Five years’ experience with value-based quality improvement teams: the key factors to a successful implementation in hospital care

BMC Health Services Research – 2022

Background

In recent years, value-based healthcare (VBHC) has become one of the most accepted concepts for fixing the ‘broken’ healthcare systems. Numerous hospitals have embraced VBHC and are trying to implement value-based quality improvement (VBQI) into their practice. However, there is a lack of knowledge on how to practically implement VBHC and organizations differ in their approach. The aim of this study was to explore the main factors that were experienced as hindering and/or supporting in the implementation of VBQI teams in hospital care.

Methods

A qualitative study was performed with semi-structured interviews with 43 members of eight VBQI teams in a large Dutch top-clinical teaching hospital. Participants included physicians, physician assistants, nurses, VBHC project leaders, managers, social workers, researchers and paramedics. Interview grids were structured according to the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). A thematic content analysis with open coding was used to identify emerging (sub)themes.

Results

We identified nine main factors divided over three domains (organization, culture and practice) that determined whether the implementation of VBQI teams was successful or not: 1). Practical organization of value-based quality improvement teams, 2). Organizational structure 3). Integration of VBHC with existing quality improvement approaches and research 4). Adoption and knowledge of the VBHC concept in the hospital 5). Multidisciplinary engagement 6). Medical leadership 7). Goal setting and selecting quality improvement initiatives 8). Long-cycle benchmarking and short-cycle feedback 9). Availability of outcome data.

Conclusions

Overall, this study goes beyond the general VBHC theory and provides healthcare providers with more detailed knowledge on how to practically implement value-based quality improvement in a hospital care setting. Factors in the ‘organization’ and ‘practice’ domain were mentioned in the strategic value agenda of Porter and Lee. Though, this study provides more practical insight in these two domains. Factors in the ‘culture’ domain were not mentioned in the strategic value agenda and have not yet been thoroughly researched before.

Daniels, K., Rouppe van der Voort, M.B.V., Biesma, D.H. et al. Five years’ experience with value-based quality improvement teams: the key factors to a successful implementation in hospital care. BMC Health Serv Res 22, 1271 (2022). https://doi.org/10.1186/s12913-022-08563-5

Evaluating quality improvement at scale: A pilot study on routine reporting for executive board governance in a UK National Health Service organisation

Evaluation and Program Planning – Feb 2023

Highlights

•Not much is known about what routine reporting is useful for quality improvement (QI) governance in healthcare settings.

•We undertook a retrospective evaluation to diagnose measurement and data accrual challenges.

•Routine monitoring of process factors (e.g., learning cycles) can underpin visibility of QI’s organisational impact.

Chua, K. C., Henderson, C., Grey, B., Holland, M., & Sevdalis, N. (2023). Evaluating quality improvement at scale: A pilot study on routine reporting for executive board governance in a UK National Health Service organisation. Evaluation and Program Planning, 97, 102222.

QI Evidence Update for July 2022

Andrea Gibbons & Jess Pawley | Somerset NHS Foundation Trust

The ‘QI Evidence Update’ for July is now available. The bulletin, compiled by Andrea Gibbons and Jess Pawley at Somerset NHS Foundation Trust, brings together the latest research and developments in quality improvement, integrated care, population health, patients and people, NHS performance, workforce and technology, plus events and training. This month’s bulletin includes links to papers on a perinatal care quality improvement package, standardised hospital information cards, encouraging openness in healthcare, a bitesize guide to overseas recruitment, remote consulting in general practice, and much more.

Improving QI Communications

Kent Community Health NHS Foundation Trust | nd | Improving QI Communications

Networking and sharing stories of success were central to two quality improvement (QI) projects which focused on communications

Kent Community Health’s trust’s QI Media and Communications Officer Jane Barlow set out to increase visits to the Kent Community Health NHS Foundation Trust (KCHFT) QI website and the other looked at raising the profile of KCHFT QI work, via Twitter.

The KCHFT dedicated QI website was launched in July 2019. Previously the trust had a QI page on its main website. The dedicated website brings together QI stories, projects, tools and training all into one place. The site has been continually tweaked as a result of feedback from colleagues from KCHFT and other healthcare trusts, who regularly use the resource.

QI tools used included a driver diagram, which helped to set out an action plan to increase the number of visitors and page visits. Run charts and statistical process control (SPC) charts were used to record and measure improvement.

The Twitter project aimed to increase the number of followers on Twitter, by 100 per cent, over 12 months, along with increasing levels of engagement with posts.

