Micro level | |
Barriers | Enablers |
Lack of time and resources | Perceived need to improve from low baseline performance |
Lack of QI experience | Embedding data collection into normal practice |
Extra data collection needed in addition to NCA data | Multi-faceted approach to data feedback |
Lack of awareness of scale of local problems | Leverage of existing networks to disseminate data |
Difficulty communicating and collaborating across diverse groups of stakeholders | Use of patients as a ‘technology of persuasion’ |
Challenges overturning embedded practices | Enthusiasm for QI project |
Rotational shift patterns of clinical staff threaten sustainability of projects | Â |
Meso level | |
Barriers | Enablers |
Challenges collecting data | Supportive digital context |
Difficulties accessing existing data | Effective collaboration between managers and clinicians |
Difficulties engaging ‘peripheral’ (but important) staff groups like IT or pathology | QI seen as part of normal practice |
Lack of incentivisation for clinical staff to perform QI | Sense of community amongst healthcare professionals |
Challenges integrating multidisciplinary teams | Avoidance of blame culture |
Macro level | |
Barriers | Enablers |
Challenges regarding data validity/timeliness/completeness | Valid and timely data feedback* |
Unconvincing evidence base for improvement | Productive collaborations between hospitals* |
Disputed processes of case-mix adjustment | Facilitated sharing of best practice between sites* |
Lack of clear actions for improvement provided by NCAs | Central provision of data analytical/visualisation tools* |
NCA reports inaccessible to managers/commissioners | Evidence base perceived as strong* |
NCA data insufficient for local needs | National performance perceived as weak or variable* |
Financial incentives (e.g. best practice tariffs) | |
Relevant and concise reports | |
Regulatory/professional pressures to involve patients/public can motivate PROM/PREM collection and use |