How Team-Based Reflection Affects Quality Improvement Implementation (original) (raw)

2012, Quality Management in Health Care

Quality improvement (QI) interventions in health care organizations have produced mixed results with significant questions remaining about how QI interventions are implemented. Team-based reflection may be an important element for understanding QI implementation. Extensive research has focused on individual benefits of reflection including links between reflection, learning, and change. There are currently no published studies that explore how team-based reflection impact QI interventions. We selected 4 primary care practices participating in a QI trial that used a facilitated, team-based approach to improve colorectal cancer screening rates. Trained facilitators met with a team of practice members for up to eleven 1-hour meetings. Data include audiorecorded team meetings and associated fieldnotes. We used a template approach to code transcribed data and an immersion/crystallization technique to identify patterns and themes. Three types of team-based reflection and how each mattered for QI implementation were identified: organizational reflection promoted buy-in, motivation, and feelings of inspiration; process reflection enhanced team problem solving and change management; and relational reflection enhanced discussions of relational dynamics necessary to implement desired QI changes. If QI interventions seek to make changes where collaboration and coordination of care is required, then deliberately integrating team-based reflection into interventions can provide opportunities to facilitate change processes. Keywords health care; primary care; quality improvement; reflection; teams Quality improvement (QI) interventions in clinical settings seek to enhance the extent to which health care is safe, timely, effective, efficient, equitable, and patient centered, while resulting in the best-possible patient outcomes. 1 Despite the variety of QI approaches that have been tested, the dominant conclusion is that QI effectiveness is "consistently inconsistent," 2 with some interventions being "successful" and some with limited to no