The investigators reflect: what we have learned from the Deepening our Understanding of Quality Improvement in Europe (DUQuE) study

Groene, Oliver; Suñol, Rosa; Klazinga, Niek; Kringos, Dionne; Lombarts, Kiki M. J. M. H.; Plochg, Thomas; Lopez, Maria A ndrée; Secanell, Mariona; Vallejo, Paula; Bartels, Paul; Kristensen, Solvejg; Michel, Philippe; Saillour-Glénisson, F.; Vlcek, F.; Car, Márcia Regina; Jones, Shannon; Klaus, Erika; Bottaro, Silvânia Moraes; Garel, Pascal; Saluvan, Mehmet; Bruneau, Charles; Depaigne-Loth, Anne; Shaw, Charles D.; Hammer, Antje; Ommen, Oliver; Pfaff, Holger; Botje, Daan; Wagner, Cordula; Kutaj–Wąsikowska, Halina; Kutryba, Basia; Escoval, Ana; Livio, A.; Eiras, Margarida; França, Margarida; Leite, Isabel Cristina de Moura; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, Russell; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Wang, A.; Thompson, Andrew

doi:10.1093/intqhc/mzu024

Cited by 15 publications

(8 citation statements)

References 4 publications

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“…The nonconformities and the supporting observations in our material indicated that the inspected organizations had deficiencies in having a functional management system. This is in line with previous research showing that management systems are not always systematically implemented and that it is questionable to what degree they actually support clinical work [25, 33]. Accordingly, if corrective measures solely address structural deficiencies in the management system, there is an inherent risk that the changes have limited impact on the quality of care.…”

Section: Discussionsupporting

confidence: 85%

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities

Hovlid

Høifødt

Smedbråten

et al. 2015

BMC Health Serv Res

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BackgroundExternal inspections are widely used in health care as a means of improving the quality of care. However, the way external inspections affect the involved organization is poorly understood. A better understanding of these processes is important to improve our understanding of the varying effects of external inspections in different organizations. In turn, this can contribute to the development of more effective ways of conducting inspections. The way the inspecting organization states their grounds for noncompliant behavior and subsequently follows up to enforce the necessary changes can have implications for the inspected organization’s change process. We explore how inspecting organizations express and state their grounds for noncompliant behavior and how they follow up to enforce improvements.MethodsWe conducted a retrospective review, in which we performed a content analysis of the documents from 36 external inspections in Norway. Our analysis was guided by Donabedian’s structure, process, and outcome model.ResultsDeficiencies in the management system in combination with clinical work processes was considered as nonconformity by the inspecting organizations. Two characteristic patterns were identified in the way observations led to a statement of nonconformity: one in which it was clearly demonstrated how deficiencies in the management system could affect clinical processes, and one in which this connection was not demonstrated. Two characteristic patterns were also identified in the way the inspecting organization followed up and finalized their inspection: one in which the inspection was finalized solely based on the documented changes in structural deficiencies addressed in the nonconformity statement, and one based on the documented changes in structural and process deficiencies addressed in the nonconformity statement.ConclusionExternal inspections are performed to improve the quality of care. To accomplish this aim, we suggest that nonconformities should be grounded by observations that clearly demonstrate how deficiencies in the management system might affect the clinical processes, and that the inspection should be finalized based on documented changes in both structural and process deficiencies addressed in the nonconformity statement.

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Section: Discussionsupporting

confidence: 85%

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities

Hovlid

Høifødt

Smedbråten

et al. 2015

BMC Health Serv Res

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“…Once identified, such factors need to be observed and monitored over time and statistical models could aim to assess the association of context factors with the effectiveness of QI interventions, where appropriate. We have recently illustrated some of the methodological challenges related to these tasks [ 55 , 56 ] and at current, the multiple relationships and pathways between exposure, outcome, and context variables in research on QI strategies are not yet sufficiently understood. Alternatively, context might be considered as an integral component of the subject area that evolves, changes and interacts with the intervention during the time period of QI project implementation.…”

Section: Discussionmentioning

confidence: 99%

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews

Kringos

Suñol²,

Wagner

et al. 2015

BMC Health Serv Res

120

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BackgroundIt is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors.MethodsWe conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool.ResultsWe included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences.ConclusionsContextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0906-0) contains supplementary material, which is available to authorized users.

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“…It is also possible that the lack of a consensus over patient involvement reflects a situation in which this aspect of CG is less well integrated into the culture of the hospital. This idea is encouraged by the conclusion of Groene and Sunol (2014), based on their large-scale study on quality improvement in Europe, that “levels of patient involvement are low and seem tokenistic” 33. We see this as a concern since patient involvement is central to high-quality healthcare, and a lack of positive attitudes towards patient involvement poses a barrier towards their involvement in decisions about their care 12…”

Section: Discussionmentioning

confidence: 99%

Rethinking clinical governance: healthcare professionals’ views: a Delphi study

et al. 2017

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ObjectiveAlthough the guiding principle of clinical governance states that healthcare professionals are the leading contributors to quality and safety in healthcare, little is known about what healthcare professionals perceive as important for clinical governance. The aim of this study is to clarify this by exploring healthcare professionals' views on clinical governance.DesignBased on a literature search, a list of 99 elements related to clinical governance was constructed. This list was refined, extended and restricted during a three-round Delphi study.Setting and participantsThe panel of experts was formed of 24 healthcare professionals from an academic hospital that is seen as a leader in terms of its clinical governance expertise in the Netherlands.Main outcome measuresRated importance of each element on a four-point scale.ResultsThe 50 elements that the panel perceived as most important related to adopting a bottom-up approach to clinical governance, ownership, teamwork, learning from mistakes and feedback. The panel did not reach a consensus concerning elements that referred to patient involvement. Elements that referred to a managerial approach to clinical governance and standardisation of work were rejected by the panel.ConclusionsIn the views of the panel of experts, clinical governance is a practice-based, value-driven approach that has the goal of delivering the highest possible quality care and ensuring the safety of patients. Bottom-up approaches and effective teamwork are seen as crucial for high quality and safe healthcare. Striving for high quality and safe healthcare is underpinned by continuous learning, shared responsibility and good relationships and collaboration between healthcare professionals, managers and patients.

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The investigators reflect: what we have learned from the Deepening our Understanding of Quality Improvement in Europe (DUQuE) study

Cited by 15 publications

References 4 publications

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews

Rethinking clinical governance: healthcare professionals’ views: a Delphi study

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