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HealthMarch 29, 2021

Strategies for developing successful healthcare quality improvement initiatives

By: Sarah Handzel, BSN, RN
New quality improvement (QI) initiatives roll out each year at hundreds of healthcare facilities across the country, but many of these programs are not successful and don’t help organizations provide better patient care.

In many cases, these programs involve top-down processes emphasizing education about needed change and forced adherence with new processes and procedures. But the failure to achieve sustainable outcomes often undermines the time and effort the organization puts into such programs.

An article in the February 2021 edition of Nursing Management1 explores this issue, highlighting the reasons why QI initiatives usually are not successful and providing strategies to help nurse leaders achieve QI goals.

Why QI initiatives fail in healthcare organizations

Creating and sustaining meaningful change within a healthcare organization requires the use of a complex set of skills. The process is often a great deal more challenging than initially thought. In many cases, traditional educational approaches aren’t sufficient for educating staff members on seemingly simple changes.

Additionally, change itself may be exceedingly difficult for an organization and the people employed there. QI initiatives often fail because leadership cannot accurately identify what problem needs to change, instead jumping to immediate fixes that don’t truly address the underlying issue. Lack of knowledge and skill among frontline healthcare workers may also influence the success of QI initiatives. Successful programs require advanced skills in navigating various levels of the organization, and many nursing staff members have not been adequately prepared to do so.

Failure to allow enough time for a QI process to work usually results in project failure. Successful changes require time to think and plan, and, in many cases, the planning phase of the project is rushed. But there should also be enough time to implement, evaluate, and rework any parts of the QI initiative which don’t help the organization meet its goals. Providing this time to nurses can be especially challenging.

The role of nurses in successful QI initiatives

Clinical nurses are often the first to identify important challenges and barriers to care at the bedside, and they implement most QI initiatives. However, they aren’t usually involved in problem identification and solution planning, even though they have a unique perspective on potential solutions. Clinical nurses should be included in all aspects of the QI initiative so that the project can benefit from their perspective, experience, and expertise.

Bidirectional leadership is also crucial to successful QI programs. By working together, staff nurses and organizational leaders facilitate a commitment to sustainability, and staff engagement and empowerment. Once any QI initiative is implemented, focus must shift to sustaining the program to achieve its goals. Creating a plan for sustaining change is vital to the process, and QI initiatives are more successful if there are strategies for sustaining change in place at the beginning of the process.

When nurses and other organizational leaders practice key success strategies, meaningful QI outcomes can be achieved, adapted, sustained, and spread to other areas of the organization. Leaders should consider working with a clinical nurse specialist who can help evaluate current practices and any evidence-based reasons for change.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. O’Donoghue, Sharon C. DNP, RN, et al. “Leading Sustainable Quality Improvement.” NursingCenter, Feb. 2021,
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