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Barriers and facilitators of Canadian quality and safety teams: a mixed-methods study exploring the views of health care leaders

Authors White DE, Norris JM, Jackson K, Khandwala F

Received 5 July 2016

Accepted for publication 19 September 2016

Published 12 December 2016 Volume 2016:8 Pages 127—137

DOI https://doi.org/10.2147/JHL.S116477

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Professor Russell Taichman


Deborah E White,1 Jill M Norris,1 Karen Jackson,2 Farah Khandwala3

1Faculty of Nursing, University of Calgary, 2Workforce Research and Evaluation, Alberta Health Services, 3Cancer Care Services, Alberta Health Services, Calgary, AB, Canada


Background: Health care organizations are utilizing quality and safety (QS) teams as a mechanism to optimize care. However, there is a lack of evidence-informed best practices for creating and sustaining successful QS teams. This study aimed to understand what health care leaders viewed as barriers and facilitators to establishing/implementing and measuring the impact of Canadian acute care QS teams.
Methods: Organizational senior leaders (SLs) and QS team leaders (TLs) participated. A mixed-methods sequential explanatory design included surveys (n=249) and interviews (n=89). Chi-squared and Fisher’s exact tests were used to compare categorical variables for region, organization size, and leader position. Interviews were digitally recorded and transcribed for constant comparison analysis.
Results: Five qualitative themes overlapped with quantitative data: (1) resources, time, and capacity; (2) data availability and information technology; (3) leadership; (4) organizational plan and culture; and (5) team composition and processes. Leaders from larger organizations more often reported that clear objectives and physician champions facilitated QS teams (p<0.01). Fewer Eastern respondents viewed board/senior leadership as a facilitator (p<0.001), and fewer Ontario respondents viewed geography as a barrier to measurement (p<0.001). TLs and SLs differed on several factors, including time to meet with the team, data availability, leadership, and culture.
Conclusion: QS teams need strong, committed leaders who align initiatives to strategic directions of the organization, foster a quality culture, and provide tools teams require for their work. There are excellent opportunities to create synergy across the country to address each organization’s quality agenda.

Keywords: health services research, qualitative research, surveys, leadership, quality of health care

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