N. Guzman1, S. Bradley3, C. Speyer1, D. Telem2,3, S. O’Neill2,3 3University Of Michigan, Center For Healthcare Outcomes And Policy, Ann Arbor, MI, USA 1University Of Michigan, Medical School, Ann Arbor, MI, USA 2Michigan Medicine, Department Of General Surgery, Ann Arbor, MI, USA
Introduction: Despite significant resources being devoted over multiple years to projects within large-scale quality improvement (QI) collaboratives, the successes of previous projects are often not sustained. Little is known about why some hospitals are able to sustain their QI improvements and others are not. The primary aim of our study was to identify major factors contributing to strategies for sustainable improvement.
Methods: We utilized narrative performance reports for hospitals participating in the 2021 Abdominal Hernia Care Pathway pay-for-performance initiative within the statewide Michigan Surgical Quality Collaborative (MSQC). Hospitals were divided into three phases of implementation based on the Stages of Implementation Completion (SIC) model (pre-implementation, implementation, sustainment), as determined by their self-described status at the end of the project year. We then identified QI implementation strategies employed by hospitals, using the Expert Recommendations for Implementing Change (ERIC) framework.
Results: Out of 48 hospitals, 3 were in the pre-implementation phase (6%), 32 in the implementation phase (67%), and 13 in the sustainment phase (27%). The most commonly applied implementation strategies were: 1) developing and implementing tools for quality monitoring systems, 2) changing record systems, and 3) tailoring strategies. Hospitals earlier in the implementation struggled with creating acceptable quality monitoring tools, integrating smart phrases into electronic medical record (EMR) systems, and adapting tools to fit their hospital environment. Sustained-phase sites both successfully tailored these tools within the EMR and achieved uptake among staff. In particular, hospitals that developed and successfully utilized EMR “smart phrases” to facilitate data abstraction for quality monitoring were able to reach the sustainment phase more readily (Figure 1).
Conclusion: In this statewide QI initiative, the hospitals that were most facile in developing and achieving uptake of EMR modifications achieved sustainment sooner. Embedding tools into daily workflow minimizes the burden on surgeons, making sustained participation feasible. Conversely, the absence of these capabilities can be a significant barrier, particularly for smaller, lower-resourced hospitals. Thus, large-scale QI programs should consider supporting sites with clear EMR capability gaps to enable more hospitals to both achieve and sustain success.