Development of a tool for identifying and addressing prioritised determinants of quality improvement projects led by healthcare professionals: a mixed-methods study

Abstract Background: Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of non-prioritised determinants. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers for healthcare improvement projects led by healthcare professionals, supplemented with methods to identify and address each determinant. Methods: A mixed-methods study design was used to develop the tool. First, a cross-sectional study was performed, using an online survey to ask healthcare professionals about the determinants they experienced during the performance of their quality improvement project. A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts determined: 1) how healthcare professionals can be assisted to use our tool to analyse the determinants in their project and 2) how healthcare professionals can tackle the barriers or use the facilitators identified in their quality improvement project. Results: The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement projects. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the project was considered the biggest barrier. The interviews with 16 experts in implementation science led to various inputs for better identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the project at a manageable size, learning by doing and being able to influence determinants. Conclusions: This paper describes a tool for performing quality improvement projects in healthcare, with the barriers and facilitators that were considered most important by healthcare professionals. For each of these barriers and facilitators, suggestions on how to analyse and address the determinant are given. More research is needed to validate and develop the tool further.