Characteristics of Quality Improvement Projects in Health Services: A Systematic Scoping Review

Overview

Journal J Evid Based Med

Date 2025 Jan 22

PMID 39838939

Authors

Hanan Khalil

Caroline de Moel-Mandel

Deeksha Verma

Kathryn Kynoch

Ritin Fernandez

Mary-Anne Ramis

Jessica E Opie

Affiliations

Soon will be listed here.

Abstract

Objective: Current QI reports within the literature frequently fail to provide enough information regarding interventions, and a significant number of publications do not mention the utilization of a guiding model or framework. The objective of this scoping review was to synthesize the characteristics of hospital-based QI interventions and assess their alignment with recommended quality goals.

Methods: This scoping review followed the JBI methodology for scoping reviews to synthesize existing literature on hospital-based QI interventions and reporting using the PRISMA Extension for scoping reviews. Included studies involved a hospital-based QI intervention that was evaluated through the Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework, reporting on hospital users' (i.e., practitioners and patients) data. We searched Medline, CINAHL, Embase and PubMed databases for primary research published between 2015 and 2024. Grey literature was also examined. A narrative synthesis guided the integration of findings.

Results: From 1398 identified records, 70 relevant records were included. Results indicate a wide variation in QI frameworks and methods used by the included studies. The QI interventions most frequently assessed were organizational-focused (n = 59), followed by professional-related interventions (n = 41) and patient-care interventions (n = 24). There were multiple facilitators and barriers across organizational, professional, and patient care levels found in the included studies. Examples of facilitators were instrumental in driving successful QI initiatives included education, training, active leadership, and stakeholder engagement. Conversely, barriers such as time constraints, resource limitations, and resistance were highlighted.

Conclusion: Existing QI publications lack sufficient detail to replicate interventions. Using a model or framework to guide the conduct of a QI-activity may support a more robustly designed and well-conducted project. The variation of reporting characteristics suggests that future research should focus on the development of a pragmatic tool for use by front-line clinicians to support consistent and rigorous conduct of QI projects.

References

Engle R, Mohr D, Holmes S, Seibert M, Afable M, Leyson J . Evidence-based practice and patient-centered care: Doing both well. Health Care Manage Rev. 2019; 46(3):174-184. PMC: 8162222. DOI: 10.1097/HMR.0000000000000254. View

Reinhorn M, Dews T, Warren J . Utilization of a National Registry to influence opioid prescribing behavior after hernia repair. Hernia. 2021; 26(3):847-853. DOI: 10.1007/s10029-021-02495-5. View

Hines K, Mouchtouris N, Knightly J, Harrop J . A Brief History of Quality Improvement in Health Care and Spinal Surgery. Global Spine J. 2020; 10(1 Suppl):5S-9S. PMC: 6947686. DOI: 10.1177/2192568219853529. View

Flythe J, Tugman M, Narendra J, Dorough A, Hilbert J, Assimon M . Feasibility of Tablet-Based Patient-Reported Symptom Data Collection Among Hemodialysis Patients. Kidney Int Rep. 2020; 5(7):1026-1039. PMC: 7335968. DOI: 10.1016/j.ekir.2020.04.021. View

Rubenstein L, Khodyakov D, Hempel S, Danz M, Salem-Schatz S, Foy R . How can we recognize continuous quality improvement?. Int J Qual Health Care. 2013; 26(1):6-15. PMC: 3914565. DOI: 10.1093/intqhc/mzt085. View

Pooya S, Johnston K, Estakhri P, Fathi A . Successful Implementation of Enhanced Recovery After Surgery Program in a Safety-Net Hospital: Barriers and Facilitators. J Perianesth Nurs. 2021; 36(5):468-472. DOI: 10.1016/j.jopan.2020.12.011. View

Wollny K, Cui S, McNeil D, Benzies K, Parsons S, Sajobi T . Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review. Syst Rev. 2022; 11(1):259. PMC: 9717500. DOI: 10.1186/s13643-022-02119-8. View

Mulchan S, Hinderer K, Walsh J, McCool A, Becker J . Feasibility and use of a transition process planning and communication tool among multiple subspecialties within a pediatric health system. J Spec Pediatr Nurs. 2021; 27(1):e12355. DOI: 10.1111/jspn.12355. View

Eastin C, Moore B, Moulton A, Lefler L, Haydar F, Sweere M . Vaccine Acceptance During a Novel Student-led Emergency Department COVID-19 Vaccination Program. West J Emerg Med. 2023; 24(3):436-446. PMC: 10284509. DOI: 10.5811/westjem.58728. View

10.

Backhouse A, Ogunlayi F . Quality improvement into practice. BMJ. 2020; 368:m865. PMC: 7190269. DOI: 10.1136/bmj.m865. View

11.

Bindraban R, van Beneden M, Kramer M, van Solinge W, van de Ven P, Naaktgeboren C . Association of a Multifaceted Intervention With Ordering of Unnecessary Laboratory Tests Among Caregivers in Internal Medicine Departments. JAMA Netw Open. 2019; 2(7):e197577. PMC: 6659142. DOI: 10.1001/jamanetworkopen.2019.7577. View

12.

Spruce K, Butler C . Enhancing Outcomes for Outpatient Percutaneous Coronary Interventions. Clin Nurse Spec. 2017; 31(6):319-328. PMC: 5647110. DOI: 10.1097/NUR.0000000000000334. View

13.

Coles E, Anderson J, Maxwell M, Harris F, M Gray N, Milner G . The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev. 2020; 9(1):94. PMC: 7184709. DOI: 10.1186/s13643-020-01344-3. View

14.

Mueller S, Murray M, Schnipper J, Goralnick E . An initiative to improve advanced notification of inter-hospital transfers. Healthc (Amst). 2020; 8(2):100423. PMC: 11094626. DOI: 10.1016/j.hjdsi.2020.100423. View

15.

Peters M, Marnie C, Tricco A, Pollock D, Munn Z, Alexander L . Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10):2119-2126. DOI: 10.11124/JBIES-20-00167. View

16.

Ahmed S, Zidarov D, Eilayyan O, Visca R . Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network. Qual Life Res. 2020; 30(11):3035-3047. PMC: 8528775. DOI: 10.1007/s11136-020-02600-8. View

17.

Zhang Q, Yu Z, Qi B, Ni X, Moola S . Nutritional screening and nutritional interventions in patients following gastrointestinal surgery in a general surgical ward: a best practice implementation project. JBI Evid Implement. 2021; 19(4):347-356. DOI: 10.1097/XEB.0000000000000270. View

18.

Raynor T, Marcet-Gonzalez J, Roy K, Mahoney D, Murrell D, Hyle L . Development and implementation of a pre-tracheostomy multidisciplinary conference: An initiative to improve patient selection. Int J Pediatr Otorhinolaryngol. 2022; 158:111135. DOI: 10.1016/j.ijporl.2022.111135. View

19.

Kellogg K, Hettinger Z, Shah M, Wears R, Sellers C, Squires M . Our current approach to root cause analysis: is it contributing to our failure to improve patient safety?. BMJ Qual Saf. 2016; 26(5):381-387. DOI: 10.1136/bmjqs-2016-005991. View

20.

Rutledge R, Romaire M, Hersey C, Parish W, Kissam S, Lloyd J . Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts. Milbank Q. 2019; 97(2):583-619. PMC: 6554509. DOI: 10.1111/1468-0009.12386. View