Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Li, Luming; Black, Whitney E.; Cheung, E.; Fisher, Weston S.; Wells, Kenneth B.

doi:10.1007/s40596-020-01317-7

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…[35][36][37][38] The coalition, a peer-to-peer QI community, was perceived as a motivator for behavioural change. A recent study noted, forming a 'consortium of clinical [physician] QI leaders who both practice clinically and work on the frontlines of QI leadership', p800 39 would increase QI, implementation and dissemination of initiatives among physicians, implying the potential of this approach as a QI engagement strategy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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 experience following a laboratory test overuse initiative supported by a QI coalition.MethodsAs part of a larger mixed-methods study, structured virtual interviews were conducted with 12 physicians. The Theoretical Domains Framework (TDF) and the Behavioural Change Wheel (BCW) were used to identify characteristics that influence physician behaviour change for QI leadership and participation and appropriate blood urea nitrogen (BUN) test ordering. A content analysis of physicians’ statements to the TDF was performed, resulting in overarching themes; relevant TDF domains were mapped to the intervention functions of the BCW.ResultsNine overarching themes emerged from the data. Eight of 14 TDF domains influence QI leadership and participation, and 10 influence appropriate BUN-test ordering behaviours. The characteristics participants described that promoted a change in their QI participation, leadership and appropriate BUN-test ordering were: QI education with hands-on training; physician peer mentorship/support; personnel assistance (QI and analytics) and communication from a trusted/credible physician leader who shares data and insights about the physician role in the initiative, clinical best practice and past project success. Other elements included: a simply designed initiative requiring minimal effort and no clinical workflow disruptions; revised order forms/panels and limiting test-order frequency when laboratory tests are normal. Additionally, various future intervention strategies were identified. For their initial initiative participation, physicians acknowledged coalition leader or member credibility was more important than awareness of the coalition.ConclusionsBased on physicians’ described perceptions and experiences, coalition characteristics that influenced their QI leadership and participation, and appropriate BUN-test ordering behaviours were revealed; these characteristics aligned to several TDF domains. The findings suggest that these behaviours are multidimensional, requiring a multistrategy approach to change behaviour.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Implementing Quality Improvement Initiatives Within Community Psychiatry: Challenges and Strategies

Ogbu-Nwobodo,

Fang,

Gill

et al. 2024

Community Ment Health J

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Implementation of quality improvement (QI) initiatives within community mental health settings is crucial to addressing equity-related issues affecting mental health services delivery, including for co-occurring substance use disorders. Given the growing recognition of QI interventions as an effective framework to facilitate structural change within systems of care, it is important to equip mental health providers with the knowledge and ability to execute QI initiatives that are feasible, sustainable, and integrate a health equity lens. To demystify the QI process, we describe the design and methodologies of four fellows’ capstone projects conducted during the 2022–2023 academic year at the University of California, San Francisco (UCSF) Public Psychiatry Fellowship at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). By highlighting fellows’ experiences with leading QI initiatives within community mental health settings, we discuss strategies for overcoming implementation barriers including stakeholder engagement and transparency factors, resource and time constraints, unexpected changes in direction, and lack of infrastructure for QI. Lastly, we reflect on best practices and sustainability considerations for leading QI initiatives in partnership with academic centers, departments of public health, and community mental health clinics.

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QI Consultation Service: Piloting a Novel Approach to Improving Quality Improvement Initiatives in an Academic Psychiatry Department

Ho,

Finn,

Torrey

2023

American Journal of Medical Quality

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Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Cited by 3 publications

References 20 publications

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

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

Implementing Quality Improvement Initiatives Within Community Psychiatry: Challenges and Strategies

QI Consultation Service: Piloting a Novel Approach to Improving Quality Improvement Initiatives in an Academic Psychiatry Department

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