The importance of contextual factors in influencing quality improvement and implementation (QI&I) initiatives is broadly acknowledged. Existing treatments of context have primarily viewed it as static and distinct from interventions themselves. The objective of this study was to advance understanding of the complex and dynamic interaction between context, intervention, and implementation strategies. Using the Model for Understanding Success in Quality (MUSIQ), we aimed to better understand the roles of, and inter-relationships between, contextual factors within QI&I initiatives.
Secondary analysis was performed on qualitative data collected as part of two studies: (1) an evaluation of a state-wide obstetrical quality improvement (QI) initiative, and (2) a study of the use of Plan-Do-Study-Act cycle method in QI projects. Electronic coding databases from each study were reviewed jointly. Data analysis was initiated deductively using MUSIQ as a template. Codes were added in an inductive manner.
All original factors in MUSIQ were observed to be important in the QI initiatives studied and new factors were identified. Three distinct types of context were identified; the setting(s) of care in which QI&I takes place (Type 1); the context of the team conducting a specific project (Type 2); and the wider context supporting general QI&I (Type 3). The picture of context emerging from this study is a dynamic one with multiple, closely-linked factors operating at different levels in a system that is constantly changing in response to QI&I initiatives. To capture this complexity, a revised model (MUSIQ v2.0) was created positioning use of structured QI&I approaches as the focal point and demonstrating how context influenced effective use of these approaches, and in turn, how these approaches supported teams in navigating context by adapting interventions to fit local settings.
MUSIQ is a useful tool to explore the roles of, and inter-relationships between, contextual factors within QI&I initiatives. The revised model may help address some existing controversies about how context influences QI&I success and help ensure that future research efforts consider context not as static background, but as a complex system that is constantly changing, tightly-linked, and governed by feedback loops.
Julie E. Reed, Heather C. Kaplan†, Sharif A. Ismail. BMC Health Services Research201818:584 https://doi.org/10.1186/s12913-018-3348-7
You might also like...
Change in a system as complex as health and care is hard. We'll share fresh insights on this challenge at our annual event.
Darshal Patel reflects on the lessons that behavioural insights offer to health care improvement.
The Health Foundation selects three research projects for programme exploring the use of behavioural insights in health care
The programme supports research that designs, tests and evaluates behavioural interventions that can improve efficiency and r...
Health Foundation @HealthFdn
Data analytics enables new information flows to and from patients and the public. This helps people make better-in… https://t.co/8dO4tZsA6DFollow us on Twitter
Work with us
We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.View current vacancies
The Q Community
Q is an initiative connecting people with improvement expertise across the UK.Find out more