Characteristics of QI training | Characteristics of QI activity | Individual capacity (enablers/barriers) | Organisational capacity (enablers/barriers) | Impact (outcomes) | |
---|---|---|---|---|---|
Evaluations of QI training programme | |||||
Cornett et al26 | Experiential learning through QI intervention (1). Use of coaching (2) and distance learning (3) | QI training at the working site (6). QI coaching from trainees to others in the organisation (7) | Confidence to conduct QI activities (9) | Achievement of project goals, as measurable outcomes or processes (17) | |
Davis et al27 | Webcast participants had high receptivity to QI training (3) | Receptivity to learning about and implementing QI activities (10) | |||
Riley et al28 | QI project as part of QI training (1). Full distance learning (3). Programme developed in partnership (4) | QI training at the working site (6) | Kirkpatrick model,21 including ‘learning’ and ‘behaviour’ (9). QI programme relevance rating (10). Self-efficacy and willingness to conduct a future QI project (9) | Management support (12) and availability of resources (13) | Project outcome metrics (17) |
Ruud et al29 | QI project as part of QI training (1). Programme developed in partnership (4) | Transfer of knowledge and skills gained back to the work setting (7) | Kirkpatrick model,21 including ‘learning’ and ‘behaviour’ (9) | ||
Ng and Trimnell30 | QI project as part of QI training (1). Coaching and mentorship as part of QI training (2) | Assessment of the spread of QI knowledge (7) | Kirkpatrick model,21 including ‘learning’ and ‘behaviour’ (9) | Meeting patient outcomes targeted by QI projects (17) | |
Daugherty et al31 (Emory Healthcare) | QI project as part of QI training (1). Coaching and mentorship from previously trained staff (2). Programme developed in partnership (4) | QI training at the working site (6) | Support from supervisor and from senior leadership and ongoing institutional support (12). Improved teamwork (13). Barriers included financial resources (Rask et al) (13) | Participant perception of impact on processes and outcomes, including patient satisfaction, access or safety (17) | |
Rask et al32 (Emory Healthcare) | Ability in the use of data (9) | ||||
Blake et al33 (Emory Healthcare) | Confidence to train others (9) | ||||
Lavigne34 | QI training in pharmacy curriculum (5) | Assessed motivation, importance, usefulness, awareness impact on patient health (10). Self-reported ability to identify quality issues and knowledge of and ability to implement QI methods (9) | |||
Warholak et al35 | QI training during pharmacy education (5) | ||||
Diaz et al36 | Impact after QI training during family medicine residency (5) | QI training during residency increases subsequent family physician QI involvement (10) | |||
Canal et al37 | QI project as part of QI training (1). QI training during surgery residency (5) | QI training at the working site (6) | Self-assessed QI efficacy (9) | Sponsorship and involvement from team leaders on improvement initiatives (13) | |
Djuricich et al38 | QI project as part of QI training (1). QI training during internal medicine and paediatric residency (5) | QI training at the working site (6) | Self-assessed QI efficacy (9). Interest scale (10) | ||
Ogrinc et al39 | QI project as part of QI training (1). PBLI training during internal medicine residency (5) | QI training at the working site (6) | Self-assessed confidence and proficiency in PBLI (9) | Sponsorship and involvement from team leaders of improvement initiatives (13) | |
Didic et al40 | Assessment of training programme directed at board member and executive leaders of healthcare organisations. Includes questions on board relationship with CEO and clinical leadership, culture, information and measurement (12) | ||||
Robert Wood Johnson Foundation7 | Training must be experiential (1). Importance of QI in clinical curricula (5) | Importance of QI coaches and mentor at the organisation (7) | Cost of QI training as barrier (11) | Key enablers: organisational support (12), infrastructure for QI and effective incentives (13) | |
Robert Wood Johnson Foundation41 | Importance of opportunities to apply new skills (6) | Key enablers: organisational culture, leadership support and clear sponsorship of QI projects (12) | |||
Morganti et al42 | Training reinforcement and coaching (7). Measures of QI training dosage included informal coaching (7). Patient-centred QI, involvement of family and friends at all levels (8) | Understanding of QI principles and ability to apply QI skills (9). Importance of QI training (10) | Organisational culture of QI and excellence, and leadership involvement (12). Team empowerment and financial resources; team effectiveness; end-user involvement (13). Information technology systems; performance monitoring (14) and diffusion (15) | QI progress achieved in interventions following the QI training programme, using outcomes variables from the organisations (Kirkpatrick l4: ‘results’21) (17) | |
Morganti et al43 | |||||
Evaluations of QI capacity building programmes/initiatives | |||||
Stover et al44 | QI coaching from supervisors (2). Partnership between the Ministry of Health, international and local universities, and research and training institutes (4) | Involvement of community stakeholders (8) | Self-assessed capacity for improvement work (9). Motivation for participation in improvement work: deaths, achieving health goals and positive experience with QI (10) | Perception of district culture and leadership commitment and support for QI (12). Local team empowerment (13). Use of QI data; results-oriented accountability (14) and diffusion across teams (15) | |
Matovu et al45 | QI project as part of QI training (1). Coaching and mentorship as part of QI training (2). In collaboration with local university (4) | QI training at the working site (6) | |||
Runnacles et al46 | QI project as part of QI training (1). Coaching and mentorship as part of QI training (2). Programme directed at physicians during residency (5) | QI training at the working site (6) | Organisational culture receptive to change, senior executive support, and engagement of operational and improvement managers (12) | ||
Adler et al3 | Inhospital QI training (4). Efforts to integrate QI training into medical education (5) | Participatory from top and lower management to physicians (12). Key QI capability factors: teamwork, communication, specialised QI staff and committees and HR management (13). Information infrastructure, performance measurement, oversight and accountability (14); incentives to cross-unit collaboration (15). QI strategic priority (16) | |||
