Factors influencing change in clinical practice: a qualitative evaluation of the implementation of the quality improvement in colonoscopy study.

Rajasekhar, Praveen T; Rees, Colin J; Nixon, Catherine; East, James E; Brown, Sally

Abstract

Purpose

The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.

Design/methodology/approach

Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.

Findings

Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.

Originality/value

This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.

Citation

Rajasekhar, P. T., Rees, C. J., Nixon, C., East, J. E., & Brown, S. (2016). Factors influencing change in clinical practice: a qualitative evaluation of the implementation of the quality improvement in colonoscopy study. International Journal of Health Care Quality Assurance, 29(1), 5-15. https://doi.org/10.1108/IJHCQA-09-2014-0093

• Journal Article Type: Article
• Publication Date: Feb 8, 2016
• Deposit Date: Mar 21, 2016
• Print ISSN: 0952-6862
• Publisher: Emerald
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 1
• Pages: 5-15
• DOI: https://doi.org/10.1108/IJHCQA-09-2014-0093
• Keywords: Evaluation; Implementation; Quality improvement; Service improvement; Adenoma detection rate; Qualitative interview study
• Public URL: http://researchrepository.napier.ac.uk/id/eprint/9695