G. Harvey et A. Kitson, ACHIEVING IMPROVEMENT THROUGH QUALITY - AN EVALUATION OF KEY FACTORS IN THE IMPLEMENTATION PROCESS, Journal of advanced nursing, 24(1), 1996, pp. 185-195
Quality, audit and standard setting are major issues on the present da
y nursing and health care agenda. Considerable time, energy and resour
ces have been invested in developing and implementing a range of diffe
rent quality and audit systems, yet there is limited evidence to date
to suggest that they are having any significant impact in terms of cha
nging practice and improving patient care. This paper will present the
results of a study undertaken to evaluate the implementation of three
of the most common nursing quality systems used in the United Kingdom
: Monitor, Qualpacs and the dynamic standard setting system (DySSSy).
In each case, the focus was on identifying key factors in the process
of implementation that could predict positive programme outcomes - def
ined in terms of acceptance by clinical nursing staff and perceived im
pact on the quality of patient care. The study adopted a three-stage e
valuation design, with three distinct levels of investigation and anal
ysis, and utilized a range of descriptive and exploratory methods. In
total, 14 sites implementing one of the three nursing quality systems
were studied. Additional data, derived from individuals' experiences o
f implementing quality in nursing, were used to enhance and validate t
he findings. The results indicated a number of important system-relate
d, contextual and practical issues of implementation. These were under
pinned by two key factors, defined as ownership for quality and action
to improve. However, most present day nursing quality programmes appe
ar to be failing to embrace these two concepts simultaneously. The pap
er will conclude by discussing the implications of these findings for
future developments in nursing and health care quality improvement.