Karleen F Giannitrapani1,2, Aanchal Satija3, Archana Ganesh3, Raziel Gamboa4,5, Soraya Fereydooni4,5, Taylor Hennings6, Shivani Chandrashekaran7, Jake Mickelsen8, Michelle DeNatale8, Odette Spruijt9, Sushma Bhatnagar3, Karl A Lorenz4,5. 1. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA. Karleen@stanford.edu. 2. Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA. Karleen@stanford.edu. 3. All India Institute of Medical Sciences (AIIMS), New Delhi, India. 4. Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA. 5. Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA. 6. University of California Berkeley School of Public Health, Berkeley, CA, USA. 7. Duke University School of Medicine, Durham, NC, USA. 8. Stanford Healthcare, Stanford, CA, USA. 9. Peter MacCallum Cancer Center, Melbourne, VIC, Australia.
Abstract
BACKGROUND: Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects. OBJECTIVE: To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India. PARTICIPANTS: We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts. RESULTS: Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture. CONCLUSIONS: Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
BACKGROUND: Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects. OBJECTIVE: To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India. PARTICIPANTS: We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts. RESULTS: Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture. CONCLUSIONS: Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
Authors: Anatole Manzi; Jean Claude Mugunga; Laetitia Nyirazinyoye; Hari S Iyer; Bethany Hedt-Gauthier; Lisa R Hirschhorn; Joseph Ntaganira Journal: Int J Qual Health Care Date: 2019-06-01 Impact factor: 2.038
Authors: J Ferlay; M Colombet; I Soerjomataram; C Mathers; D M Parkin; M Piñeros; A Znaor; F Bray Journal: Int J Cancer Date: 2018-12-06 Impact factor: 7.396