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Readiness of General Hospitals That Participate in Pediatric Quality Improvement Initiatives
Jordan Vaughan1, Yeelen Edwards1, Jonathan Rodean2
1University of California, San Francisco, California.
Insights
General hospitals show high readiness for pediatric quality improvement (QI) initiatives, though challenges in feasibility and implementation exist. Assessments of organizational readiness to change can guide effective pediatric QI efforts in these settings.
Area of Science:
- Healthcare Management
- Pediatric Quality Improvement
- Implementation Science
Background:
- General hospitals serve most hospitalized children but face pediatric quality improvement (QI) challenges.
- Assessing organizational readiness to change and feasibility is crucial for effective QI.
- The SIP study aimed to improve care for hospitalized children with asthma, pneumonia, and bronchiolitis.
Purpose of the Study:
- To assess the readiness for implementing pediatric QI interventions in general hospitals.
- To evaluate the feasibility of evidence-based practices in pediatric care within general hospitals.
Main Methods:
- A mixed-methods approach using electronic surveys and qualitative interviews.
- Validated tools like the Organizational Readiness to Implement Change (ORIC) and Feasibility of Intervention Measure (FIM) were employed.
- Data analysis included descriptive statistics and thematic analysis of survey and interview data.
Main Results:
- 186 clinicians from 15 hospitals completed surveys; readiness scores (ORIC, FIM) were high but variable.
- Community hospitals with pediatric beds reported higher readiness than children's hospitals (median ORIC 4.4 vs 4.0, P=0.02).
- Anticipated feasibility challenges included aligning practices and securing IT support for EMR changes.
Conclusions:
- General hospitals exhibit high, yet variable, readiness for pediatric QI.
- Specific feasibility threats were identified, highlighting areas for targeted support.
- Readiness assessments can effectively inform and support pediatric QI initiatives in general hospital settings.
Background And Objective:
General hospitals care for more than 70% of hospitalized children nationally but face challenges in pediatric quality improvement (QI). Feasibility and organizational readiness to change assessments can help inform effective QI. Our objective was to assess readiness to implement pediatric QI interventions among a broad sample of general hospitals participating in the Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children (SIP) study.
Methods:
We conducted a mixed-methods study. Data were collected via electronic surveys and qualitative interviews. Participants included multidisciplinary inpatient pediatric clinicians and QI leaders. Surveys used validated tools, including the Organizational Readiness to Implement Change (ORIC) and Feasibility of Intervention Measure (FIM). Interview guides developed using an implementation framework explored feasibility of implementing evidence-based practices. We analyzed data using descriptive statistics and thematic analysis.
Results:
A total of 424 participants from 15 hospitals were approached, and 186 (44%) completed the survey. ORIC and FIM scores were scaled 1 to 5, with higher scores indicating agreement. Response results did not differ based on clinician type or experience. Clinicians at community hospitals with pediatric beds reported greater readiness than nested children's hospitals (median ORIC 4.4 vs 4.0, P = 0.02). Interviewees' (n = 21) anticipated feasibility challenges included aligning practices across hospital care settings and obtaining information technology support for electronic medical record changes.
Conclusions:
In this mixed-methods study, we found high but variable readiness for pediatric QI and identified specific threats to feasibility. We also illustrated how such assessments can be used to support pediatric QI efforts in general hospitals.
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