The Influence of Context on Quality Improvement Success in Health Care: A Systematic Review of the Literature

Abstract

Context:The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. Methods:The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field.Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Conclusions:Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all

Promoting Success: A Getting To Outcomes® Guide to Implementing Continuous Quality Improvement for Community Service Organizations

“…Of note, simply having top leadership aware of CQI and using a top-down approach to lead it tends not to be associated with successful CQI implementation (Kaplan et al 2010).…”

“…For example, the data were presented to principals and the school board to demonstrate the reach that the program had in meeting the needs of the students, and connecting them to resources to assist them-the particular outcome goal of this program. (Shortell et al, 1995;Deo et al, 2009;Baird, Hu, and Reeve, 2011;Rad, 2006;Kaplan et al, 2010 4. Develop and support one or more CQI champions.…”

“…Motivated teams with strong leadership and invested in quality improvement are associated with more successful CQI projects (Kaplan et al, 2010).…”

“…An organization may have more than one CQI champion at the same time to provide support and legitimacy to the CQI effort. It is important that leadership designates a champion to take on CQI responsibilities as it can improve the success of CQI efforts (Kaplan et al, 2010). …”

“…It is important that leadership designates a champion to take on CQI responsibilities as it can improve the success of CQI efforts (Kaplan et al, 2010).…”