Implementing an Organization-Wide Quality Improvement Initiative

Abstract

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

“…Table 4 summarizes the frequency of each of the 12 MM KB roles across included studies. The two most common MM KB roles were to monitor and evaluate the progress of a project (14, 36.8%) [ 40 , 41 , 47 – 51 , 54 , 57 , 60 , 63 – 66 ] and to convince others of the need for, and benefit of a project (12, 31.6%) [ 46 – 48 , 50 , 51 , 55 , 58 , 61 , 64 – 67 ]. For example, MM KBs played an important role in monitoring the progress of projects to evaluate and reinforce practice change [ 41 , 50 ].…”

“…The most common barriers were lack of resources in 12 (32.0%) studies and lack of time in 12 (32.0%) studies. A lack of resources (budget constraints, limited staff) made it challenging for MM KBs to move their projects forward [ 39 , 42 , 44 , 47 , 52 , 55 , 57 , 64 , 68 – 71 ]. For example, inadequate funds interfered with obtaining appropriate resources and undermined the feasibility of implementing projects [ 47 , 55 ].…”

“…For example, inadequate funds interfered with obtaining appropriate resources and undermined the feasibility of implementing projects [ 47 , 55 ]. In addition, staffing issues created difficulty in engaging staff in project work and low staffing levels limited capacity to provide desired standards of care [ 42 , 64 ]. Additionally, a lack of protected time for data collection or other project work was identified as a significant barrier to implementing projects [ 17 , 19 , 39 , 42 , 44 , 47 , 52 , 55 , 57 , 64 , 68 , 71 ].…”

“…In addition, staffing issues created difficulty in engaging staff in project work and low staffing levels limited capacity to provide desired standards of care [ 42 , 64 ]. Additionally, a lack of protected time for data collection or other project work was identified as a significant barrier to implementing projects [ 17 , 19 , 39 , 42 , 44 , 47 , 52 , 55 , 57 , 64 , 68 , 71 ]. MM KBs also lacked the time to nurture, support and adequately coach staff [ 39 , 55 ].…”

Increasing Recruitment Rates in an Inpatient Clinical Research Study Using Quality Improvement Methods

“…The input of staff is also highly valuable in the use of QI in the health care setting because many QI projects involve active participation and buy-in from a multidisciplinary staff. 2,17,18 Similarly important was the desire to improve recruitment without pressuring families to participate. Thus, certain tests of change, such as compensation for the child, were discussed with the CCHMC IRB before implementation, and care was taken to ensure that there was appropriate balance between compensation and coercion.…”