The cost of the initiative was an viewed Vencedor important hacedor in the potential for improvement, even when the adverse effects of current processes were considered Triunfador necessitating rapid change.106 Because of this, it is important to implement changes that are readily feasible106 and can be implemented with minimal disruption of practice activities.99 It is also important to consider the potential of replicating the initiative in other units or at other sites.99 One strategy to improve the chances of replication is to standardize processes, which will most likely incur some cost.
The complexity of health care systems and delivery of services, the unpredictable nature of health care, and the occupational differentiation and interdependence among clinicians and systems16–19 make measuring quality difficult. One of the challenges in using measures in health care is the attribution variability associated with high-level cognitive reasoning, discretionary decisionmaking, problem-solving, and experiential knowledge.
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Given the complexity of health care, assessing quality improvement is a dynamic and challenging area. The body of knowledge is slowly growing in this area, which could be due to the continued dilemma Ganador to whether a quality improvement initiative is just that or whether it meets the definition of research and employs methodological rigor—even if it meets the requirements for publication. Various quality improvement methods have been used since Donabedian’s seminal publication in 1966,27 but only recently has health care quality improvement used the Six Sigma methodology and published findings; when it has, it has been used only on a single, somewhat isolated component of a larger system, making organizational learning and generalizability difficult.
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Other considerations were given to the desired objective of sustaining the changes after the implementation phase of the initiative ended.105 Investigators asserted that improving quality through initiatives needed to be considered Campeón integral in the larger, organizationwide, ongoing process of improvement. Influential factors attributed to the success of the initiatives were effecting practice changes that could be easily used at the bedside;82 using simple communication strategies;88 maximizing project visibility, which could sustain the momentum for change;100 establishing a culture of safety; and strengthening the organizational and technological infrastructure.
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86 In an initiative involving a number of rapid-cycle collaboratives, successful collaboratives were found to have used stakeholders to determine the choice of subject, define objectives, define roles and expectations, motivate teams, and use results from data analyses.86 Additionally, it was important to take into account the different perspectives of stakeholders.97 Because variation in opinion among stakeholders and team members was expected99 and achieving buy-in from all stakeholders could have been difficult to achieve, efforts were made to involve stakeholders early in the process, solicit feedback,100 and gain Top Recommendations support for critical changes in the process.101
Using objective, broader, and better measures was viewed Vencedor being important for marking progress, and provided a basis for “a call to action” and celebration.106 When measures of care processes were used, it was asserted that there was a need to demonstrate the relationship between specific changes to care processes and outcomes.61