Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary

Abstract

BackgroundHealth and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation.MethodsDatabase searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies’ websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski’s meta-summary and measured frequency effect sizes (FES) for enablers and barriers.Results4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%).ConclusionsThe most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.

Our mission and how we hope to move the field forward: statement from theBMJ Quality & Safetysenior editorial team 2023

“…These papers are often about holistic frameworks such as quality indicators used by healthcare regulators and accreditation bodies. 7 This is a strength because it increases the ambition of the work by covering a wide range of patient groups and contexts. Occasionally we publish papers on topics slightly outside the six core dimensions of quality.…”

Meeting external demands to improve quality and safety of care: learning systematically from the literature

“…In this context, the systematic review by Kelly and colleagues in this issue of BMJ Quality & Safety, and their summary of factors that influence implementation of health and social care standards 4 are important contributors to increase our understanding in this area. The review includes 35 papers and grey literature documents that focus on implementation challenges of responding to standards and processes imposed through regulation, accreditation or other external parties.…”