Evaluating clinician-led quality improvement initiatives: A system-wide embedded research partnership at Stanford Medicine

A bridge between worlds: Embedding research in telepractice co-design with disability community

Introduction

Co-production approaches are increasingly being advocated for as a way of addressing the research translatory gap while including patient and public involvement in development of services they access, and particularly in disability service provision. Embedded research (ER) is a method which integrates the researcher within the target organization to better facilitate both co-production of research outputs and the reduction of the research translation gap. The aim of this reflection is to better understand the commonalities and differences between ER in a disability context to accounts published in academic literature.

Method

A review of embedded researcher literature was completed in combination with a personal reflection of lived experience as an embedded researcher within a disability support service organization. The reflective process included review of research journal entries and other records of lived experience (photographs, audio recordings, drawings) maintained throughout the period in the role of embedded researcher. A reflexive thematic analysis process was used.

Results

I reflect throughout the article upon five themes which highlight both the commonalities between my experiences and those of other embedded researchers as well as instances where they differed. The five themes include (1) A knowledge bridge, (2) Considerations of positionality, (3) Ethical complexity, (4) Anticipating change, and (5) Existing in the in-between together.

Conclusion

Experiences of ER appear to transcend the discipline in which the research is being embedded, and while the lived experience in a disability host organization was invaluable in facilitating a successful co-produced research project, significant avenues for improvement exist in terms of ethical frameworks, methodological guidance, and communities of support.

Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

BACKGROUND

Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists.

METHODS

This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system.

RESULTS

Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%).

CONCLUSIONS

These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

Partnership-building considerations for implementation science in learning health systems: a case study of the Implementation Science Collaborative in Alberta, Canada

Introduction

Implementation of health innovations is inherently collaborative, requiring trans-sectoral partnerships between implementation researchers, innovation teams, and implementation practitioners. Implementation science has been shown to improve implementation successes; however, challenges that hinder partnerships to advance implementation science continue to persist. Using a whole-system approach to assess and respond to implementation science partnership barriers may shed light on effective responses.

Methods

We conducted a case study of Alberta's learning health system, using semi-structured group and individual interviews to create a nuanced understanding of the considerations required for implementation research collaborations. We interviewed 53 participants representing 21 offices in the health system, academia, professional associations, and government who regularly plan, evaluate, and/or study health system implementation initiatives in Alberta. Using the Partnership Model for Research Capacity Building, we identified current facilitators and challenges for partnerships for conducting and using implementation science, at different levels of Alberta's health-research ecosystem.

Results

Alberta's healthcare system is well set up to readily embed intervention effectiveness and efficacy research. Infrastructure was also in place to strengthen implementation practice. However, weaknesses around exchanging knowledge and skills, providing feedback and mentoring, and accommodating diversity affected the ability of both individuals and teams to build implementation science capacity. Without this capacity, teams could not participate in embedded implementation research collaborations. We report the response of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit to these barriers to provide practical guidance on various program options to strengthen individual- and organization-level implementation science capacity.

Discussion

This study applied a whole-system approach to assess factors across Alberta's health-research ecosystem, which affect partnerships to advance implementation science. Our findings illustrated that partnership considerations go beyond interpersonal factors and include system-wide considerations. With the results, health organization leaders have (1) a method for assessing organizational capability to readily embed implementation research and (2) a catalog of potential responses to create conditions to readily engage with implementation science in their day-to-day implementation processes.