted in a single FHU, the intervention's multidimensional approach holds the potential for broader applicability. Conclusion In the future, healthcare teams should continue to reflect on achieved results, maintain knowledge, and empower patients in contraceptive method choices. The study contributes to improved care quality and highlights the positive impact on medical practice and patient outcomes.

Rationale and design for Healthy Hearts for Michigan (HH4M): A pragmatic single-arm hybrid effectiveness-implementation study

BackgroundThe burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery. MethodsPrimary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period. ResultsFifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26). ConclusionThis three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation.

Original Research: Exploring Frontline Nurses' Self-Perceived Levels of QI Engagement and QI Competence.

Nurse engagement in quality improvement (QI) is critical in the delivery of safe high-quality care, yet few studies have evaluated frontline nurses in this area. The purpose of this study was to identify and compare levels of self-reported QI engagement and QI competence among frontline nurses and nurse leaders. This study used a cross-sectional descriptive design. A convenience sample of frontline nurses (bedside RNs and advanced practice nurses) and nurse leaders from acute and ambulatory care sites completed the Nursing Quality Improvement in Practice (NQuIP) tool, which measures engagement and competence (knowledge, skills, and attitudes) in QI. Data from 6,351 surveys completed by frontline nurses and nurse leaders representing 66 sites nationwide were analyzed. Only 52.5% of all respondents reported participating in QI. Knowledge scores were relatively high, while skills scores-especially those related to using QI tools-were low. Overall attitudes toward QI were positive. Nurse leaders scored significantly higher in engagement and competence than the frontline nurses they supervise. The study findings indicate that nurse engagement in QI is limited. Although nurses' knowledge levels appear to be high, their limited competency in QI-related skills may contribute to low QI engagement. Leaders must make efforts to increase nurse engagement in order to attain high-quality outcomes. Using the NQuIP tool will allow leaders to evaluate nurses' self-perceived QI competence and engagement, which will aid in identifying target areas and developing effective strategies for improvement.

Longitudinal Introductory Pharmacy Practice Experience and Quality Improvement: Innovation and Impact

Longitudinal Introductory Pharmacy Practice Experience and Quality Improvement: Innovation and Impact

The moderating effect of knowledge-sharing on learning organisation and quality improvement practices

PurposeThe aim of this research is to determine the impact of a learning organisation (LO) on developing quality improvement practices (QIPs) and to propose knowledge-sharing (KS) as a moderator which is anticipated to support the beneficial effect of a LO on QIP. A further objective is to establish whether training provision raises the abilities of healthcare organisations (HCOs) to attain greater standards of QIP via a LO and KS.Design/methodology/approachA total of 240 responses, obtained from employees working at private HCOs in Jordan, comprised the valid dataset. Structural equation modeling (SEM) was utilised for data analysis. Multigroup analysis (MGA) was performed to compare the impact of workers who had or had not undergone training.FindingsThe findings indicated that QIP was significantly enhanced by LO. HCOs with the objective of converting a KS-moderated LO could attain improved QIP standards, but within the surveyed establishments, this effect was only appreciated at modest degrees. By performing MGA, no variations were identified in the impact of workers.Practical implicationsManagers should place more emphasis on training and learning within HCOs. However, respondents did indicate that their establishments had notable degrees of KS, suggesting a potential strength that could be used positively by the managerial hierarchy.Originality/valueThis study encompasses an original contribution to contemporary scholarship in the field of knowledge management and quality through its examination of the moderating effect of KS on LO and QIP.

