An exploratory analysis of the Model for Understanding Success in Quality
An exploratory analysis of the Model for Understanding Success in Quality
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DOI：
10.1097/hmr.0b013e3182689772
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发表时间：
2013-10-01
影响因子：
2.5
通讯作者：
Margolis, Peter A.
中科院分区：
文献类型：
--
作者：
Kaplan, Heather C.;Froehle, Craig M.;Margolis, Peter A.
背景：经验表明，环境的差异会导致质量改进（QI）干预措施的有效性发生变化。然而，对于哪些环境因素会影响成功，以及它们如何发挥影响，人们知之甚少。目的：使用理解质量成功模型（MUSIQ），我们对环境在质量成功中的作用进行了探索性定量测试。方法：我们采用横断面设计调查了三种环境中参与改善项目的个人：儿科医院、国家改善合作医院附属医院和赞助改善顾问培训计划参与者的组织。参与QI项目的个人完成了一份调查问卷，评估MUSIQ中包含的环境因素和感知成功的措施。通径分析用于测试环境变量对MUSIQ成功的直接、间接和总影响。结果：在研究的74个项目中，发现MUSIQ中的大多数上下文因素与至少一个QI项目绩效结果显着相关。环境因素对感知QI成功的两种测量方法有显著影响，包括资源可用性、QI团队领导、团队QI技能、微系统动机、微系统QI文化和微系统QI能力。高层领导项目发起人、组织QI文化、QI团队决策和微系统QI领导的影响证据较弱。这些最初的测试增加了MUSIQ作为一种工具的有效性，用于确定哪些环境因素影响改进成功并理解它们如何发挥影响。实践含义：使用MUSIQ，管理人员和QI实践者可以开始识别在QI项目执行之前或期间必须处理的上下文方面，并计划策略来修改上下文以增加成功。QI研究人员需要进行额外的工作，以改进理论，改进测量方法，并验证MUSIQ在更广泛的QI工作中作为预测工具。
Background: Experience suggests that differences in context produce variability in the effectiveness of quality improvement (QI) interventions. However, little is known about which contextual factors affect success or how they exert influence.Purpose: Using the Model for Understanding Success in Quality (MUSIQ), we perform exploratory quantitative tests of the role of context in QI success.Methodology: We used a cross-sectional design to survey individuals participating in QI projects in three settings: a pediatric hospital, hospitals affiliated with a state QI collaborative, and organizations sponsoring participants in an improvement advisor training program. Individuals participating in QI projects completed a questionnaire assessing contextual factors included in MUSIQ and measures of perceived success. Path analysis was used to test the direct, indirect, and total effects of context variables on QI success as hypothesized in MUSIQ.Findings: In the 74 projects studied, most contextual factors in MUSIQ were found to be significantly related to at least one QI project performance outcome. Contextual factors exhibiting significant effects on two measures of perceived QI success included resource availability, QI team leadership, team QI skills, microsystem motivation, microsystem QI culture, and microsystem QI capability. There was weaker evidence for effects of senior leader project sponsors, organizational QI culture, QI team decision-making, and microsystem QI leadership. These initial tests add to the validity of MUSIQ as a tool for identifying which contextual factors affect improvement success and understanding how they exert influence.Practice Implications: Using MUSIQ, managers and QI practitioners can begin to identify aspects of context that must be addressed before or during the execution of QI projects and plan strategies to modify context for increased success. Additional work by QI researchers to improve the theory, refine measurement approaches, and validate MUSIQ as a predictive tool in a wider range of QI efforts is necessary.