Enabling continuous learning and quality improvement in health care

Quality Coordinators' Perspectives on Quality Improvement in Primary Healthcare in Kosovo: A Qualitative Study

AIMS

This qualitative descriptive study provides insights into the experiences of quality coordinators (QCs) in primary healthcare to inform policy and practice actions and empower QCs to enhance healthcare quality.

METHODS

We conducted focus group discussions with purposefully selected QCs to understand their motivations, job experiences, factors influencing healthcare quality, and suggestions for quality improvement. Content analysis and deductive coding were used to scrutinize the responses and answer the research questions.

RESULTS

The QCs thought highly about their job performance and were motivated by both extrinsic and intrinsic factors. Clinical audits, collegial reviews, and managerial support positively affected QCs' performance. In contrast, a lack of managerial support, limited working hours, and changes in organizing work caused the opposite. Empowerment and external support positively influenced healthcare quality, whereas lack of resources, managerial support, or training had a negative influence. Suggestions to improve quality include the role of QCs, external supervision, and centralization of the QCs' network.

CONCLUSION

Appointing QCs alone does not guarantee quality improvement. It is essential to ensure that QCs have the appropriate skills, tools, management support, and open communication channels. Further research is required to evaluate the effects of sex and age on QCs' performance.

Facilitating Organizational Learning in Nursing Teams

Organizational learning is an effective strategy professional development educators and other nurse leaders can use to improve individual, team, and organizational outcomes. Professional development educators can foster organizational learning by implementing certain actions, called mechanisms, associated with organizational learning. This article highlights five such mechanisms, presents practical examples of each, and suggests evidence-based recommendations professional development educators and nurse leaders can use to better facilitate organizational learning. [J Contin Educ Nurs. 2022;53(8):379-384.].

Multi-level learning in public healthcare medical teams: the role of the social environment

PURPOSE

This study explores how individual, dyad and team levels of learning interact in public healthcare medical teams.

DESIGN/METHODOLOGY/APPROACH

A single interpretive case study is carried out in the public Health Service Executive (HSE) in Ireland, involving three rounds of semi-structured interviews with non-consultant hospital doctors (NCHDs), supported by relevant professional documentation and researcher log entries.

FINDINGS

An experience hierarchy, interpersonal relationships and social dynamics form the backdrop to learning interactions within public healthcare medical teams. Individual and team learning primarily occur in informal settings where interpreting and developing understanding takes place either in dyads, small groups or with the whole team. NCHD learning may vary depending on how effectively they build interpersonal relationships, take advantage of informal learning opportunities and manage the social dynamics within their team. Willingness and confidence to share insights and asking questions are triggers for individual and team learning.

RESEARCH LIMITATIONS/IMPLICATIONS

As a single case study focused on the HSE NCHD individual and team learning experience, this research study represents a relatively small exploration of individual and team learning interplay in the public healthcare medical team environment. The development of learning theory in this domain presents an intriguing avenue of further research, including observation of interactions within a team.

PRACTICAL IMPLICATIONS

The findings have practical relevance to those who are interested in the effectiveness of post-graduate/ NCHD learning in the public healthcare system. Interpersonal relationships and social norms play strong roles in how interaction and learning occurs in a team. These findings highlight the challenge of ensuring consistent quality across individual NCHDs or across hospital sites when training is heavily influenced by the approach of senior colleagues/ consultants to their more junior colleagues and the degree to which they take an active interest in NCHD learning.

ORIGINALITY/VALUE

The proposed learning framework is a key theoretical contribution, which draws upon the multi-levels of learning and provides greater insight into how individual, dyad and team learning interact in public healthcare medical teams when managing patient care. The findings have practical relevance in how to facilitate effective teamwork and learning interactions and for those who are interested in the consistency and quality of the training experience for NCHDs.

Performance management in complex adaptive systems: a conceptual framework for health systems

Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.

Implementing Continuous Quality Improvement in an Integrated Community Urology Practice: Lessons Learned

OBJECTIVE

To determine the effectiveness of 2 different continuous quality improvement interventions in an integrated community urology practice. We specifically assessed the impact of audited physician feedback on improving physicians' adoption of active surveillance for low-risk prostate cancer (CaP) and adherence to a prostate biopsy time-out intervention.

MATERIALS AND METHODS

The electronic medical records of Genesis Healthcare Partners were analyzed between August 24, 2011 and September 30, 2020 to evaluate the performance of 2 quality interventions: audited physician feedback to improve active surveillance adoption in low-risk CaP patients, and audited physician feedback to promote adherence to an electronic medical records embedded prostate biopsy time-out template. Physician and Genesis Healthcare Partners group adherence to each quality initiative was compared before and after each intervention type using ANOVA testing.

RESULTS

For active surveillance, we consistently saw an increase in active surveillance adoption for low risk CaP patients in association with continuous audited feedback (P < .001). Adherence to the prostate biopsy time-out template improved when audited feedback was provided (P < .001).

CONCLUSION

The implementation of clinical guidelines into routine clinical practice remains challenging and poses an obstacle to the improvement of United States healthcare quality. Continuous quality improvement should be a dynamic process, and in our experience, audited feedback coupled with education is most effective.

Performance Measure Development, Use, and Measurement of Effectiveness Using the Guideline on Mechanical Ventilation in Acute Respiratory Distress Syndrome. An Official American Thoracic Society Workshop Report

Guideline implementation tools are designed to improve uptake of guideline recommendations in clinical settings but do not uniformly accompany the clinical practice guideline documents. Performance measures are a type of guideline implementation tool with the potential to catalyze behavior change and greater adherence to clinical practice guidelines. However, many performance measures suffer from serious flaws in their design and application, prompting the American Thoracic Society (ATS) to define its own performance measure development standards in a previous workshop in 2012. This report summarizes the proceedings of a follow-up workshop convened to advance the ATS’s work in performance measure development and guideline implementation. To illustrate the application of the ATS’s performance measure development framework, we used the example of a low–tidal volume ventilation performance measure created de novo from the 2017 ATS/European Society of Intensive Care Medicine/Society of Critical Care Medicine mechanical ventilation in acute respiratory distress syndrome clinical practice guideline. We include a detailed explanation of the rationale for the specifications chosen, identification of areas in need of further validity testing, and a preliminary strategy for pilot testing of the performance measure. Pending additional resources and broader performance measure expertise, issuing “preliminary performance measures” and their specifications alongside an ATS clinical practice guideline offers a first step to further the ATS’s guideline implementation agenda. We recommend selectively proceeding with full performance measure development for those measures with positive early user feedback and the greatest potential impact in accordance with ATS leadership guidance.