Jeffs Lianne, Bruno Frances, Zeng Rui Lin, Schonewille Noah, Kinder Kim, De Souza Gina, D'Arpino Maryanne, Baker G Ross
Jt Comm J Qual Patient Saf. 2023 May;49(5):255-264. doi: 10.1016/j.jcjq.2023.02.001. Epub 2023 Feb 14.
There is a current lack of research exploring the contextual factors of why and how quality improvement collaboratives (QICs) work. To this end, a mixed methods study was undertaken to improve our understanding of what works for whom and in what context among participants in a nationwide Canadian QIC.
The authors used a mixed methods approach consisting of a written survey and 30-to-45-minute telephone interviews with collaborative team members, coaches, and senior leaders of participating safety improvement project (SIP) organizations to identify the essential elements of an integrated approach involving implementation science/knowledge translation, quality improvement (QI), patient safety, and collaborative learning/networked approach to enhancing safety and quality and building implementation capabilities. Survey data were analyzed using descriptive statistics. Interview data were analyzed by three team members using thematic analysis and development of an emergent coding schema.
Four themes emerged as the essential elements: (1) integrating implementation science into the QI/patient safety learning collaborative; (2) reinforcing of and opening eyes to implementation science by an expert implementation specialist; (3) valuing the sense making and strategies shared by coaches; and (4) experiencing challenges to implementation amplified by the COVID-19 pandemic. Teams also reported improvements in teamwork and patient outcomes as a result of participating in the QIC.
This study's findings provide deeper insight into the "essential ingredients" (expert implementation specialist, coaches) grounded in an integrated approach that drew from QI, patient safety, and implementation science. Organizations can use the key learnings on how best to implement quality and safety projects by leveraging the sense making of the expert implementation specialist and coaches in an integrated networked learning approach.
目前缺乏对质量改进协作组织（QICs）为何以及如何发挥作用的背景因素的研究。为此，开展了一项混合方法研究，以增进我们对在加拿大全国性QIC的参与者中，什么对谁有效以及在何种背景下有效的理解。
作者采用了一种混合方法，包括对参与安全改进项目（SIP）组织的协作团队成员、教练和高级领导者进行书面调查以及30至45分钟的电话访谈，以确定一种综合方法的基本要素，该方法涉及实施科学/知识转化、质量改进（QI）、患者安全以及协作学习/网络化方法，以提高安全性和质量并建立实施能力。调查数据使用描述性统计进行分析。三名团队成员使用主题分析和制定新出现的编码模式对访谈数据进行分析。
出现了四个主题作为基本要素：（1）将实施科学融入QI/患者安全学习协作中；（2）由专家实施专家强化并关注实施科学；（3）重视教练分享的意义构建和策略；（4）经历因COVID-19大流行而加剧的实施挑战。团队还报告称，由于参与QIC，团队合作和患者结局得到了改善。
本研究的结果为基于QI、患者安全和实施科学的综合方法中的“关键要素”（专家实施专家、教练）提供了更深入的见解。组织可以利用关键经验教训，通过在综合网络学习方法中利用专家实施专家和教练的意义构建，来最佳地实施质量和安全项目。
