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The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement
BackgroundQuality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen.ObjectiveTo develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project.Methods10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model.ResultsThe Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly.ConclusionsThe MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.
Journal Article
A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact
Background
The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.
Methods
This qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.
Results
A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.
Conclusions
Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.
Journal Article
Juran's quality essentials : for leaders
\"Dr. Juran's life work on quality--boiled down to a concise guide to creating a strong, successful, globally competitive enterprise Dr. Joseph Juran was a true visionary in the field of quality, and his words continue to inspire. One of his main mantras was \"Take care of the quality, and the rest will take care of itself.\" This work is devoted to just that--taking care of the quality. In it, the Juran Institute team presents the leadership values, beliefs, and actions of top companies, and identifies the strategies that have resulted in measurable success. Juran's Quality Essentials offers succinct, field-tested methods applicable to any industry, from service to manufacturing, and includes realistic timetables of implementation. This unique resource describes three universal quality management methods: 1. designing innovative products and services; 2. creating breakthroughs in current performance; and 3. assuring repeatable and compliant processes. Reveals how to align quality goals and methods to a company's strategic plan Provides a transformation model and roadmap Demonstrates how executive leadership is the key to a company's quality revolution--and how to make quality happen. Filled with insider tips for staying adaptable and using a benchmark to sustain performance Shows how to apply planning, control, and improvement to quality leadership for competitive advantage \"-- Provided by publisher.
Book
When the patient is the expert: measuring patient experience and satisfaction with care
In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.
Journal Article
SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).
Journal Article
Politics of Urban Runoff
When rain falls on the city, it creates urban runoff that cause flooding, erosion, and water pollution. Municipal engineers manage a complex network of technical and natural systems to treat and remove these temporary water flows from cities as quickly as possible. Urban runoff is frequently discussed in terms of technical expertise and environmental management, but it encompasses a multitude of such nontechnical issues as land use, quality of life, governance, aesthetics, and community identity, and is central to the larger debates on creating more sustainable and livable cities. In this book, Andrew Karvonen uses urban runoff as a lens to view the relationships among nature, technology, and society. Offering theoretical insights from urban environmental history, human geography, landscape and ecological planning, and science and technology studies as well as empirical evidence from case studies, Karvonen proposes a new relational politics of urban nature.After describing the evolution of urban runoff practices, Karvonen analyzes the urban runoff activities in Austin and Seattle--two cities known for their highly contested public debates over runoff issues and exemplary stormwater management practices. The Austin case study highlights the tensions among urban development, property rights, land use planning, and citizen activism; the Seattle case study explores the city's long-standing reputation for being in harmony with nature. Drawing on these accounts, Karvonen suggests a new relational politics of urban nature that is situated, inclusive, and action-oriented to address the tensions among nature, technology, and society.
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