Bierbaum Mia, Hillier Susan, Ellis Louise A, Clay-Williams Robyn, Goodrich Angie, Padbury Robert, Hibbert Peter
IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
Australian Institute of Health Innovation (AIHI), Macquarie University, Sydney, Australia.
BMC Health Serv Res. 2025 Mar 27;25(1):457. doi: 10.1186/s12913-025-12557-4.
Continuous quality improvement (CQI) initiatives are commonly used to enhance patient safety and quality of care. A novel South Australian Local Health Network (SALHN) Continuous Improvement Program (CIP009) has integrated a top-down model of executive-directed change initiatives, with a bottom-up approach of clinician designed interventions to address an organisational-wide goal of improved patient flow. This study evaluated the strengths and challenges of CIP009 implementation from the perspective of participants and deliverers.
A qualitative study was conducted in 2023/2024 to evaluate the implementation of CIP009 and 12 associated quality improvement projects. Semi-structured interviews and focus groups were conducted with key stakeholders (executives, coaches and CIP009 fellows) and guided by the Consolidated Framework for Implementation Research (CFIR). A document review and observations of CIP009 team meetings were also conducted. Data were analysed inductively using thematic analysis, then deductively mapped against the five CFIR domains.
Thirty-one participants were interviewed individually or in focus groups, two presentation days and six team meetings were observed, and 78 documents were reviewed. Seven key themes were identified highlighting key challenges and strengths of CIP009 implementation within the SALHN setting. These included four key strengths: the CIP framework and culture (the flexible framework, common language, training, and a culture of flattened hierarchy); the benefits of support from a dedicated, internal improvement Faculty (wrap around support from coaches); the advantages of an enthusiastic team member disposition and incentives (vested interests to enhance workflow and patient outcomes); and effective teams and team composition (teams comprised of senior clinician change agents). Three key challenges included: workforce and organisation-level challenges (individual workloads, workforce capacity, and data access); team cohesion, logistics and stakeholder engagement challenges (issues in the way teams worked together); and training and support shortcomings (the training course, and the top-down nature of CIP009).
This evaluation identified that CIP009 was considered an effective multifaceted CQI program. The strengths of CIP009 support a learning health system (a data driven model, utilising systematic frameworks, with commitment from leadership, and a culture of continuous learning). Further integration of implementation science principles may support the program to overcome the key challenges identified. These findings will inform and guide improvement efforts within future iterations of CIP.
持续质量改进（CQI）举措通常用于提高患者安全和护理质量。南澳大利亚地方卫生网络（SALHN）的一项新型持续改进计划（CIP009）将自上而下的行政主导变革举措模式与自下而上的临床医生设计干预方法相结合，以实现改善患者流程这一全组织范围的目标。本研究从参与者和实施者的角度评估了CIP009实施的优势和挑战。
2023年至2024年进行了一项定性研究，以评估CIP009及12个相关质量改进项目的实施情况。对关键利益相关者（管理人员、教练和CIP009研究员）进行了半结构化访谈和焦点小组讨论，并以实施研究综合框架（CFIR）为指导。还对CIP009团队会议进行了文件审查和观察。使用主题分析对数据进行归纳分析，然后根据CFIR的五个领域进行演绎映射。
对31名参与者进行了个人访谈或焦点小组讨论，观察了两个展示日和六次团队会议，并审查了78份文件。确定了七个关键主题，突出了在SALHN环境中实施CIP009的关键挑战和优势。其中包括四个关键优势：CIP框架和文化（灵活的框架、通用语言、培训以及扁平化等级制度的文化）；来自专门的内部改进教员支持的好处（教练提供全方位支持）；热情的团队成员态度和激励措施的优势（增强工作流程和患者结果的既得利益）；以及有效的团队和团队组成（由资深临床医生变革推动者组成的团队）。三个关键挑战包括：劳动力和组织层面的挑战（个人工作量、劳动力能力和数据访问）；团队凝聚力、后勤和利益相关者参与方面的挑战（团队合作方式存在的问题）；以及培训和支持的不足（培训课程以及CIP009的自上而下性质）。
本次评估确定CIP009是一个有效的多方面CQI计划。CIP009的优势支持学习型卫生系统（一种数据驱动的模式，利用系统框架，有领导的承诺以及持续学习的文化）。进一步整合实施科学原则可能支持该计划克服所确定的关键挑战。这些发现将为CIP未来迭代中的改进工作提供信息和指导。
