So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare

Batalden, Paul B.; Davidoff, Frank; Marshall, Martin; Bibby, Jo; Pink, Colin

doi:10.1136/bmjqs.2011.051698

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…This variability fragments the evidence base, making it difficult to compare and synthesize findings across studies. Recent calls to address these challenges focus on the need for theory development to explain how CQI works and factors that influence its effectiveness, and the identification of valid and reliable measures to enable theories to be tested [21-26]. …”

Section: Introductionmentioning

confidence: 99%

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

et al. 2013

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BackgroundMeasuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments.MethodsData sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments. Study selection: To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.ResultsWe identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited.ConclusionsExisting instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.

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Section: Introductionmentioning

confidence: 99%

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

et al. 2013

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“…The tools at its disposal are equally complex. Its development requires scientists to have a deep understanding of the environment within which their work is applied and an intimate relationship with both the practitioners and those who use the service (Batalden, Davidoff, Marshall, Bibby, & Pink, 2011).…”

Section: Context -Where?mentioning

confidence: 99%

Turning the tables: When the student teaches the professional — A case description of an innovative teaching approach as told by the students

Savage

Amanali

Andersson

et al. 2011

Nurse Education Today

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“…[28][29][30][31][32][33][34][35][36] At the level of health-care practice, it is known that patient safety is informed by the beliefs and values of health-care professionals, [37][38][39][40][41] and is ultimately underpinned by their personal commitment to care. 42,43 The extent and burden of the problem Despite growing awareness of the challenges posed by patient safety, [44][45][46] and concerted improvements efforts within some health-care systems, 47,48 considerable hospital patient safety problems persist. Global estimates of the burden of harm vary.…”

Section: Overviewmentioning

confidence: 99%

“…Centred on Deming's system of profound knowledge, 178 the MI-PDSA approach is an acknowledged cornerstone of the science of improvement, 44,181 and is informed by a diverse array of theoretical perspectives.…”

Section: Lives + National Programme In Nhs Walesmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare

Cited by 21 publications

References 22 publications

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Turning the tables: When the student teaches the professional — A case description of an innovative teaching approach as told by the students

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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