Interprofessional reflective practice to improve pediatric healthcare outcomes

ABSTRACT There is limited research on the combined concepts of interprofessional reflective practice on healthcare outcomes. This research sought to better understand the concepts of interprofessional and reflective practice when utilized together to assess provider perception of improved healthcare outcomes in a pediatric setting. This article explores these concepts while also contributing to the body of knowledge for pediatric healthcare providers and quality improvement (QI) practices. After completion of a reflective QI project, 50 pediatric providers including nurse practitioners, physician assistants, and physicians were surveyed utilizing the reflective practice questionnaire (RPQ) along with other QI relevant healthcare data points. The results of this research demonstrated that interprofessional providers perceived the reflective project beneficial to improve their care to the pediatric population. These perceptions were consistent with the sister QI project that revealed significant improvements in care, thus validating the perceptions of the providers. Furthermore, provider participants demonstrated statistically significant overall satisfaction with an interprofessional reflective process. Many strides have been made utilizing both concepts in the educational preparation of healthcare providers with intentions to improve healthcare outcomes. This research supports the concept that pediatric healthcare outcomes may be improved through interprofessional reflective practice.

The Morning Report Practice and Its Contribution to Education of Internal Medicine Residents: A Multicenter Cross-Sectional Survey in the Eastern Province, Saudi Arabia.

Morning Report (MR) is a ubiquitous traditional educational activity in internal medicine residency training. It is under-researched; hence, this study was conducted. It aimed to examine the practice of MR by internal medicine residents, their motivation to engage with it, and their perception of its contribution to education. This was a multi-center cross-sectional study. The data was collected using an online self-administered 12-item questionnaire that covered MR practice, respondents' motivation for participation, MR contribution to education, and its impact on the practice of evidence-based medicine and quality improvement and patient safety. One hundred seventy residents returned the online questionnaire (54.7%). The respondents' gender and year of training were balanced (P > 0.05). The most common MR frequency and duration were five days per week (85.4%) and 45-60 minutes (47.1%), respectively. The most common format was handover combined with an emergency long case presentation (55.8%), and consultants were the most common facilitators (79.7%). The respondents' motivation to engage with MR was predominantly intermediate. The top reasons for attending and not attending MR were mandatory attendance and embarrassing questions, respectively. The perceived MR contribution to residents' different roles development was predominantly intermediate; however, it was predominantly very low/low (42%) for overall education. The perceived MR impact on the practice of EBM and QIPS were both predominantly intermediate. MR was found to be a commonly practiced educational activity in internal medicine residency training programs in the eastern province of Saudi Arabia. The case discussion was the core format for education. The respondents' motivation to participate in MR and their perception of its contribution to education was predominantly intermediate. To our best knowledge, this is the first study in Saudi Arabia that examined MR. We hope its findings will be taken for further MR studies and actions for improvement.

Understanding Quality Improvement and Continuing Professional Mentorship: A Needs Assessment Study to Inform the Development of a Community of Practice.

Quality improvement (QI) programming attempts to bridge the gap between patient care and standards of care. Mentorship could be a means through which QI is fostered, developed, and incorporated into continuing professional development (CPD) programs. The current study examined (1) models of implementation for mentorship within the Department of Psychiatry of a large Canadian academic center; (2) mentorship as a potential vehicle for alignment of QI practices and CPD; and (3) needs for the implementation of QI and CPD mentorship programs. Qualitative interviews were conducted with 14 individuals associated with the university's Department of Psychiatry. The data were analyzed through thematic analyses with two independent coders using COREQ guidelines. Our results identified uncertainty among the participants regarding the conceptualization of QI and CPD, illustrating difficulties in determining whether mentorship could be used to align these practices. Three major themes were identified in our analyses: sharing of QI work through communities of practices; the need for organizational support; and relational experiences of QI mentoring. A greater understanding of QI is necessary before psychiatry departments can implement mentorship to enhance QI practices. However, models of mentorship and needs for mentorship have been made clear and include a good mentorship fit, organizational support, and opportunities for both formal and informal mentorship. Changing organizational culture and providing appropriate training is necessary for enhancing QI.

