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Beyond Clinical Engagement: a Pragmatic Model for Quality Improvement Interventions
BMJ Quality and Safety (09/01/2016) Vol. 25, No. 9, P. 716; Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

In this study, researchers in the United Kingdom sought to explore the role of managerial staff in quality improvement (QI) implementation. They outlined a "model for alignment" highlighting key factors of practical importance for successful QI using observations from the Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) study. Through structured discussion, clinical staff sought to identify risks to the delivery of high quality care on a daily basis, addressing them promptly through facilitated communication with senior clinicians and managers before patient harm occurred. Multidisciplinary tools systematically collect data relevant to front-line care delivery problems, and teams would then assess and rank the apparent safety threats. Interventions are co-designed or adapted with clinicians, with a focus on quality strategies having the strongest evidence for effectiveness and implementation. Clinicians' participation is to be supported, recognized, and rewarded, perhaps as part of a formal performance management process. Middle managers coordinate alignment of the improvement efforts with organizational goals, and are themselves heavily incentivized to see QI facilitation as a core role of their own. Middle managers' interest in quality is further reinforced by protected board time for quality issues, and board-level use of quality metrics. The researchers conclude that next generation of guidelines for QI reporting will emphasize narrative understanding, while addressing the alignment of clinical and managerial priorities.

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