Development of a tool for identifying and addressing prioritised determinants of quality improvement initiatives led by healthcare professionals: a mixed-methods study

Abstract

Background Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of determinants that are not prioritised based on being experienced as most important. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers supplemented with methods to identify and address each determinant. The tool can be used by those performing quality improvement initiatives in healthcare practice. Methods A mixed-methods study design was used to develop the tool. First, an online survey was used to ask healthcare professionals about the determinants they experienced as most facilitating and most hindering during the performance of their quality improvement initiative. A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts were performed to gain insight on how to analyse and address the determinants in our tool. Results The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement initiatives. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the initiative was considered the most important barrier. The interviews with 16 experts in implementation science led to various inputs for identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the initiative at a manageable size, learning by doing and being able to influence determinants. Conclusions This paper describes the development of a tool with prioritised determinants for performing quality improvement initiatives with suggestions for analysing and addressing these determinants. The tool is developed for those engaged in quality improvement initiatives in practice, so in this way it helps in bridging the research to practice gap of determinants frameworks. More research is needed to validate and develop the tool further.

Complexity and involvement as implementation challenges: results from a process analysis

“…It is important to indicate what is expected from stakeholders, i.e. how they can make a positive contribution, to listen carefully to what they say about the improvement initiative, to inform them periodically about implementation progress and to create room for questions [ 42 , 43 ]. A communication plan can help to structure the communication [ 42 ].…”

“…how they can make a positive contribution, to listen carefully to what they say about the improvement initiative, to inform them periodically about implementation progress and to create room for questions [ 42 , 43 ]. A communication plan can help to structure the communication [ 42 ]. When stakeholders have a clear understanding of the need for change and the management expectations they will be more likely to support new improvement initiatives [ 43 ].…”

“…Making sufficient contact at all layers of the hospital and especially with key figures of the stakeholder analysis is important [ 42 ]. Our stakeholder analysis focused on the perioperative setting, insufficiently taking into account the higher level of hospital management and the diversity within the perioperative disciplines involved.…”

“…If stakeholders, like surgeons are important for the implementation of innovations, it is sensible to check how they view the project by, for example, inviting them to an information meeting or by talking to them. Thereby carefully listening and taking the resistance seriously and trying to look for a common denominator [ 42 ]. Overall, it is important to discuss the personal interests and underlying reasons for professionals’ lack of motivation and commitment by approaching them individually.…”

Optimizing Implementation in Cancer Control (OPTICC): protocol for an implementation science center

“…Finally, our determinant prioritization methods rely on three criteria: criticality, chronicity, and ubiquity, which overcome the limitations of traditional rating categories that are not clearly linked to impact [ 49 ]. Criticality is how a determinant affects or likely affects an implementation outcome.…”