Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study
International Journal of Health Care Quality Assurance
ISSN: 0952-6862
Article publication date: 8 February 2016
Abstract
Purpose
The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.
Design/methodology/approach
Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.
Findings
Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.
Originality/value
This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.
Keywords
Acknowledgements
This study was completed by the QIC study team: Dr Praveen T. Rajasekhar, Professor Colin J. Rees, Dr James E. East, Professor Brian P. Saunders, Professor Matthew D. Rutter, Professor Michael G. Bramble, Professor Pali Hungin, Dr Siwan Thomas-Gibson, Sister Angela Hooker, Dr John Painter, Sister Donna Brand, Dr John R. Greenaway, Sister Susan McConnell, Dr Simon Panter, Sister Zoe Clapham, Dr Anjan Dhar, Sister Ann Hardy, Dr Deepak Kejariwal, Sister Kathleen Vallance, Dr Chris MacDonald, Sister Rosie Hinson, Dr Jayesh Vasani, Sister Angela Lee, Dr Matthew Warren, Sister Sandra Marshall, Ms Sarah Mills, Sister Maureen Carmichael, Sister Clare Westwood, Sister Josie Dent, Dr Jaime Barbour and Sister Susan Dreyer. The QIC study was developed through and supported by the British Society of Gastroenterology Endoscopy Research Committee.
Citation
Rajasekhar, P.T., Rees, C.J., Nixon, C., East, J.E. and Brown, S. (2016), "Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study", International Journal of Health Care Quality Assurance, Vol. 29 No. 1, pp. 5-15. https://doi.org/10.1108/IJHCQA-09-2014-0093
Publisher
:Emerald Group Publishing Limited
Copyright © 2016, Emerald Group Publishing Limited