An intraorganizational model for developing and spreading quality improvement innovations

Area of Science:

• Healthcare Management
• Organizational Behavior
• Primary Care Innovation

Background:

• Policy reforms promote quality improvement (QI) innovations in primary care.
• Practitioners need guidance on spreading QI innovations within healthcare organizations.

Purpose of the Study:

• To identify strategies for facilitating intraorganizational spread of QI innovations in large healthcare organizations.
• To develop a process model for effective internal dissemination of QI initiatives.

Main Methods:

• Ethnographic observation and interviews were conducted in a large medical group.
• A new method for intraorganizational process development and spread of three QI innovations was implemented across 10 primary care sites.
• Quantitative outcomes were compared between traditional and new methods, and a process model was created.

Main Results:

• The medical group successfully improved processes for rooming, depression screening, vaccine errors, and Pap smears using the new method.
• A nine-step model for QI process development and spread was detailed, emphasizing shared understanding and leveraging existing structures.
• Preexisting organizational elements like communication channels, roles, workflows, and performance feedback systems were crucial facilitators.

Conclusions:

• Intraorganizational spread of QI innovations is achievable and sustainable.
• A structured, nine-step approach is essential for developing and spreading QI processes across multiple sites.
• Leveraging existing organizational structures and addressing potential barriers are key to successful QI implementation.