PMID- 36215702
OWN - NLM
STAT- MEDLINE
DCOM- 20221207
LR  - 20230104
IS  - 1554-558X (Electronic)
IS  - 0894-1912 (Linking)
VI  - 42
IP  - 4
DP  - 2022 Oct 1
TI  - Barriers and Facilitators to the Implementation and Adoption of a Continuous 
      Quality Improvement Program in Surgery: A Case Study.
PG  - 227-235
LID - 10.1097/CEH.0000000000000461 [doi]
AB  - INTRODUCTION: As postoperative adverse events (AEs) drive worsened patient 
      experience, longer length of stay, and increased costs of care, surgeons have 
      long sought to engage in innovative approaches aimed at reducing AEs to improve 
      the quality and safety of surgical care. While data-driven AE performance 
      measurement and feedback (PMF) as a form of continuing professional development 
      (CPD) has been presented as a possible approach to continuous quality improvement 
      (CQI), little is known about the barriers and facilitators that influence 
      surgeons' engagement and uptake of these CPD programs. The purpose of this 
      knowledge translation informed CPD study was to examine surgeons' perspectives of 
      the challenges and facilitators to participating in surgical CQI with the broader 
      objective of enhancing future improvements of such CPD interventions. METHODS: 
      Using Everett Rogers diffusion of innovations framework as a sampling frame, the 
      participants were recruited across five surgical divisions. An exploratory case 
      study approach, including in-depth semistructured interviews, was employed. 
      Interview transcripts were analyzed and directly coded using the Theoretical 
      Domains Framework. RESULTS: Directed coding yielded a total of 527 coded barriers 
      and facilitators to behavior change pertaining to the implementation and adoption 
      of PMF with the majority of barriers and facilitators coded in four key 
      theoretical domains environmental context and resources, social influences, 
      knowledge, and beliefs about consequences. A key barrier was the lack of support 
      from the hospital necessitating surgeons' self-funding their own PMF programs. 
      Facilitators included having a champion to drive CQI and using seminars to 
      facilitate discussions around CQI principles and practices. DISCUSSION: This 
      study identified multiple barriers and facilitators to surgeons' engagement and 
      uptake of a data-driven PMF system in surgery. A key finding of the study was the 
      identification of the influential role of positive deviance seminars as a quality 
      improvement and patient safety mechanism that encourages surgeon engagement in 
      PMF systems.
CI  - Copyright (c) 2022 The Alliance for Continuing Education in the Health Professions, 
      the Association for Hospital Medical Education, and the Society for Academic 
      Continuing Medical Education.
FAU - ElChamaa, Rima
AU  - ElChamaa R
AD  - Ms. ElChamaa: Research Associate, Office of Continuing Professional Development, 
      University of Ottawa, Ottawa, Ontario, Canada, and Department of Innovation in 
      Medical Education, University of Ottawa, Ottawa, Ontario, Canada. Mr. Seely: 
      Professor of Surgery, Divisions of Thoracic Surgery and Critical Care Medicine, 
      University of Ottawa, Ontario, Canada, and Scientist, Ottawa Hospital Research 
      Institute, Ottawa, Ontario, Canada. Ms. Jeong: Research Associate, Office of 
      Continuing Professional Development, University of Ottawa, Ottawa, Ontario, 
      Canada, and Professor, Department of Innovation in Medical Education, University 
      of Ottawa, Ottawa, Ontario, Canada. Dr. Kitto: Director of Research, Office of 
      Continuing Professional Development, University of Ottawa, Ottawa, Ontario, 
      Canada, and Department of Innovation in Medical Education, University of Ottawa, 
      Ottawa, Ontario, Canada.
FAU - Seely, Andrew J E
AU  - Seely AJE
FAU - Jeong, Dahn
AU  - Jeong D
FAU - Kitto, Simon
AU  - Kitto S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221010
PL  - United States
TA  - J Contin Educ Health Prof
JT  - The Journal of continuing education in the health professions
JID - 8805847
SB  - IM
MH  - Humans
MH  - *Quality Improvement
MH  - Surveys and Questionnaires
COIS- Disclosures: The authors declare no conflict of interest.
EDAT- 2022/10/11 06:00
MHDA- 2023/01/05 06:00
CRDT- 2022/10/10 16:42
PHST- 2022/10/11 06:00 [pubmed]
PHST- 2023/01/05 06:00 [medline]
PHST- 2022/10/10 16:42 [entrez]
AID - 00005141-202204240-00002 [pii]
AID - 10.1097/CEH.0000000000000461 [doi]
PST - ppublish
SO  - J Contin Educ Health Prof. 2022 Oct 1;42(4):227-235. doi: 
      10.1097/CEH.0000000000000461. Epub 2022 Oct 10.