Popivanov Petar, McCarthy Siobhan Eithne, Finn Mairead
Coombe Women and Infants University Hospital, Dublin, Ireland
RCSI University of Medicine & Health Sciences, Dublin, Ireland.
BMJ Open Qual. 2025 Feb 8;14(1):e002967. doi: 10.1136/bmjoq-2024-002967.
Improving the quality of patient care remains a global necessity. Despite system and professional benefits, current evidence indicates that the spread of improvement principles among front-line healthcare workers remains poor.While education and training alone are unlikely to result in consistent improvement practice, coaching can play a critical role in sustainable, evidence-based improvement implementation. Peer quality improvement coaching (PQIC) places the power and agency in the shared relationship between coach and coachee to shape coachee quality improvement (QI) outcomes.Study objective was to develop and pilot an evidence-based protocol for implementation and evaluation of a PQIC for front-line staff engaged in small to intermediate improvement efforts.
We conducted a multistage case-study design and implementation process. First, a systematised literature review identified themes about the theory and practice of QI coaching (QIC). Second, these themes guided the development of a PQIC protocol. Finally, the protocol was piloted and evaluated among staff in a single-centre tertiary maternity hospital. PQIC effectiveness was assessed using evaluation tools identified in the literature.
Effectiveness; strategies and models; moderating factors and methods for evaluation of QIC emerged from the literature. Together with Bloom's taxonomy and Kirkpatrick's educational model, these themes informed the development of this PQIC protocol. It was piloted in three steps: education, coaching and evaluation. A survey revealed that the participants in the education step achieved excellent scores. Following the coaching journey, the coached multidisciplinary team leaders completed their improvement initiatives and demonstrated increased QI knowledge and skills measured by the 'IHI improvement advisor self-assessment tool' and 'IHI assessment scale for collaboratives'.
Built on established education, peer coaching and QI concepts, this evidence-based PQIC protocol adds to international evidence on how to support front-line healthcare workers in their improvement efforts. Future research needs to assess protocol effectiveness across different settings.
提高患者护理质量仍是全球的一项必要任务。尽管有系统和专业方面的益处，但目前的证据表明，改进原则在一线医护人员中的传播情况仍然不佳。虽然仅靠教育和培训不太可能带来持续的改进实践，但辅导在基于证据的可持续改进实施中可以发挥关键作用。同伴质量改进辅导（PQIC）将权力和能动性置于辅导者与被辅导者之间的共享关系中，以塑造被辅导者的质量改进（QI）成果。研究目的是制定并试行一项基于证据的方案，用于对参与小型至中型改进工作的一线员工实施和评估PQIC。
我们进行了一个多阶段的案例研究设计和实施过程。首先，系统的文献综述确定了关于QI辅导（QIC）理论和实践的主题。其次，这些主题指导了PQIC方案的制定。最后，该方案在一家单中心三级妇产医院的员工中进行了试行和评估。使用文献中确定的评估工具评估PQIC的有效性。
文献中出现了QIC的有效性、策略和模式、调节因素及评估方法。这些主题与布鲁姆分类法和柯克帕特里克教育模式一起，为该PQIC方案的制定提供了参考。它分三个步骤进行试行：教育、辅导和评估。一项调查显示，教育步骤中的参与者取得了优异成绩。在经历辅导过程后，接受辅导的多学科团队领导完成了他们的改进计划，并通过“IHI改进顾问自我评估工具”和“IHI协作评估量表”显示出QI知识和技能有所提高。
基于既定的教育、同伴辅导和QI概念，这个基于证据的PQIC方案为如何支持一线医护人员进行改进工作增添了国际证据。未来的研究需要评估该方案在不同环境中的有效性。
