The influence of contextual factors on healthcare quality improvement initiatives: a realist review.
Context
Evidence-based practice
Health improvement
Healthcare
Implementation
Knowledge translation
Quality improvement
Realist review
Realist synthesis
Journal
Systematic reviews
ISSN: 2046-4053
Titre abrégé: Syst Rev
Pays: England
ID NLM: 101580575
Informations de publication
Date de publication:
26 04 2020
26 04 2020
Historique:
received:
05
11
2019
accepted:
30
03
2020
entrez:
28
4
2020
pubmed:
28
4
2020
medline:
25
6
2021
Statut:
epublish
Résumé
Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes. PROSPERO CRD42017062135.
Sections du résumé
BACKGROUND
Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare?
METHODS
A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework.
RESULTS
Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings.
CONCLUSIONS
This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017062135.
Identifiants
pubmed: 32336290
doi: 10.1186/s13643-020-01344-3
pii: 10.1186/s13643-020-01344-3
pmc: PMC7184709
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
94Références
BMJ Qual Saf. 2016 Dec;25(12):986-992
pubmed: 26369893
Implement Sci. 2013 Jun 20;8:70
pubmed: 23786847
BMJ Qual Saf. 2011 Apr;20 Suppl 1:i18-23
pubmed: 21450764
J Health Serv Res Policy. 2005 Jul;10 Suppl 1:21-34
pubmed: 16053581
Int J Qual Health Care. 2017 Oct 1;29(5):740-744
pubmed: 28992157
BMJ Qual Saf. 2018 Mar;27(3):226-240
pubmed: 29055899
Implement Sci. 2017 Feb 15;12(1):21
pubmed: 28202031
J Health Organ Manag. 2016;30(2):258-78
pubmed: 27052625
Qual Manag Health Care. 2009 Jan-Mar;18(1):25-39
pubmed: 19148027
Implement Sci. 2011 Mar 09;6:18
pubmed: 21385467
Int J Qual Health Care. 2018 Jul 1;30(6):416-422
pubmed: 29617795
Am J Surg. 2019 Feb;217(2):233-243
pubmed: 30477760
BMJ Qual Saf. 2016 Mar;25(3):173-81
pubmed: 26056321
Syst Rev. 2017 Aug 23;6(1):168
pubmed: 28830572
Med J Aust. 2004 Mar 15;180(S6):S57-60
pubmed: 15012583
Clin Med (Lond). 2019 Jan;19(1):47-56
pubmed: 30651245
BMJ Qual Saf. 2011 Jul;20(7):611-7
pubmed: 21617166
Age Ageing. 2018 Mar 01;47(2):311-317
pubmed: 29315375
BMC Palliat Care. 2016 Jul 15;15:61
pubmed: 27422410
J Am Med Dir Assoc. 2015 Aug 1;16(8):648-53
pubmed: 25833386
BMC Health Serv Res. 2015 Jul 22;15:277
pubmed: 26199147
BMJ Qual Saf. 2018 Oct;27(10):763-765
pubmed: 30007916
BMJ Open. 2016 Aug 04;6(8):e010988
pubmed: 27491666
BMJ Qual Saf. 2011 Jul;20(7):604-10
pubmed: 21493589
BMJ Qual Saf. 2018 Mar;27(3):207-217
pubmed: 29101292
BMJ Open. 2016 Sep 22;6(9):e011886
pubmed: 27660317
Int J Health Care Qual Assur. 2011;24(7):523-39
pubmed: 22204086
Qual Saf Health Care. 2007 Feb;16(1):2-3
pubmed: 17301192
BMJ Qual Saf. 2012 Oct;21(10):876-84
pubmed: 22543475
Acad Pediatr. 2013 Nov-Dec;13(6 Suppl):S45-53
pubmed: 24268084
BMC Health Serv Res. 2017 Jan 23;17(1):68
pubmed: 28114940
Fam Pract. 2016 Aug;33(4):426-31
pubmed: 27297465
BMC Health Serv Res. 2018 Jul 25;18(1):584
pubmed: 30045741
J Am Board Fam Med. 2017 May-Jun;30(3):337-349
pubmed: 28484066
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Int J Qual Health Care. 2018 Apr 20;30(suppl_1):15-19
pubmed: 29462325
BMC Health Serv Res. 2018 May 10;18(1):347
pubmed: 29743068
BMC Health Serv Res. 2015 Sep 07;15:362
pubmed: 26345184
BMJ Open. 2015 Aug 03;5(8):e008567
pubmed: 26238395
Am J Med Qual. 2017 May/Jun;32(3):313-321
pubmed: 27117636
BMJ Qual Saf. 2012 Jan;21(1):13-20
pubmed: 21835762
Int J Qual Health Care. 2018 Nov 1;30(9):692-700
pubmed: 29669040
Syst Rev. 2018 May 5;7(1):72
pubmed: 29729669
BMJ. 2018 Nov 28;363:k4907
pubmed: 30487286
BMC Health Serv Res. 2014 May 13;14:215
pubmed: 24884879
BMC Health Serv Res. 2015 Feb 14;15:62
pubmed: 25890333
Milbank Q. 2010 Dec;88(4):500-59
pubmed: 21166868
Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23
pubmed: 23690380
BMC Med. 2013 Jan 29;11:21
pubmed: 23360677
Milbank Q. 2011 Jun;89(2):167-205
pubmed: 21676020
Implement Sci. 2013 Mar 09;8:28
pubmed: 23497438
Milbank Q. 2004;82(4):581-629
pubmed: 15595944
BMC Health Serv Res. 2017 Feb 7;17(1):120
pubmed: 28173796
Soc Sci Med. 2010 Nov;71(9):1692-701
pubmed: 20850918
J Eval Clin Pract. 2016 Feb;22(1):77-85
pubmed: 26303398
Stud Health Technol Inform. 2016;222:275-87
pubmed: 27198109
Implement Sci. 2013 Sep 08;8:107
pubmed: 24010732
BMJ Open. 2017 Sep 7;7(9):e015455
pubmed: 28882908
Leadersh Health Serv (Bradf Engl). 2016 Oct 3;29(4):402-414
pubmed: 27707147
Acad Emerg Med. 2015 Jun;22(6):720-9
pubmed: 25996451
BMC Health Serv Res. 2014 Dec 19;14:642
pubmed: 25547227
PLoS One. 2018 Feb 28;13(2):e0192224
pubmed: 29489842
Annu Rev Public Health. 2019 Apr 1;40:361-372
pubmed: 30633712
Health Care Manage Rev. 2018 Jul/Sep;43(3):261-269
pubmed: 29533271
BMJ. 2011 Feb 03;342:d195
pubmed: 21292719
BMC Health Serv Res. 2014 Nov 19;14:545
pubmed: 25407487
Implement Sci. 2013 Oct 08;8:119
pubmed: 24098940
Clin Pediatr (Phila). 2016 Aug;55(9):825-37
pubmed: 26743455
Implement Sci. 2016 Oct 19;11(1):141
pubmed: 27756414