A tri-theory-driven approach to engaging team members in quality improvement

Conventional quality improvement methodologies are often deployed in silos using a narrow, predefined scope, bypassing opportunities to leverage frontline team member input and expertise. Existing frameworks acknowledge the importance of interprofessional team engagement but often overemphasize quantitative improvements while underappreciating their employees' emotional distress attributable to working in dysfunctional systems. Insufficient attention to frontline insights and employee emotional states can result in marginal improvement outcomes with limited sustainability.

We describe three leading theories of quality improvement, namely, participatory management theory, systems theory, and peer support principles, and discuss their individual limitations as a way to motivate an integrative approach to include frontline health care workers in problem solving and process improvement. We demonstrate how these theories may be combined into a tri-theory methodology to promote sustainable change initiatives that are selected and implemented by these workers.

Using a real-world application of the tri-theory methodology in an academic medical center, the interprofessional team was able to successfully implement accountable care teams within the organization.

Integrating systems and participatory management theories with peer support principles provides an empowering approach for creating conditions that mitigate burnout, nurture trusting relationships, and enable the team's emotional stress to be leveraged in identifying the critical improvement areas.