Both of the project SMART aims were achieved (Source: Kent Community Health)

Full details available from Kent Community Health

Improving QI Communications

A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project

Wainwright, T. & McDonald, D. | 2021 | A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project | The TQM Journal | Vol. 33| No. 7 | DOI 10.1108/TQM-12-2020-0301

A a review of the current enhanced recovery after surgery (ERAS) pathway was undertaken at the Golden Jubilee National Hospital (GJNH), in Glasgow, Scotland, a recognised national centre for hip and knee replacement within Scotland. This came in response to ongoing national improvement work driving hospital boards across Scotland to improve, the outcomes at the GJNH became average when benchmarked nationally. This review would help ascertain where further improvements could be made that would improve clinical outcomes and maximise capacity.

Abstract

Purpose – Health services continue to face economic and capacity challenges. Quality improvement (QI) methods
that can improve clinical care processes are therefore needed. However, the successful use of current QI methods
within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical
pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.

Design/methodology/approach – A model to manage variability was adapted for use as a QI method and
deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a
mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases,
was used to assess its effectiveness.

Findings – Following the use of the novel QI method and the subsequent changes to care processes, the length
of hospital stay was reduced by 18 per cent. However, the interventions to improve care process highlighted by the QI
method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the
model to manage variability) was simple, effective, offered advantages over other QI methods and had
highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing
and organisational issues had prevented changes being implemented and a greater improvement being made.

Originality/value – The quality of QI reporting in surgery has previously been highlighted as poor and
lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not
only describes and presents the results of using a novel QI method but also provides new insights in regard to
important contextual factors that may influence the success of QI methods and efforts.

A hospital-based mixed-methods observational study to evaluate a hip and knee replacement quality improvement project [paper]

Spotlight on quality improvement

British Society for Rheumatology | nd | Spotlight on quality improvement: Dr Iona Thorne

In this blog post the British Society for Rheumatology speak to Dr Iona Thorne, a consultant acute/obstetric physician and rheumatologist at Chelsea and Westminster Hospital NHS Trust.

Dr Thorne is one of the founding members of British Society for Rheumatology (BSR’s) QI special interest group. She spent a year at the Care Quality Commission (CQC) visiting organisations with an embedded QI programme. She explains how she became involved in QI work and some of the benefits to undertaking and implementing QI generally, and what BSR is doing with QI specifically.

Read the full post from the British Society for Rheumatology

Improving a dietetic service for care home residents

Kent Community Health NHS Foundation Trust | nd | Improving a dietetic service for care home residents

A project, which aimed to improve a dietetic service for care home residents who need nutritional support, has resulted in patients being discharged quicker and increased staff capacity.

A review by the Community Dietetic Team within Kent Community Health NHS Foundation Trust (KCHFT), indicated that some residents were staying on caseloads for a prolonged period of time. The project looked to see if things could be done differently, so that patients could be discharged sooner, while also making sure patients would still receive quality care. It also wanted to make sure dietetic staff time was being spent in the most efficient and effective way.

Two pilot studies were set up involving 30 patients each. The studies tested various changes to see what would lead to an improvement (Source: Kent Community Health NHS Foundation Trust

Full details of the quality improvement project are available from Kent Community Health NHS Foundation Trust

QI conference 2021 [video]

Kent Community Health NHS Foundation Trust | nd | QI conference 2021

Kent Community Health NHS Foundation Trust (KCHFT) recently held a QI conference ( earlier this month, 7 October) it is now available as video. The recorded sessions include a talk from guest speaker Hugh McCaughey, NHS Director of Improvement and Medical Director Sarah Phillips

The day also included presentations on QI projects underway at KCHFT, presentations by improvement organisations KCHFT work closely with and workshops.

You can also watch the video on Vimeo

Can pizza lead to sustainable quality improvement in the NHS?

NHS Providers | September 2021 |  Can pizza lead to sustainable quality improvement in the NHS?

This blog post from Nicola Burgess highlights the principle of fostering informal talk as part of formal routines represents an effective mechanism for breaking down silos, sharing knowledge for collaborative improvement and fostering connectedness between those that steer the organisation at a strategic level, and those who lead the organisation at an operational level (and at the frontline of service delivery).

Can pizza lead to sustainable quality improvement in the NHS?

Different approaches to making and testing change in healthcare

Ogrinc G, Dolansky M, Berman A J, Chambers D A, Davies L. | 2021| Different approaches to making and testing change in healthcare | BMJ | 374| :n1010|  doi:10.1136/bmj.n1010

Improving the quality of healthcare is complex. It requires input not just from healthcare providers but also from patients and families to identify gaps, develop meaningful interventions, and ensure that interventions improve care and outcomes, and consider value from their perspective.1 Closing gaps in healthcare quality, improving workflows, and implementing evidence based interventions require change, but not all changes are successful, and most come with unintended consequences. In this analysis Greg Ogrinc and colleagues call for greater exploitation of the synergies between quality improvement and implementation science in improving care

Article available from the BMJ