A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders
Catherine Alexander, Dana Tschannen, Debora Argetsinger, Hasna Hakim, Kerry A. Milner
Abstract
AIM: This study aimed to understand the facilitators and barriers of quality improvement (QI) from the perspective of nurses and leaders at the frontline. BACKGROUND: Nurse engagement in QI has been associated with quality care and improved patient outcomes, yet nurse reported participation is low. METHODS: A descriptive qualitative design and purposive sampling was used to examine barriers and facilitators of nurse engagement. RESULTS: Facilitators (1) A leader's influence on a QI culture. Subthemes: creating buy-in, support of a just culture and working in partnership with nurses. Barriers (1) Barriers in organizational culture for nurses to lead QI. Subthemes: organizational hierarchy, absence of a just culture, nurses' role not valued, lack of accountability for QI in nursing role and resistance to change. (2) Barriers in organisational structure for nurses to lead QI. Subthemes: manager disengagement, time pressures, lack of access to timely data, lack of QI knowledge, siloed departments and lack of QI experts. CONCLUSION: Barriers to QI engagement prevent nurses from fully engaging in QI. Creating a just culture and building the infrastructure to support nurse engagement is critical for success. IMPLICATIONS FOR NURSING MANAGEMENT: Specific facilitators and barriers were identified that nurse leaders can assess in their practice setting and use relevant strategies to support engagement in QI.