Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that...

Area of Science:

• Operational Research
• Health Services Research
• Systems Thinking

Background:

• Improving care integration across healthcare sectors is crucial, especially with limited resources.
• Existing methods often lack the ability to target interventions based on patient risk.
• Congenital heart disease (CHD) care pathways involve multiple sectors, highlighting the need for integrated approaches.

Purpose of the Study:

• To combine qualitative and quantitative operational research methods.
• To augment and inform an improvement initiative for infants with CHD.
• To address complex care pathways spanning multiple healthcare sectors.

Main Methods:

• Soft systems methodology (SSM) was used to systematically analyze service changes from diverse professional and patient perspectives.
• Classification and regression tree (CART) analysis of national audit data was performed.
• Data visualization techniques were employed to inform resource-constrained service improvement.

Main Results:

• A 'Rich Picture' was developed, detailing key service features for infants with CHD.
• CART analysis guided discussions on targeting interventions for specific patient risk groups.
• Consensus was reached on targeted quality improvement recommendations, influencing national service decisions.

Conclusions:

• Addressing complex, multi-sector service provision requires acknowledging and integrating multiple perspectives.
• Targeting service improvements based on patient risk is essential, particularly with limited resources.
• A combined qualitative and quantitative operational research approach offers a valuable strategy for service improvement.