The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement
The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement
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DOI：
10.1136/bmjqs-2011-000010
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发表时间：
2012-01-01
影响因子：
5.4
通讯作者：
Margolis, Peter A.
中科院分区：
文献类型：
--
作者：
Kaplan, Heather C.;Provost, Lloyd P.;Margolis, Peter A.
背景：质量改进 (QI) 努力在医疗保健领域已变得普遍，但其成功率存在显着差异。背景差异被认为是造成某些变异性的原因。目标：开发一个概念模型，组织和 QI 研究人员可以使用该模型来理解和优化影响 QI 项目成功的背景因素。方法：向 10 名 QI 专家提供系统文献综述的结果，然后参与两轮意见收集，以识别和定义重要的背景因素。随后，专家们亲自会面，以确定因素之间的关系，并开始构建模型。结果：理解质量成功的模型 (MUSIQ) 根据医疗保健系统的水平进行组织，并确定了可能影响 QI 成功的 25 个背景因素。假设微系统内的背景因素和与 QI 团队相关的因素直接影响 QI 的成功，而组织内部和外部环境的因素被认为间接影响成功。结论：MUSIQ 框架有潜力指导 QI 方法在医疗保健和焦点研究中的应用。 MUSIQ 的特殊性和因素之间关系的明确描述使我们能够更深入地了解环境影响 QI 成功的作用机制。 MUSIQ 还为支持进一步研究测试和完善理论并推进 QI 科学领域提供了基础。
Background: Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen.Objective: To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project.Methods: 10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model.Results: The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly.Conclusions: The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.