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Effectiveness of quality improvement collaboratives in UK surgical settings and barriers and facilitators influencing their implementation: a systematic review and evidence synthesis.

Published version
Peer-reviewed

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Authors

Atkins, Eleanor 
Birmpili, Panagiota  ORCID logo  https://orcid.org/0000-0002-0108-1733
Glidewell, Liz 
Li, Qiuju 
Johal, Amundeep S 

Abstract

BACKGROUND: High-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear. This review assessed effectiveness of QICs in National Health Service (NHS) surgical settings, and identified factors that influenced implementation. METHODS: A systematic search of MEDLINE and EMBASE, as well as grey literature, was conducted in January 2022 to identify evaluations of QICs in NHS surgical settings. Data were extracted on the intervention, setting, study results and factors that were identified as facilitators or barriers. These were coded using the Consolidated Framework for Implementation Research (CFIR). The quality of study reports was assessed using Quality Improvement Minimum Criteria Set. RESULTS: Fifteen reports on 10 QICs met inclusion criteria. The evaluations used study designs of different strength, with one using a stepped-wedge randomised controlled trial (RCT). Eight studies reported the QIC had been successful in achieving their principal aims, which covered a mix of patient outcomes and process indicators. The study based on the RCT found the QIC was not successful (no improvement in patient outcomes). Each article reported a range of facilitators and barriers to effectiveness of implementation of the QIC, which were spread across the CFIR domains (intervention, outer setting, inner setting, individuals and process). There were few barriers reported in the intervention domain that related to the QIC. There was no clear relationship between numbers of facilitators and barriers reported and effectiveness. CONCLUSIONS: Studies have reported QICs to be effective in increasingly complex contexts, but their results must be treated with caution. The evaluations often used weak study designs and the quality of reports was variable. Evaluation with strong study design should be integral to future QICs. PROSPERO REGISTRATION NUMBER: CRD42022324970.

Description

Peer reviewed: True


Acknowledgements: The authors would like to thank Sarah Frankham and Camila Garces-Bovett for their assistance in developing the search strategy for this systematic review.

Keywords

Implementation science, Quality improvement, Surgery, Humans, Quality Improvement, Quality of Health Care, Delivery of Health Care, United Kingdom, Randomized Controlled Trials as Topic

Journal Title

BMJ Open Qual

Conference Name

Journal ISSN

2399-6641
2399-6641

Volume Title

Publisher

BMJ
Sponsorship
Circulation Foundation (N/A)
Royal College of Surgeons of England (N/A)