Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India

Giannitrapani, Karleen F.; Satija, Aanchal; Ganesh, Archana; Gamboa, Raziel; Fereydooni, Soraya; Hennings, Taylor; Chandrashekaran, Shivani; Mickelsen, Jake; DeNatale, Michelle; Spruijt, Odette; Bhatnagar, Sushma; Lorenz, Karl

doi:10.1007/s11606-020-06152-y

Cited by 10 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Quality and Safety Education for Nurses (QSEN) QI competency is a valuable resource for strategies and skills related to data collection, evaluation and improvement in patient outcomes of care (Cronenwett et al, 2007; Cronenwett et al, 2009). However, more studies are needed to test and expand nurses' QI capacity at the frontline (Bevan, 2010; Giannitrapani et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

Alexander

Tschannen

Argetsinger

et al. 2022

J Nursing Management

View full text Add to dashboard Cite

Aim: This study aimed to understand the facilitators and barriers of quality improvement (QI) from the perspective of nurses and leaders at the frontline.Background: Nurse engagement in QI has been associated with quality care and improved patient outcomes, yet nurse reported participation is low.Methods: A descriptive qualitative design and purposive sampling was used to examine barriers and facilitators of nurse engagement.Results: Facilitators (1) A leader's influence on a QI culture. Subthemes: creating buy-in, support of a just culture and working in partnership with nurses. Barriers(1) Barriers in organizational culture for nurses to lead QI. Subthemes: organizational hierarchy, absence of a just culture, nurses' role not valued, lack of accountability for QI in nursing role and resistance to change. (2) Barriers in organisational structure for nurses to lead QI. Subthemes: manager disengagement, time pressures, lack of access to timely data, lack of QI knowledge, siloed departments and lack of QI experts. Conclusion:Barriers to QI engagement prevent nurses from fully engaging in QI. Creating a just culture and building the infrastructure to support nurse engagement is critical for success.Implications for Nursing Management: Specific facilitators and barriers were identified that nurse leaders can assess in their practice setting and use relevant strategies to support engagement in QI.

show abstract

Section: Discussionmentioning

confidence: 99%

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

Alexander

Tschannen

Argetsinger

et al. 2022

J Nursing Management

View full text Add to dashboard Cite

show abstract

“…Although processes about team roles and team goals may directly relate to the interview probes about teams and teamwork (Giannitrapani et al, 2020), stakeholder appreciation of a nonhierarchical culture of equity and respect appeared organically across sites. Prioritizing a nonhierarchical organization culture may have arisen in part because of the contrast with more typical structures of medical hierarchy between disciplines (Brooks et al, 2020)—the longstanding nature of hierarchy in medicine is especially persistent in India (Varghese et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Facilitators of palliative care quality improvement team cohesion

Connell

Zupanc

Lorenz

et al. 2023

Health Care Manage Rev

Self Cite

View full text Add to dashboard Cite

Background: The Palliative Care: Promoting Access and Improvement of the Cancer Experience (PC-PAICE) initiative is a team-based, palliative care (PC) quality improvement (QI) project working to promote high-quality PC in India. As a PC QI initiative, PC-PAICE implementation relied upon building interdisciplinary teams, providing the ideal context for understanding facilitators of team cohesion that compelled clinical, organizational, and administrative team members to work together. There is an opportunity to leverage the intersection between QI implementation and organizational theory to inform and improve implementation science. Purpose: As a subaim of a larger implementation evaluation, we aimed to identify facilitators of team cohesion within QI implementation context. Methodology: A quota sampling approach captured the perspectives of 44 stakeholders across three strata (organizational leaders, clinical leaders, and clinical team members) from all seven sites through a semistructured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). We used a combination of inductive and deductive approaches informed by organizational theory to identify facilitators. Result: We identified three facilitators of PC team cohesion: (a) balancing formalization and flexibility around team roles, (b) establishing widespread awareness of the QI project, and (c) prioritizing a nonhierarchical organizational culture. Practice Implications: Leveraging CFIR to analyze PC-PAICE stakeholder interviews created a data set conducive to understanding complex multisite implementation. Layering role and team theory to our implementation analysis helped us identify facilitators of team cohesion across levels within the team (bounded team), beyond the team (teaming), and surrounding the team (culture). These insights demonstrate the value of team and role theories in implementation evaluation efforts.

show abstract

“…The detailed methodology for conducting, coding, and analyzing interviews has been published. 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India

Satija

Lorenz

Spruijt

et al. 2022

JCO Global Oncology

Self Cite

View full text Add to dashboard Cite

PURPOSE Seven major palliative care (PC) centers in India were mentored through the Palliative Care—Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) by US and Australian academic institutions to implement a quality improvement (QI) project to improve the accessibility and quality of PC at their respective centers. The objective was to evaluate the experiences of teams in implementing QI methods across diverse geographical settings in India. METHODS A quota sampling approach was used to elicit perspectives of local stakeholders at each site. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Analysis leveraged deductive and inductive approaches. RESULTS We interviewed 44 participants (eight organizational leaders, 12 clinical leaders, and 24 team members) at seven sites and identified five themes. (1) Implementing QI methods enabled QI teams to think analytically to solve a complex problem and to identify resources. (2) Developing a problem statement by identifying specific gaps in patient care fostered team collaboration toward a common goal. (3) Making use of QI tools (eg, A3 process) systematically provided a new, straightforward QI toolkit and improved QI teams' conceptual understanding. (4) Enhancing stakeholder engagement allowed shared understanding of QI team members' roles and processes and shaped interventions tailored to the local context. (5) Designing less subjective processes for patient care such as assessment scales to identify patient's symptomatic needs positively changed work practices and culture. CONCLUSION Engaging and empowering multiple stakeholders to use QI methods facilitated the expansion and improvement of PC and cancer services in India. PC-PAICE demonstrated an efficient, effective way to apply QI methods in an international context. The impact of PC-PAICE is being magnified by developing a cadre of Indian QI leaders.

show abstract

Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India

Cited by 10 publications

References 28 publications

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

Facilitators of palliative care quality improvement team cohesion

Quality Improvement in Itself Changes Your Thinking: Lessons From Disseminating Quality Improvement Methods Through a Multisite International Collaborative Palliative Care Project in India

Contact Info

Product

Resources

About