Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities

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Title: Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities
Authors: Pannick, S
Sevdalis, N
Athanasiou, T
Item Type: Journal Article
Abstract: Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers – particularly middle managers – also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of frontline staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.
Issue Date: 8-Dec-2015
Date of Acceptance: 13-Oct-2015
ISSN: 2044-5423
Publisher: BMJ Publishing Group
Start Page: 716
End Page: 725
Journal / Book Title: BMJ Quality & Safety
Volume: 25
Copyright Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:
Sponsor/Funder: Imperial College Healthcare NHS Trust
West Middlesex University Hospital NHS Trust
Imperial College Healthcare Charity
Funder's Grant Number: RDPSC 79560
Research Fellow
Keywords: Healthcare quality improvement
Implementation science
Quality improvement methodologies
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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