From: The influence of contextual factors on healthcare quality improvement initiatives: a realist review
Domain | How? | Why? | When? | For whom? |
---|---|---|---|---|
Leadership | Leaders enthusiastic about change had a motivational effect on staff, and the involvement of leaders or executive sponsors lead to a more positive experience of improvement. | Encouraging leadership leads to shared responsibility and increased accountability—promoting progress and staff empowerment. | To support motivational efforts and address operational and organisational barriers. | Professional groups and frontline staff. |
Organisational characteristics | Empowers individuals/teams to achieve change. Formal structures (data, training) influence how an organisation delivers improvement initiatives. | The QI infrastructure reflects an organisation’s ability to intentionally, and systematically use improvement approaches to change processes and improve outcomes. It demonstrates an organisation’s readiness for change. | Planning and pre-implementation phases—prior to the adoption or spread of an improvement initiative. | Individuals and frontline teams. |
Change agents | Drive initiatives, enable others and/or hold teams accountable for implementation. | Facilitate engagement with stakeholders, and help teams identify problems, develop solutions and understand the use QI methodologies. | All stages in the improvement journey. | A wide range of staff, including individuals and frontline teams. |
Multi-disciplinary collaboration | Fosters team ownership and shared goals across the organisational system levels. | Flattens hierarchies and aligns the interests of multiple stakeholders. | All stages in the improvement journey. | Actors at various organisational and system levels. |