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Implementing quality improvement in vascular services: a qualitative study
Panagiota Birmpili1,2, Eleanor Atkins3,2, Jon R Boyle4
1Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK pbirmpili@rcseng.ac.uk.
Background:
The Peripheral Arterial Disease Quality Improvement Programme (PAD QIP) was a quality improvement (QI) collaborative between 11 English vascular surgery centres from May 2020 to May 2022, aiming to expedite treatment for PAD. This qualitative study explored beliefs about the PAD QIP and barriers and facilitators to implementation of changes in vascular surgery.
Methods:
Sixteen semi-structured interviews were conducted with clinicians from the vascular centres that participated in the PAD QIP and were analysed using framework analysis, based on the five broad domains within the Consolidated Framework for Implementation Research.
Results:
Five themes captured the main factors that affected the implementation of changes in the pathway of patients with chronic limb-threatening ischaemia: the programme, the benefit for patients, the role of the team, the resources and organisational processes, and the polarising effect of COVID-19. Regarding the programme, participants stated that the concrete timeframes, external performance monitoring, peer comparison and the programme's national reach helped them obtain resources to implement changes. Learning from and sharing experiences with others was also useful. Accurate performance data were considered essential for leveraging resources, but data entry was onerous and required dedicated staff. The view that the programme was beneficial for patients, the support of a team of healthcare professionals and organisational support in the form of resources were important requirements for implementation, while the COVID-19 pandemic also played a crucial role as a contextual factor beyond the control of the participants. The main factors that differed between high-implementation and low-implementation centres were team beliefs, team structure, team compatibility, networks/communication, resources, implementation climate, relative priority and evidence strength.
Conclusions:
This QI collaborative facilitated the implementation of changes according to participants, while team and organisational support was crucial.
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