Choosing quality problems wisely: identifying improvements worth developing and sustaining

Sustaining quality improvement efforts: emerging principles and practice

“…16 Such an approach may feel too 'slow', and certainly calls for being selective about which problems are significant enough to devote the time. 17 In addition, it may require that attention first be focused on finding an effective intervention-and then solving how it can be integrated in workflow to be sustainable, using resources that will also be available after the QI project or collaborative ends. From publications in our own journal, we perceive a direct correlation between the time spent understanding the problem, the workflow and the priorities of the leadership and staff (reflected in sophisticated key driver diagrams) with how likely the QI intervention and associated outcomes are to ultimately be sustained.…”

Simulation: a key tool for refining guidelines and demonstrating they produce the desired behavioural change

“…Given that the revised guidelines were specific to the medication tested, it is unusual that we see a tendency toward a worsening effect on generic medication preparation skills. Again, this finding was not significant, but we highlight this to remind ourselves of the very real possibility that some interventions might introduce new and unexpected errors in response to changing workflow and practice 6 ; simulations offer an opportunity to spot these risks in advance.…”

“…4 In fact, far from magic bullets, interventions aimed at increasing the degree to which patients receive care recommended in guidelines (eg, educational interventions, reminders, audit and feedback, financial incentives, computerised decision support) typically produce disappointingly small improvements in care. [5][6][7][8][9][10] Much improvement work aims to 'make the right thing to do the easy thing to do.' Yet, design solutions which hardwire the desired actions remain few and far between.…”

“…Further, improvement interventions which 'softwire' such actionsnot guaranteeing that they occur, but at least increasing the likelihood that clinicians will deliver the care recommended in guidelines-mostly produce small improvements. [5][6][7][8][9] Until this situation changes, we need to acknowledge the persistent reality that guidelines themselves represent a main strategy for promoting care consistent with current evidence, which means their design should promote the desired actions. 11 12 In this respect, guidelines constitute a type of clinical decision support.…”

Evaluating quality improvement at scale: design considerations for routine reporting to executive board of a healthcare organisation in the UK National Health Service

“…For an executive board, this framework should generate strategic insights that can inform resource commitments in QI. For staff and improvement specialists, routine reporting should offer a feedback loop to support discussion and engagement around nding the right focus [27] and applying QI with delity [19,28]. Developing routine reporting can be an asset for improving practice [29], and honing the implementation science of QI in healthcare.…”