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Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study

Brooks, Joanna Veazey PhD, MBE; Gorbenko, Ksenia PhD; Bosk, Charles PhD

Quality Management in Healthcare: April/June 2017 - Volume 26 - Issue 2 - p 55–62
doi: 10.1097/QMH.0000000000000128
Health Care Providers and Quality Improvement

Background: Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project.

Methods: Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis.

Results: We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project.

Conclusions: Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work.

Implications: Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City (Dr Brooks); Department of Population Health Science and Policy, Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York (Dr Gorbenko); and Department of Sociology, Department of Anesthesia and Critical Care, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Dr Bosk).

Correspondence: Joanna Veazey Brooks, PhD, MBE, Department of Health Policy and Management, University of Kansas School of Medicine, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66160 (

This research was funded by the Agency for Healthcare Research and Quality (HHSA2902010000271). The authors thank Catherine van de Ruit for assistance with data collection, their colleagues at the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, and undergraduate research assistants at the University of Pennsylvania. The authors are also thankful to the participating hospitals and each of their interviewees who graciously shared their experiences with them.

We declare no conflicts of interest and we submitted our project to the appropriate institutional review board.

© 2017Wolters Kluwer Health | Lippincott Williams & Wilkins