Contextual factors and competencies influencing quality improvement: perspectives from nurses and nurse managers

This paper explores nurses' and nurse managers' perceptions of crucial contextual factors and competencies that facilitate or hinder quality improvement projects in acute hospital settings.

A descriptive qualitative method was employed, utilising three focus groups and two semi-structured interviews with 22 nurses and nurse managers from two Belgian hospitals. Data were analysed using inductive thematic analysis.

Five domains emerged: motivation and trigger, continuous improvement, team factors and dynamics, organisational factors and stakeholders. Participants indicated that motivation is strongly enhanced when the trigger for quality improvement originates within the team. At the team level, nurse managers should be present and provide support, while nurses, as clinical leaders, need to influence peers and offer feedback. Organisational support and adequate resources are essential for successful quality improvement efforts.

Our findings enrich existing frameworks by highlighting how leadership at all levels, team-driven motivation and organisational support foster a conducive environment for quality improvement in nursing teams. This study also informs future research exploring the interplay of these factors using diverse methodologies.

Hospitals and healthcare teams should incorporate these factors into quality improvement strategies to enhance the effectiveness of these initiatives and their outcomes.

While prior research predominantly focuses on organizational-level factors, this study offers novel insights into how contextual factors and competencies across various levels support quality improvement, with a particular emphasis on nursing teams. Our study fills a gap in the literature by exploring the nursing perspective on these factors.