Study provides insights into problems confronting quality improvement educational programs in rural hospitals
Research Activities, May 2010, No. 357
To improve health care performance, hospitals and other health care delivery organizations have embraced a strategy known as continuous quality improvement (QI). This approach aims to improve clinical outcomes and system efficiency in part by delivering rapid-cycle educational programs to hospital leadership and staff. While the strategy is popular, its success in actually improving quality performance is inconsistent. A new study by Giovanni Filardo, Ph.D., of the Baylor Health Care System, and colleagues reveals some of the problems confronting QI educational programs in rural hospitals.
The study consisted of a randomized control trial involving 47 rural and small community hospitals located in Texas. All had access to a Web-based quality benchmarking and care-review tool to analyze quality and safety measures. Participating hospitals were randomized to either a formal QI educational program or to usual quality management. The intervention program consisted of two 2-day, face-to-face teaching sessions on rapid-cycle process improvement methods specifically focused on improving pneumonia and heart failure care. After these sessions, the hospitals conducted QI projects over 3 months along with monthly coaching via conference calls and emails. Hospitals randomized to the control group did not receive the educational program, although both groups continued to have access to the Web-based tool.
Among the 23 hospitals randomized to the intervention group, only 16 completed the classroom session component and just 6 hospitals completed the full training program, despite an initial commitment by the hospital CEO or president to full participation. No pneumonia or heart failure care benefit was observed in the 23 intervention hospitals, the 16 that completed the classroom session component, or the 6 hospitals that also participated in coaching sessions and an annual QI conclave. However, no hospital participated with the full team of physician leader, nurse leader, and administrative operational leader for whom the program was intended. Of the 42 individuals who attended educational sessions, 5 (12 percent) left their positions during the study period. This lack of availability and inconsistency of appropriate leaders (QI champions), due to the chronic understaffing and high staff turnover that plagues rural and small hospitals, presented substantial barriers to achieving benefit from the QI education program, note the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS15431).
See "A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results," by Dr. Filardo, David Nicewander, M.S., Jeph Herrin, Ph.D., and others in the International Journal for Quality in Health Care 21(4), pp. 225-232, 2009.