Pedagogical approaches in quality improvement coaching in healthcare: a Swedish case study of how improvement coaches approach learning in a contemporary healthcare system

Norman, Ann-Charlott; Fritzén, Lena; Gäre, Boel Andersson

doi:10.3402/nstep.v1.30178

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…Having some form of human component within the process is seen as beneficial to actively manage the barriers and enablers that are encountered ( 9 ). Various roles are described in the implementation and improvement literature, for example, knowledge brokers and boundary spanners ( 10 ), opinion leaders ( 11 ), academic detailers ( 12 ), improvement coaches ( 13 , 14 ), and educational outreach visitors ( 15 ), to name just a few. While terminology varies and often overlaps, there are some distinct differences in terms of how specific roles function ( 16 ).…”

Section: Tailoring To Context—who and How?mentioning

confidence: 99%

Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

Harvey

Lynch

2017

Front. Public Health

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Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.

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Section: Tailoring To Context—who and How?mentioning

confidence: 99%

Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

Harvey

Lynch

2017

Front. Public Health

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“…The iterative approach supported an ongoing analysis and reflection process, which gradually deepened the staff teams' knowledge of the children. The social interaction that occurs when people analyse phenomena and solve things together, is an important learning aspect of improvement work (Norman, 2015). Skills development for staff who support individuals with intellectual disabilities is promoted by multiple components such as workshops, coaching and feedback (Simpson et al, 2022), which build up the current improvement programme.…”

Section: Discussionmentioning

confidence: 99%

Enhancing staff capacity to support children with intellectual disability receiving residential services: A realist evaluation of an improvement program

Wallin

Petersson

Josefsson

et al. 2023

Policy Practice Intel Disabi

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Children with intellectual disability receiving residential support, according to the Swedish Disability Act, need substantial support to cope with everyday life. These children have cognitive and communicative limitations, entailing difficulties for staff in consulting the children regarding their support arrangements. In addition, due to lack of research there are knowledge gaps and uncertainties concerning how staff can provide the children's support. To deliver high qualitative support, research suggests that disability organisations should (1) continuously work with quality improvement, (2) adopt a multidimensional framework that explains human functioning and disability as a basis for understanding individual support needs, and (3) use person-centred approaches. Based on these principles, this study has applied a realist evaluation to identify enablers and barriers during the implementation of an improvement programme aimed at improving staff's ability to provide support to children living in special residences.

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“…the facilitators themselves) at the centre of the intervention so that it becomes more than a toolkit document, but a facilitator's guide to supporting this work. The QI coaching models in health care 142 may provide opportunities for articulating such a role outside a research context.…”

Section: Working With Patient Experience Feedback: Pushing the Boundaries Of Quality Improvementmentioning

confidence: 99%

Using patient experience data to develop a patient experience toolkit to improve hospital care: a mixed-methods study

Sheard

Marsh

Mills

et al. 2019

Health Serv Deliv Res

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Background Patients are increasingly being asked to provide feedback about their experience of health-care services. Within the NHS, a significant level of resource is now allocated to the collection of this feedback. However, it is not well understood whether or not, or how, health-care staff are able to use these data to make improvements to future care delivery. Objective To understand and enhance how hospital staff learn from and act on patient experience (PE) feedback in order to co-design, test, refine and evaluate a Patient Experience Toolkit (PET). Design A predominantly qualitative study with four interlinking work packages. Setting Three NHS trusts in the north of England, focusing on six ward-based clinical teams (two at each trust). Methods A scoping review and qualitative exploratory study were conducted between November 2015 and August 2016. The findings of this work fed into a participatory co-design process with ward staff and patient representatives, which led to the production of the PET. This was primarily based on activities undertaken in three workshops (over the winter of 2016/17). Then, the facilitated use of the PET took place across the six wards over a 12-month period (February 2017 to February 2018). This involved testing and refinement through an action research (AR) methodology. A large, mixed-methods, independent process evaluation was conducted over the same 12-month period. Findings The testing and refinement of the PET during the AR phase, with the mixed-methods evaluation running alongside it, produced noteworthy findings. The idea that current PE data can be effectively triangulated for the purpose of improvement is largely a fallacy. Rather, additional but more relational feedback had to be collected by patient representatives, an unanticipated element of the study, to provide health-care staff with data that they could work with more easily. Multidisciplinary involvement in PE initiatives is difficult to establish unless teams already work in this way. Regardless, there is merit in involving different levels of the nursing hierarchy. Consideration of patient feedback by health-care staff can be an emotive process that may be difficult initially and that needs dedicated time and sensitive management. The six ward teams engaged variably with the AR process over a 12-month period. Some teams implemented far-reaching plans, whereas other teams focused on time-minimising ‘quick wins’. The evaluation found that facilitation of the toolkit was central to its implementation. The most important factors here were the development of relationships between people and the facilitator’s ability to navigate organisational complexity. Limitations The settings in which the PET was tested were extremely diverse, so the influence of variable context limits hard conclusions about its success. Conclusions The current manner in which PE feedback is collected and used is generally not fit for the purpose of enabling health-care staff to make meaningful local improvements. The PET was co-designed with health-care staff and patient representatives but it requires skilled facilitation to achieve successful outcomes. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Pedagogical approaches in quality improvement coaching in healthcare: a Swedish case study of how improvement coaches approach learning in a contemporary healthcare system

Cited by 7 publications

References 14 publications

Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

Enhancing staff capacity to support children with intellectual disability receiving residential services: A realist evaluation of an improvement program

Using patient experience data to develop a patient experience toolkit to improve hospital care: a mixed-methods study

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