Rowland Paula, Lising Dean, Sinclair Lynne, Baker G Ross
Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
Centre for Interprofessional Education, University of Toronto/University Health Network, Toronto, Ontario, Canada.
Int J Qual Health Care. 2018 Jul 1;30(6):416-422. doi: 10.1093/intqhc/mzy045.
This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions.
Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS.
Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes.
Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context.
Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies.
Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.
本范围综述探讨了关于质量改进（QI）团队流程的已知情况，特别是团队如何影响结果。目的是为QI领导者提供基于研究的指导，并为未来的研究问题提供信息。
检索的数据库包括：医学文献数据库（MedLINE）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）、科学引文索引数据库（Web of Science）和Scopus数据库。
符合条件的出版物为英文撰写，发表于1999年至2016年之间。如果文章研究了QI团队的流程、与医疗保健QI相关且为原始研究，则纳入综述。如果文章关于QI团队流程的细节不足，则排除。
提取的描述性细节包括：作者、地理区域和卫生部门。综合（医疗保健）团队有效性模型用于综合研究结果，这些结果涉及团队有效性的各个领域：任务设计、团队流程、社会心理特征和组织背景。
在两个搜索阶段中，共审查了4813条引文。其中，48篇全文文章纳入了综合分析。本综述表明，QI团队也可能出现功能失调。此外，功能失调的QI团队不太可能影响实践。然而，仅靠一个功能正常的QI团队不太可能带来变革。积极的QI团队动态可能是实施QI策略的必要但不充分条件。
进一步研究的领域包括：QI团队与临床微观系统之间的相互作用、理解跨专业代表在QI团队中的作用以及探索QI团队任务、组成和流程之间的相互作用。