Collaborating to DrEaM bigger and better: the challenges in using digital data to drive quality improvement in clinical practice

Background: Supporting patients to Drink, Eat and Mobilise (DrEaMing) within 24 h of major surgery is associated with reduced length of hospital stay and late complications.1 This quality metric was assigned a financial incentive in the 2022 NHS England CQUIN scheme with a compliance target of 60–70% for specific surgical patient cohorts. Beyond the CQUIN, we wanted to deliver DrEaMing to all surgical patients and embed a culture change by reinvigorating core concepts of enhanced recovery pathways. Optimal use of our electronic healthcare record, EPIC, was key to our strategy, aiming to provide surgical teams with sustainable real-time data to drive quality improvement (QI) through electronic extraction of CQUIN metrics. Methods: CQUIN specialty data were extracted from EPIC quarterly. Anaesthetic registrars worked as DrEaMing champions alongside clinical nurse specialists (CNS) to facilitate collaborative working within the perioperative team. Key stakeholders were educated on how to record DrEaMing instructions and provision allowing electronic audit of CQUIN compliance with accurate time stamps. A total of 26 ward staff involved in DrEaMing provision on postoperative surgical wards were surveyed on barriers to DrEaMing. Results: EPIC data from 2022–23 showed varying CQUIN compliance rates across surgical specialties. Gynae-oncology documentation of postoperative DrEaMing instructions increased from 0% in April to 100% by January, however, postoperative DrEaMing provision plateaued around 60–70%. Overall CQUIN attainment across the year was <50%. Colorectal CQUIN compliance was limited by poor documentation of postoperative eating instructions and subsequent poor ward eating provision (Fig. 6), reflecting the heterogenous nature of colorectal procedures undertaken and varied recovery approach by teams. Surveys of ward staff across women’s health and colorectal surgery revealed burden of documentation, lack of access to means to document and unclear surgical postoperative instructions were important barriers to ward documentation of DrEaMing provision. Conclusion: DrEaMing compliance using EPIC data extraction at UCLH remains poor, despite motivated staff and a culture of QI, but was significantly higher with manual review of the notes trawl highlighting disparity between clinical practice and use of new EPIC builds. Our aim to make DrEaMing data easily accessible for QI requires further buy-in from surgical teams and engagement with ward staff. Permanent CNS act as pivotal change champions, through education and raising awareness. 1.Oliver CM, Warnakulasuriya S, McGuckin D, et al. Br J Anaesth 2022; 129: 114–26

INnovation, QUality Improvement, Research, and Evidence-Based Practice (INQUIRE): A Navigation Model for Change and Discovery.

Despite scholarly articles and pathway models delineating quality improvement (QI), evidence-based practice (EBP), research, and innovation, guidance is lacking when determining the project method. A practical, step-by-step approach is needed to support project navigation. To describe development and evaluation of a decision-making pathway model. The INQUIRE Model was developed using an iterative approach and was evaluated with 23 national conference attendees. The evaluation included 4 Likert-type items ranging from 1 (strongly disagree) to 7 (strongly agree). The model guides users through project planning steps based on an identified trigger (eg, problem, opportunity, and challenge) to ultimately select a project method that aligns with the project scope and availability of a solution. Model evaluation found identification of the project method improved by 14%, scanning for a solution by 8%, avoiding missed steps by 36%, and building a team by 10%. Findings suggest INQUIRE can enhance project planning and method (eg, QI, EBP, research, and innovation) selection. Organizations should evaluate project planning current state to identify the potential benefit of model incorporation.

Data Science and Precision Oncology Nursing: Creating an Analytic Ecosystem to Support Personalized Supportive Care across the Trajectory of Illness

The authors' objective is to present an overarching framework of an analytic ecosystem using diverse data domains and data science approaches that can be used and implemented across the cancer continuum. Analytic ecosystems can improve quality practices and offer enhanced anticipatory guidance in the era of precision oncology nursing. Published scientific articles supporting the development of a novel framework with a case exemplar to provide applied examples of current barriers in data integration and use. The combination of diverse data sets and data science analytic approaches has the potential to extend precision oncology nursing research and practice. Integration of this framework can be implemented within a learning health system where models can update as new data become available across the continuum of the cancer care trajectory. To date, data science approaches have been underused in extending personalized toxicity assessments, precision supportive care, and enhancing end-of-life care practices. Nurses and nurse scientists have a unique role in the convergence of data science applications to support precision oncology across the trajectory of illness. Nurses also have specific expertise in supportive care needs that have been dramatically underrepresented in existing data science approaches thus far. They also have a role in centering the patient and family perspectives and needs as these frameworks and analytic capabilities evolve.

