In today's healthcare environment, hospitals face mounting pressure to improve quality, safety, and efficiency. While many professional guidelines provide evidence-based recommendations for improving care, there has been less attention to documenting the strategies that enable hospitals to successfully implement these quality initiatives.
Increasingly, healthcare organizations have realized that knowing what to do to improve care is just part of the equation in improving outcomes. New knowledge must to transformed into information that clinicians can and will use. Metrics must be identified and tracked to see that changes are implemented and, if not, where unexpected or unaddressed issues may have derailed or delayed acceptance.
Why do we need evidence-based strategies to help with quality improvement? Because more than half of quality improvement initiatives fail.1 That means hospitals know what to do to improve safety, outcomes or quality of care and agree to take the recommended steps, but do not or cannot actually make the changes needed for the initiative to become integrated into practice.
Two recent studies across five countries provide evidence-based guidance on how healthcare organizations can raise the rate of successfully implemented quality programs. Both focus on the role of leadership support and the commitment required at all levels to make significant organizational change. Underlying their research is the recognition that many current initiatives such as reducing readmissions, improving antimicrobial stewardship or reducing healthcare-acquired infections do require significant changes in traditional roles, workflows and communication.
In a study of 120 U.S. health centers, researchers used a mix of surveys and interviews to assess how top managers' support influences middle managers' commitment to initiatives. They found that top managers can facilitate implementation by directly conveying to middle manager that the initiative is an organizational priority as well as by allocating funding, training, human resources and performance reviews in support of the initiative. Top managers can also support quality programs by convincing middle managers that implementation of the innovation is possible with the resources that have been allocated.
For their part, middle managers can improve outcomes by communicating with senior managers about the specific support they need. Such assistance could, for instance, include asking a medical director to directly encourage resistant providers to make changes necessary for the initiative to succeed.
A four-country European study also found that the relationships between key staff has a significant impact on the ability of organizations to implement quality initiatives.2 The researchers found that managerial leaders and clinical leaders charged with implementing an initiative need to engage with each other to generate commitment, negotiate conditions and maintain forward momentum. Failure to do so, they noted, could slow down or disrupt the process.
They noted that "relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change." For those charged with implementing quality improvement programs, the importance of leadership support cannot be overstated. The insights provided by these two recent studies may help hospital administrators and the clinical leaders responsible for implement initiatives to better understand exactly what kind of support is needed and how to better structure communication to ensure it is provided.
How has the leadership team at your hospital demonstrated support for key quality initiatives?
- Birken SA, Lee SYD, Weiner BJ, Chin MH, Chiu M, Schaefer CT. From Strategy to Action: How Top Managers' Support Increases Middle Managers' Commitment to Innovation Implementation in Healthcare Organizations. Health Care Manage Rev. 2015 April-June;40(2):159-168.
- Zijpp TJ, Niessen T, Eldh AC, Hawkes C, Mockford C, Wallin L, McCormack B, Rycroft-Malone J, Seers K. A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence. WVN 2016;00:1-11.