Davis et al47 | Barriers to QI: lack of time, resources, perceived low relevance, poor leadership and teamwork commitment to QI, and insufficient QI training and experience (11). Mandatory QI for accreditation may be a QI driver (10) | Leadership support (12). Number of staff trained in QI and regular contact between teams and decision-makers (13). Data collection and monitoring (14). National QI initiative (16) | |||
Health Quality Ontario48 (Learning Community programme) | QI coaching is a key element of this improvement programme (2). Virtual workspace and knowledge sharing (3) | QI training at the working site (6) | Motivation included positive past experience with QI, example from other organisations, need to meet specific improvement goals and external pressures (10) | ||
QI capacity evaluations | |||||
Weiner et al49 | Extent of organisational deployment; senior management (12), hospital staff and physician participation (13). Diffusion across units (15) | Hospital level outcomes quality measures (17) | |||
Gagliardi et al50 | Education and training as key QI role (7) | Role of accreditation as a QI driver (10) | Senior management and board involvement, fostering QI culture (12). Communication and teamwork (13). Data analysis and monitoring (14). Strategic planning (16) | Adverse events and patient satisfaction (17) | |
Ontario Hospital Association51 | Frequent partnership to develop QI plans (4). | Growing involvement of patient and community in QI (8) | Insufficient opportunities for formally training staff in QI (11) | Leadership involvement in QI (12) | |
British Columbia Patient Safety and Quality Council52 | Distance learning to increase QI training feasibility (3) | Importance of QI training and coaching at work and through personal study (7) | Tuition fees as a barrier to QI training (11) | Support of their organisations is critical for QI trainees (12) | |
Lawrence and Tomolo53 | Assessment tool for QI during medical education (5) | Self-efficacy in QI plan development and implementation, developing a data collection plan, and teaching QI principles (9) | |||
Assessment or analysis related to QI capacity building | |||||
Batalden et al54 | Practice-based learning and improvement (PBLI) as one of six general competencies of graduate medical education (5) | ||||
Butterworth et al55 | Undergraduate QI training for nurses and doctors (5) | ||||
Headrick et al56 | Use of web-based resources (3). Partnership between IHI, universities and healthcare organisations (4). Interprofessional QI training for undergraduate nurses and doctors (5) | Focus on application in care setting (6) | Evaluation on knowledge and skills (9); and perceived importance of QI (10) | Focus on interprofessional communications and teamwork (13) | Minimal though recognised importance of evaluating changes in behaviour and outcomes (17) |
American Academy of Family Physicians57 | Family medicine resident should have knowledge in specific QI tools (5) | Family medicine resident should have hands-on experience leading performance improvement initiatives (6) | |||
Saskatchewan Health Quality Council58 | Lectures in QI to students in various health science programmes (5) | ||||
Hutchison et al59 | Partnership with provincial medical associations for QI training in primary care (4) | Performance measurement (17) | |||
Farley et al60 | Integration of patient perspective into QI (8) | ||||
Headrick et al61 | QI training for medical students (5) | Learners engaging in care and improvement (6). Health professionals engaged in and teaching QI (7). Patient and family engagement (8) | Leadership involvement in QI (12). Data transforming into useful information (14) | ||
American Association of Colleges of Nursing62 | Knowledge and skills in leadership, quality improvement and patient safety among nursing educational standards (5) | Effective working relationships and open communication and cooperation within the interdisciplinary team; use of information and communication technologies to enhance care and improve outcomes (13). Employ data for QI and safety (14) | Use performance methods to assess and improve outcomes (17) | ||
Cronenwett et al63 (Quality and Safety Education for Nurses (QSEN)) | QI competency should be developed during prelicensure nursing education (5) | QI competency skill on seeking information about QI projects (6) | QI competency requires skills on the use of QI methods, tools and quality measurement (9) | QI competency requires knowledge and skills on reviewing and improving outcomes of care (17). | |
Cronenwett et al64 (QSEN) | QSEN competencies are appropriate for advance practice nurses, including QI (5) | ||||
Batalden and Davidoff5 | Domains of QI interest include knowledge of customer/beneficiary and the social context (8). Knowledge of particular contexts is involved in QI (6) | Knowledge on improvement methods (9) | Domains of QI interest include leading and following, collaboration (13); measurement, variation and accountability (14). Strategy as driver of change is involved in QI (16) | Performance measurement to assess the effect of changes (17) | |
Bevan12 | Capability building needs to be ‘hard-wired’ into the practice (6). Train initially those who can spread the skills most widely (7). Enable service users to drive and influence change (8) | Importance of assessing knowledge and skills in improvement (9) and interest (10). Performance management should include incentives (10). Insufficient time as barrier (11) | Key elements highlighted relate to culture and leadership support (12); teamwork and human resources management (13); measurement, use of evidence and benchmarks (14). Capability building strategies (16) need to take account of how change spreads in complex adaptive systems (15) | Connect skill building to results and realising benefits. Importance of evidence from economic assessments (17) | |
Batalden et al65 (Veterans Administration National Quality Scholars (VAQS)) | Mentoring is a critical part of the programme (2). Use of distance learning technologies (3). Collaborative programme between universities and VA care sites (4) | Most important venues for learning are the programme sites themselves (6). Physicians trained by this programme should be able to teach QI (7) | |||
Splaine et al66 67 (VAQS) | Curriculum domains include: leading and following, collaboration (13); measurement, variation and accountability (14) | ||||
Curriculum knowledge domains include customer/beneficiary knowledge and social context (8) |
Merged cells indicate that the same content was included in more than one related article.