Factors influencing family physician engagement in practice-based quality improvement: Qualitative study.

To explore the experiences of family physicians leading quality improvement (QI) efforts and to better understand facilitators and barriers related to advancing QI in family practice. Qualitative descriptive study. The Department of Family and Community Medicine at the University of Toronto in Ontario. The department launched a quality and innovation program in 2011 with the dual goals of teaching QI skills to learners and supporting faculty in leading QI efforts in practice. Family physician faculty who held QI leadership roles at any of the department's 14 teaching units between 2011 and 2018. Fifteen semistructured telephone interviews were conducted over 3 months in 2018. Analysis was informed by a qualitative descriptive approach. Consistency of responses across the interviews was suggestive of thematic saturation. Substantial variation was found in the level of engagement with QI in practice settings despite the common training, forms of support, and curriculum the department provided. Four factors influenced the uptake of QI. First, committed leadership across the organization was fundamental to developing an effective QI culture. Second, external drivers such as mandatory QI plans sometimes motivated engagement in QI but sometimes were barriers, particularly when internal priorities conflicted with external demands. Third, at many practices, QI was widely perceived as extra work rather than as a way to enable better patient care. Finally, physicians described lack of time and resources as a challenge, particularly in community practices, and advocated for practice facilitation as a mechanism to support QI efforts. Advancing QI in primary care practice will require committed leaders, a clear understanding among physicians of the potential benefits of QI, alignment of external demands with internal drivers for improvement, and dedicated time for QI work along with support such as practice facilitation.

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

PurposeThe purpose of this paper is to explore and describe the perspectives and reasoning of senior development leaders in healthcare organizations, when reflecting on design as theory and practice in relation to more traditional methods and tools for improving quality and support innovation.Design/methodology/approachThe paper is based on a qualitative interview design with five development and innovation leaders from separate healthcare regions in Sweden. They have, to varying degrees, applied design theory and practice for quality improvement and innovation in their organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.FindingsThe major findings are to be found in the balancing act for leadership and organizations in healthcare when it comes to introducing and combining different theories and practices for improving quality and support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.Practical implicationsThe narratives from the leaders' experience of applying design theory and practice for improving healthcare quality can help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design theories, practices, methods and tools in a healthcare context.Originality/valueThe study provides a unique insight when it captures and illustrates five different organizations' experiences when applying design for developing healthcare quality.

Does International Accreditation Provide for Greater Enrolment, Program Completion, Employment, and Employer Satisfaction?

Aim: The current research was conducted to examine the potential influence of international accreditation of universities on the enhancement of students’ enrolment and educational quality, employment opportunities, and employer satisfaction. The study also contextualized the findings to focus on the case of Guyana.&#x0D; Methodology: A secondary qualitative research methodology was used to conduct this research. It comprised using an inductive approach to gather and study the most contemporary and relevant secondary literature on the subject. Afterward, through thematic analysis, major qualitative finding and their patterns were segmented in the form of two major themes.&#x0D; Findings: This study discovered that international accreditation benefits both business satisfaction and student satisfaction. It was discovered that the planning and self-study evaluation activities for accreditation operate as a catalyst for quality improvement practices. The results also imply that consistent efforts to satisfy requirements for international accreditation can raise the level of instruction given to pupils. It is yet unknown, though, how certification will impact Guyana's employment prospects and employee happiness.

