Understanding Why Quality Initiatives Succeed or Fail: A Sociotechnical Systems Perspective

Efforts to implement quality improvements in surgery are notoriously problematic. One needs to look no farther than recent attempts to implement checklists, team training, and surgical briefings. These interventions have been empirically shown to improve team communication and performance. Yet numerous barriers to implementation have limited their broad adoption and use. Apparently, knowing the remedy (intervention) does not translate into knowing how to administer (implement) it. Or in surgical terms, knowing "what" procedure needs to be performed does not necessarily mean that one knows "how" to perform it. Surgeons serve a vital leadership role in driving quality and patient safety initiatives in the operating room. Achieving success requires both an in-depth understanding of the intervention and the complex dynamics of the elements involved in the implementation process. To aid in this endeavor, the present article describes a Model for Understanding System Transitions Associated with the Implementation of New Goals (MUSTAING). The model highlights important variables associated with implementation success. It also provides a tool for diagnosing why certain interventions may not have worked as intended so that improvements in the implementation process can be made. Finally, the model offers a general framework for guiding future implementation or "how to" research.