Implementing quality improvement through knowledge brokering: a Dutch case study

Managerial quality improvement (QI) in terms of accountability management has become central to healthcare institutions. Yet, managerial QI is largely considered irrelevant by healthcare professionals. In consequence, the implementation of managerial QI implementation is hampered. Knowledge brokering is discussed as a means to foster the implementation of (QI) knowledge in healthcare. Yet, the benefit of knowledge brokering for managerial QI has so far been neglected. Therefore, this research asks how knowledge brokering can support the implementation of managerial QI.

This article builds on a single case study approach as a unit of analysis. Qualitative data collection comprises 21 semi-structured interviews at the managerial and clinical levels, 220 h of participant observation and document analysis.

This paper identifies three strategies of how brokers implement managerial QI into a hospital by means of knowledge brokering: prioritizing, obscuring and redefining. The strategies help to transform multiple external QI demands into one managerial QI strategy. Yet the strategies also reduce non-managerial perspectives on QI, which generates frustration among healthcare professionals.

The paper works out the benefits and costs of managerial knowledge brokering. This allows to spell out practical implications for managers, nurses and clinicians who have to deal with managerial QI in healthcare organizations.

This paper fulfils an identified need to study managerial knowledge brokering practices as a means to implement managerial QI into healthcare organizations. By doing that, the article adds to the body of research on knowledge translation in healthcare.