Barriers and facilitators to disseminating quality improvement and patient safety research: a scoping review

Despite an abundance of quality improvement (QI) and patient safety (PS) research and on-the-ground initiatives, patients continue to suffer from iatrogenic harm. Addressing shortcomings in the dissemination of QI and PS research is one important step to improving patient care outcomes. The objective of this scoping review is to identify the barriers and facilitators, and related strategies/targets, to disseminating QI/PS research.

The current review was conducted according to the JBI methodology for scoping reviews and PRISMA (preferred reporting items for systematic reviews and meta-analyses) extension for scoping reviews. A protocol was registered on the Open Science Framework website (doi: 10.17605/OSF.IO/RT57F). Databases searched included Medline, CINAHL, and Embase. Studies detailing barriers and facilitators, or solutions, to QI/PS research published between 2001 and March 2024 were included. Data on barriers and facilitators were coded deductively according to the theoretical domains framework (TDF).

Searches identified 5848 articles, of which 16 articles were included. Among studies seeking to understand (68.8%) barriers and facilitators to QI/PS dissemination, the TDF domain, environmental context and resources (ECR), was cited most frequently (68.8% of studies; e.g. availability of Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines), followed by skills (43.8%; e.g. poor reporting of QI/PS work), belief about consequences (37.5%; e.g. clearly highlighting the potential outcomes of dissemination) and goals (31.3%; e.g. early planning for dissemination). Studies seeking to address factors influencing dissemination (31.3% of studies) applied structured mentorship and curricular interventions to improve QI/PS dissemination, and suggested/enacted strategies were most commonly related to the individual's ECR (25%; e.g. provision of a writing coach), behavioural regulation (25%; e.g. improved rates of publication), and knowledge (25%; e.g. workshop introducing QI tools).

Organizational commitment and resourcing, access to QI/PS tools, programmes and reporting guidelines, and dedicated time, funding and resources are needed, alongside training programmes that target QI/PS knowledge and skills, and promotional pathways that nurture QI/PS activity. Research is required to cultivate effective QI/PS training programmes for qualified healthcare professionals, examine the identified factors in PS research specifically, and develop a consensus QI taxonomy to support the dissemination of QI research.