Developing programme theories as part of a realist evaluation of a healthcare quality improvement programme

The application of realist approaches to health services research and evaluation has continued to grow over the past two decades. However, difficulties in defining and operationalising key realist concepts of contexts, mechanisms and outcomes in healthcare settings continue to be recognised within the realist evaluation literature. Reflecting on an ongoing realist evaluation of a healthcare quality improvement programme across an inter-organisational context, this article explores some of the methodological challenges encountered by the author in the early stages of programme theory development. An individualised operationalisation and application of realist concepts are presented to demonstrate how initial programme theories can be developed despite the methodological difficulties presented.

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Healthcare quality improvement programme improves monitoring of people with diabetes*1

Evidence-based Healthcare ◽

10.1016/s1462-9410(04)00040-3 ◽

2004 ◽

Vol 8 (3) ◽

pp. 122-124

Author(s):

P DENIG

Keyword(s):

Quality Improvement ◽

Healthcare Quality ◽

Healthcare Quality Improvement ◽

Quality Improvement Programme ◽

Improvement Programme

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Healthcare quality improvement programme improves monitoring of people with diabetes

Evidence-based Healthcare ◽

10.1016/j.ehbc.2004.03.005 ◽

2004 ◽

Vol 8 (3) ◽

pp. 122-124

Author(s):

Petra Denig

Keyword(s):

Quality Improvement ◽

Healthcare Quality ◽

Healthcare Quality Improvement ◽

Quality Improvement Programme ◽

Improvement Programme

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Don't Mourn: Organize. Reviving Mental Health Services Research for Healthcare Quality Improvement

Clinical Psychology Science and Practice ◽

10.1111/cpsp.12028 ◽

2013 ◽

Vol 20 (1) ◽

pp. 120-126 ◽

Cited By ~ 3

Author(s):

Kimberly E. Hoagwood

Keyword(s):

Mental Health ◽

Quality Improvement ◽

Mental Health Services ◽

Health Services Research ◽

Health Services ◽

Healthcare Quality ◽

Services Research ◽

Healthcare Quality Improvement ◽

Mental Health Services Research

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Qualitative process evaluation of the Perioperative Quality Improvement Programme (PQIP): study protocol

BMJ Open ◽

10.1136/bmjopen-2019-030214 ◽

2019 ◽

Vol 9 (7) ◽

pp. e030214 ◽

Cited By ~ 1

Author(s):

Duncan Wagstaff ◽

S Ramani Moonesinghe ◽

Naomi J Fulop ◽

Cecilia Vindrola-Padros

Keyword(s):

Quality Improvement ◽

Process Evaluation ◽

Elective Surgery ◽

Project Team ◽

Structured Interviews ◽

Framework Analysis ◽

Programme Theory ◽

Hospital Size ◽

Quality Improvement Programme ◽

Improvement Programme

IntroductionThe Perioperative Quality Improvement Programme (PQIP) is designed to measure complications after major elective surgery and improve these through feedback of data to clinicians. Previous research suggests that despite the significant resources which go into collecting data for national clinical audits, the information they contain is not always used effectively to improve local services.Methods and analysisWe will conduct a formative process evaluation of PQIP comprising a multisited qualitative study to analyse PQIP’s programme theory, barriers, facilitators and wider contextual factors that influence implementation. The research will be carried out with the PQIP project team and six National Health Service (NHS) Trusts in England, selected according to geographical location, type of hospital, size and level of engagement with PQIP. We will include one Trust which has not expressed interest in the PQIP for comparison and to explore the role of secular trend in any changes in practice. We will use semi-structured interviews (up to 144 in Trusts and 12 with the project team), non-participant observations (up to 150 hours) and documentary analysis. We will track the lifecycle of perioperative data, exploring the transformations it undergoes from creation to use. We will use framework analysis with categories both from our research questions and from themes emerging from the data.Ethics and disseminationEthical approval has been granted from the University College London Research Ethics Committee (ref 10375/001). Permissions to conduct research at NHS Trusts have been granted by local Research and Development offices in coordination with the Health Research Authority. We will follow guidelines for data security, confidentiality and information governance. Findings will be shared at regular time points with the PQIP project team to inform the implementation of the programme, and with participating NHS Trusts to help them reflect on how they currently use data for improvement of perioperative services.

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Using virtual worlds as a platform for collaborative meetings in healthcare: a feasibility study

BMC Health Services Research ◽

10.1186/s12913-020-05290-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Michael J. Taylor ◽

Chiya Shikaislami ◽

Chris McNicholas ◽

David Taylor ◽

Julie Reed ◽

...

Keyword(s):

Quality Improvement ◽

Virtual Environment ◽

Virtual Worlds ◽

Virtual World ◽

Healthcare Quality ◽

Healthcare Quality Improvement ◽

Face To Face ◽

Collaborative Task ◽

Healthcare Settings

Abstract Background Healthcare teams often consist of geographically dispersed members. Virtual worlds can support immersive, high-quality, multimedia interaction between remote individuals; this study investigated use of virtual worlds to support remote healthcare quality improvement team meetings. Methods Twenty individuals (12 female, aged 25–67 [M = 42.3, SD = 11.8]) from 6 healthcare quality improvement teams conducted collaborative tasks in virtual world or face-to-face settings. Quality of collaborative task performances were measured and questionnaires and interviews were used to record participants’ experiences of conducting the tasks and using the virtual world software. Results Quality of collaborative task outcomes was high in both face-to-face and virtual world settings. Participant interviews elicited advantages for using virtual worlds in healthcare settings, including the ability of the virtual environment to support tools that cannot be represented in equivalent face-to-face meetings, and the potential for virtual world settings to cause improvements in group-dynamics. Reported disadvantages for future virtual world use in healthcare included the difficulty that people with weaker computer skills may experience with using the software. Participants tended to feel absorbed in the collaborative task they conducted within the virtual world, but did not experience the virtual environment as being ‘real’. Conclusions Virtual worlds can provide an effective platform for collaborative meetings in healthcare quality improvement, but provision of support to those with weaker computer skills should be ensured, as should the technical reliability of the virtual world being used. Future research could investigate use of virtual worlds in other healthcare settings.

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The use of process mapping in healthcare quality improvement projects

Health Services Management Research ◽

10.1177/0951484818770411 ◽

2018 ◽

Vol 31 (2) ◽

pp. 74-84 ◽

Cited By ~ 16

Author(s):

Grazia Antonacci ◽

Julie E Reed ◽

Laura Lennox ◽

James Barlow

Keyword(s):

Quality Improvement ◽

Success Factors ◽

Healthcare Quality ◽

Process Mapping ◽

Healthcare Quality Improvement ◽

Healthcare Settings ◽

Multiple Data ◽

Five Factors ◽

Improvement Interventions ◽

Service Data

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK’s National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants’ experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator’s experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

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