Teaching Professional Peer Review With the Use of Simulation.

Quality improvement practices such as peer review and just culture are important components of patient safety initiatives, and health professions students should be introduced to these practices during their education. The purpose of this study was to evaluate a peer-review simulation learning experience using just culture principles in a graduate-level, online nursing education program. The students rated their learning experience with high, positive scores in all 7 domains on the Simulation Learning Experience Inventory. Responses to the open-ended question indicated that the students thought the experience provided opportunities for deep learning, increased confidence, and enhanced critical thinking skills. A peer-review simulation program using just culture principles provided a meaningful learning experience for graduate-level students in an online nursing education program.

Authentic leadership, organizational culture and the effects of hospital quality management practices on quality of care and patient satisfaction.

To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction. Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care. Using structural equation modelling, we tested a model on quality improvement practices across three participant groups that differed based on authentic leadership and hospital culture. We used survey data from a cross-sectional study conducted in 2015 measuring nurse. Managers' perceptions of authentic leadership, implementation of quality improvement, and organizational culture in Canadian hospitals. 226 nurse managers participated. Our model estimations fit for the high-relational group and mixed group. Our model explained 50.7% and 39.5% variance in our outcome variable of patient satisfaction for the high-relational group and mixed group, respectively. Our model failed to fit the low-relational group. Authentic leadership and developmental/group hospital cultures improve quality management practices, quality of care and patient satisfaction. In organizations with low authentic leadership and hierarchical/rational cultures, strategies should target increasing authentic leadership and shifting to developmental cultures. Organizations with high authentic leadership and/or developmental/group cultures should target employee engagement, autonomy and teamwork. We examined how different combinations of authentic leadership and hospital culture influence the effects of quality management practices on quality improvement and patient satisfaction. Findings demonstrate that having both high authentic leadership and developmental or group hospital cultures are essential for quality improvement practices to enhance the quality of care and patient satisfaction. These organizations would benefit the most from systemic programs aimed at standardizing quality management practices as they have the culture and leadership to support these practices. For hospitals with hierarchical/rational cultures and/or low authentic leadership, enhancing hospital culture and leadership through leadership training and accreditation programs is critically needed. The College and Association of Registered Nurses of Alberta contributed to this study by facilitating data collection and supporting the conduct of the study through messaging to its members.

The Impact of Healthcare Delivery Complexity on Practices for Clinical Quality Improvement: A Case of Healthcare Workers’ Hand Hygiene Compliance

Healthcare providers often implement quality improvement (QI) practices to improve clinical quality, which may be measured as the extent to which healthcare workers (HCWs) comply with standardized procedures designed for ensuring patient safety. Unfortunately, the effectiveness of QI practices to improve clinical quality varies from facility to facility because of healthcare delivery complexity. In this paper, we consider the contextual complexity and the provider complexity arising from healthcare delivery processes, and we propose an exploratory study based on discrete choice experiments to examine their roles in the relationship between QI practices and clinical quality. By collecting and analyzing data from 320 HCWs at a university hospital in Taiwan, we found that healthcare delivery complexity significantly moderated the effectiveness of QI practices and how they improved clinical quality. We found that the contextual complexity influenced the level of effectiveness of the QI practices, whereas the provider complexity influenced whether a QI practice may be effective or not. We also studied the effect of implementing multiple QI practices simultaneously to counter the provider complexity. We found that implementing more QI practices does not necessarily lead to better outcomes, but implementing the right ones would. Our findings provide healthcare facilities with ex ante insights for designing QI practices to improve clinical quality. Funding: W. Chen was supported by the National Natural Science Foundation of China [Grant 71902017], and C.-L. Tseng was supported by the University of New South Wales UNOVA Knowledge Hub. Supplemental Material: The online appendix is available at https://doi.org/10.1287/serv.2023.0323 .

Preliminary Program Guide: Sunday, May 21, 2023

Preliminary Program Guide: Sunday, May 21, 2023