Background
Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments.

/pdf/measuring-organizational-and-individual-factors-thought-to-3064r4yqxh.pdf

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.

Background  Hospital quality improvement initiatives are becoming increasingly common Little is known about the influence of these initiatives on resident learning and attitudes Our objective was to assess whether training in a hospital committed to involving residents in hospital-initiated, continuous quality improvement (CQI), and to participation in such activities, would influence residents' attitudes toward CQI and engagement in the hospital community Methods  We surveyed Seattle Children's Hospital pediatric residents, from residency graduation years 2002–2009 We included questions about participation in quality improvement activities during residency and measures of attitude toward CQI and of workplace engagement We used descriptive statistics to assess trends in resident participation in hospital CQI activities, attitudes toward CQI and workplace engagement Results  The overall response rate was 84% (162 of 194) Among graduated residents, there was a significant trend toward increa

/pdf/addressing-core-competencies-through-hospital-quality-127r5ahayx.pdf

Addressing Core Competencies Through Hospital Quality Improvement Activities: Attitudes and Engagement

The health workforce must be able to cope with shifts in the pattern of causes of death and disease that are being seen worldwideparticularly with the rise in noncommunicable diseases (NCDs). This requires health personnel to have a set of skills and competencies that can adapt to meet the populations growing and changing health needs. This report examines the status of the nurse workforce in the Eastern Caribbean, assessing how best to strengthen its capacity to respond to the growing burden of NCDs. The report is based on four Eastern Caribbean case studies conducted in Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines. The case studies showed that, although overall nurse staffing levels seem to be sufficient across the four countries in terms of numbers, there are nurse shortages at hospitals and health clinics, as well as in the availability of specialists. Better management of the nurse workforce is needed to ensure adequate coverage at the hospitals and clinics is maintained. In terms of specialists, while the quality of education is generally reported to be good, there are barriers to accessing specialized training which include the high-cost of seeking specialized training due to non-existing or very limited local options and the lack of built-in incentives for completing additional education. To help address the capacity constraints faced by the nurse workforce in the Eastern Caribbean to respond to NCDs, the report generated knowledge in support of two critical areas: (i) provide an understanding of the educational and training opportunities available to nurses to strengthen their capacity to meet the NCD challenges, and (ii) assess whether there is a supportive policy environment in place for nurses to play a role in addressing NCDs. As part of the study, a toolkit was developed, which can be used to strengthen the capacity for HRH planning and management with respect to NCDs.

The Nurse Workforce in the Eastern Caribbean: Meeting the Challenges of Noncommunicable Diseases

Background:
Delivering high quality health care requires an ongoing effort at all levels of the health system to adopt new knowledge in routine practice, to identify and resolve persistent quality problems, and to meet the evolving needs of populations. Continuous quality improvement (CQI) is among the most promising approaches for tackling these challenges in primary care. CQI brings teams of health professionals together to develop and test changes to the systems and processes used to deliver care. The result is expected to be substantial and sustained improvement in healthcare quality. Yet limited research on how (and indeed if) CQI works creates uncertainty over its true value and weakens our ability to predict the circumstance in which CQI will be effective.
Aims
The overarching aim of this thesis is to examine what we know about the effectiveness of CQI in primary care and develop a framework to strengthen future research. More specifically, the aims are to: (1) synthesise existing research on the effects, and factors that modify the effects, of CQI in primary care, (2) support the design of CQI research by developing a framework intended to help evaluators identify and measure factors salient to our understanding of CQI in primary care, and (3) guide selection of the best available instruments for measuring factors in the framework.
Methods
Three types of research synthesis methods were used in this thesis. Systematic review methods and metaanalysis of randomised trials were used to evaluate the effectiveness of CQI. Qualitative synthesis of prevailing concepts of CQI and factors thought to influence its effectiveness was used to develop a theorybased framework for evaluating CQI. Systematic review methods were used to identify and evaluate the measurement properties of quantitative self-report instruments suitable for measuring factors in the developed framework. Framework-based synthesis methods were used to categorise instrument content in a taxonomy designed to enable direct comparison of instruments and illustrate coverage of the framework.
Results
Based on existing evidence from randomised trials, the effects of CQI on health professional performance and patient outcomes in primary care are uncertain. AnalysiS of more than 170 papers contributed to development of the lnforming Q!!ality Improvement Research (InQuiRe) framework. InQuiRe covers four domains (CQI process, implementation approaches, enabling context, outcomes) and includes (1) a -taxonomy of factors thought relevant to understanding and predicting the process and outcomes of CQI, (2) definition of these factors, and (3) description of the mechanism by which CQI process and context are thought to interact to yield improvements in health care. Content analysis of 319 instruments identified 160 instruments measuring factors in the InQuiRe framework, 78 of which are suitable for primary care.
Conclusions
Despite an expansive literature, existing evidence is yet to address important policy and practice questions about how best to implement and ensure the success of CQI in different contexts. Addressing these questions will require evaluations that examine the interplay between CQI process, context, and outcomes. The InQuiRe framework provides a tool and suite of instruments to support the design of such evaluations.

Toward better evidence for improving the quality of primary care: a synthesis of what we know about the effectiveness of continuous quality improvement and development of a framework to strengthen future research.

Tamara Armstrong

Papers

Development of the continuous quality improvement questionnaire (CQIQ).