The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews

Dionne S. Kringos, Rosa Sunol, Cordula Wagner, Russell Mannion, Philippe Michel, Niek S. Klazinga, Oliver Groene*, DUQuE Project Consortium

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

66 Citations (Scopus)

Abstract

Background: It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors. Methods: We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool. Results: We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n∈=∈12), quality improvement support and capacity (n∈=∈11), organization (n∈=∈9), micro-system (n∈=∈8), and external environment (n∈=∈4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences. Conclusions: Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

Original languageEnglish
Article number277
Pages (from-to)1-13
Number of pages13
JournalBMC Health Services Research
Volume15
Issue number1
DOIs
Publication statusPublished - 22 Jul 2015
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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