Volume 30, Issue 3 pp. 694-701
ORIGINAL ARTICLE

A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders

Catherine Alexander DNP, MPH, RN

Corresponding Author

Catherine Alexander DNP, MPH, RN

Performance Improvement Analyst

Department of Quality Management, San Francisco VA Medical Center, San Francisco, California, USA

Correspondence

Catherine Alexander, DNP, MPH, RN, Performance Improvement Analyst, San Francisco VA Medical Center, San Francisco, CA, USA.

Email: [email protected]

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Dana Tschannen PhD, RN

Dana Tschannen PhD, RN

Associate Dean for Undergraduate Studies, Clinical Professor

School of Nursing, University of Michigan, Ann Arbor, Michigan, USA

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Debora Argetsinger DNP, AGACNP-BC

Debora Argetsinger DNP, AGACNP-BC

Director of Specialty Services

Metro Health, University of Michigan Health, Wyoming, Michigan, USA

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Hasna Hakim DNP, MPH, RN

Hasna Hakim DNP, MPH, RN

Director of the Medical-Surgical ICU

Director Medical-Surgical Intensive Care Unit, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Kerry A. Milner DNSc, RN, EBP-CH

Kerry A. Milner DNSc, RN, EBP-CH

Professor

Davis & Henley College of Nursing, Sacred Heart University, Fairfield, Connecticut, USA

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First published: 30 December 2021
Citations: 19

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.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available in the supporting information of this article.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.