Determinants of sustained physician engagement in obstetric QI: a TICD-guided qualitative study

Maternal health disparities persist despite advances in obstetric care and disproportionately affect historically marginalized populations. Quality Improvement (QI) initiatives, including those led by national and state perinatal quality collaboratives, aim to address these disparities; however, sustaining physician engagement in such initiatives remains challenging. This study applies the Tailored Implementation for Chronic Diseases (TICD) framework to identify key determinants influencing physician participation in QI initiatives within obstetric care.

A qualitative study was conducted using semi-structured interviews with 24 obstetricians and gynecologists actively engaged in maternal health QI programs across diverse healthcare settings. Participants were selected based on their involvement in QI initiatives. Data were collected between November 2021 and August 2022. Thematic analysis, guided by the TICD framework, categorized facilitators and barriers to engagement, focusing on leadership support, multidisciplinary collaboration, resource availability, and physician motivation. All participants were already engaged in QI; therefore, the study examines determinants of sustained engagement among participating physicians rather than initial participation.

Participants described participatory leadership, interdisciplinary collaboration, and patient-centered motivation as key drivers of sustained QI engagement. Supportive organizational culture and clear role expectations facilitated collaboration and resource allocation. While career advancement and financial incentives were relevant, commitment to improving maternal outcomes was the predominant motivator. Reported barriers included limited time, administrative burden, misalignment between QI priorities and clinical workflows, and insufficient training in QI methods. Physicians emphasized the value of longitudinal QI education and flexible, evidence-based guidelines adaptable to local context and patient populations.

Findings suggest that sustaining physician involvement in QI may be facilitated by participatory leadership, institutional investment (including protected time), and alignment with physician values and patient-centered priorities. Balancing standardization with adaptability and embedding longitudinal QI education were viewed as important for reducing maternal health disparities and improving implementation.