School of Nursing, Duke University, Durham, North Carolina, USA.
Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
J Clin Nurs. 2023 Jan;32(1-2):3-30. doi: 10.1111/jocn.16247. Epub 2022 Apr 10.
Healthcare organisations and teams perform improvement activities to facilitate high-quality healthcare. The use of an improvement coach who provides support and guidance to the healthcare team may facilitate improvement activities; however, no systematic review exists on the facilitators and barriers to implementing an improvement coach.
We conducted a qualitative evidence synthesis to examine the facilitators and barriers to the implementation of improvement coaching.
We searched MEDLINE , Embase and CINAHL. The final search was in March 2021. The screening eligibility criteria included the following: interdisciplinary team receiving the coaching, improvement coaching, designs with a qualitative component and primary purpose of evaluating practice facilitation in OECD countries. An ecologically-informed consolidated framework for implementation research (CFIR) served as the framework for coding. Patterns of barriers and facilitators across domains were identified through matrix analysis. Risk of bias was assessed using Critical Appraisal Skills Program. PRISMA reporting guidelines served as a guide for reporting this review.
Nineteen studies with a qualitative component met the inclusion criteria. Four themes of barriers and facilitators crossed multiple CFIR domains: adaptability (e.g. making adjustments to the project; process, or approach); knowledge and skills (e.g. understanding of content and process for the project); engagement (e.g. willingness to be involved in the process) and resources (e.g. assets required to complete the improvement process).
Improvement coaching is a complex intervention that influences the context, healthcare team being coached and improvement activities. Improvement coaches should understand how to minimise barriers and promote facilitators that are unique to each improvement project across the domains. Limitations of the study are related to the nature of the intervention including potential publication bias given quality improvement focus; the variety of terms similar to improvement coaching or selection of framework.
医疗机构和团队开展改进活动，以促进高质量的医疗保健。聘请提供支持和指导的改进教练来协助医疗团队可能会促进改进活动；但是，目前尚没有关于实施改进教练的促进因素和障碍的系统评价。
我们进行了定性证据综合分析，以研究实施改进教练的促进因素和障碍。
我们检索了 MEDLINE、Embase 和 CINAHL。最终检索时间为 2021 年 3 月。筛选合格标准包括：接受教练指导的跨学科团队、改进教练、具有定性组成部分的设计以及评估经合组织国家实践促进的主要目的。生态一致的实施研究综合框架（CFIR）作为编码框架。通过矩阵分析确定了各个领域的障碍和促进因素模式。使用关键评估技能计划评估偏倚风险。PRISMA 报告指南作为本综述的报告指南。
有定性部分的 19 项研究符合纳入标准。跨越多个 CFIR 领域的四个障碍和促进因素主题：适应性（例如，对项目、过程或方法进行调整）；知识和技能（例如，对项目内容和过程的理解）；参与度（例如，愿意参与该过程）和资源（例如，完成改进过程所需的资产）。
改进教练是一种复杂的干预措施，会影响背景、接受指导的医疗团队和改进活动。改进教练应了解如何最小化每个改进项目在各个领域中特有的障碍并促进促进因素。研究的局限性与干预措施的性质有关，包括由于质量改进重点而可能存在的发表偏倚；与改进教练或框架选择类似的各种术语。
