Project JOINTS: What factors affect bundle adoption in a voluntary quality improvement campaign?

Abstract

Background Diffusion and adoption of effective evidence-based clinical practices can be slow, especially if complex changes are required to implement new practices. Objective To examine how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery (hip and knee arthroplasty). Methods We conducted telephone interviews with hospital QI leaders from 73 of the 109 hospitals (67% response rate) in five states that participated in Project JOINTS (Joining Organizations IN Tackling SSIs), a QI campaign run by Institute for Healthcare Improvement (IHI). Using QI methods grounded in the IHI Model for Improvement, this campaign encouraged hospitals to implement an enhanced SSI prevention bundle. Hospital QI leaders reported on their hospital's adherence to the Project JOINTS QI methods; their level of engagement with Project JOINTS activities; and adoption of the SSI prevention bundle components. Interview data were analysed quantitatively and qualitatively. Results Both adherence to the QI methods and hospital engagement were positively associated with complete bundle adoption. Hospital engagement, especially the use of project materials and tools, was also positively associated with the initiation of and improved adherence to individual bundle components. Conclusions Our findings suggest that greater adherence to the QI methods and active hospital engagement in a QI campaign facilitate adoption of evidence-based patient safety bundles in orthopaedic practice.

Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

“…In general, system attitude, defined as a set of psychological/administrative responses to planned change (e.g., administrative obstacles or support from executive management), were not seen as important factors for implementation, suggesting the forces influencing uptake were perceived to be related mostly to the frontline staff directly involved in the discharge care bundle execution. These results align with research conducted by Khodyakov et al [35] on factors related to adoption of a surgical site infection prevention bundle, in which physician buy-in was perceived as a very important determinant of bundle implementation. In their case, however, staff resistance was also manifested, contrary to observations made during this study.…”

Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI’s Project JOINTS

“…However, we did not see improvement in the adoption of the evidence-based practices in our control states that were also exposed to the Partnership. Also, in our previously published qualitative research study, hospital leaders in the intervention states did not identify other initiatives with impact during the intervention period [13]. Second, in a cluster-randomized design residual imbalances could lead to differences between intervention and control states.…”

“…IHI recruited state organizations from the RSN developed during the 100,000 Lives and 5 Million Lives Campaigns. The state organizations reached out to hospitals in their states inviting them to participate in the campaign, disseminating information about the campaign and its evidence-based practices, and assisting IHI in publicizing activities described below and in a prior publication [13]. …”

“…Project JOINTS (Joining Organizations IN Tackling SSIs) was a multi-faceted, disciplined initiative that used the Rapid Spread Network (defined above), methods, and tools developed during previous IHI campaigns to influence orthopedic practices and hospitals performing hip and knee arthroplasty [13]. Rather than launch nationally as other campaigns have done, Project JOINTS was introduced in a cluster-randomized fashion to enable a rigorous, independent evaluation of its efficacy in promoting uptake of new evidence-based practices.…”

Quality improvement and emergency laparotomy care: what have we learnt from recent major QI efforts?

“…The QI campaign is a successful approach to QI, but it is likely, based on the results of the EPOCH trial, that it is not suited to complex quality problems, even in the presence of accepted evidencebased guidelines as the hard core of the intervention. 20,36 Other QI approaches, such as Lean and Six Sigma are used in the NHS but were not used in any of the three emergency surgery projects so are not included in this review. 37…”