ISQUA18-2185The Barriers and Facilitators to Sustaining Quality Improvement Initiatives and Clinical Microsystems in Irish Emergency Departments

Abstract

Objectives: The Irish Health Servce in partnership with the Emergency Medicine Programme has undertaken a large scale collaborative to embed clinical microsystems (CM) into emergency departments, (EDs). We describe the following: - The barriers and facilitators to sustaining Clinical Microsystems in Irish EDs - The experiences and perspectives of frontline staff engaged in CM in Irish EDs Methods: A qualitative approach was was used to capture ED staff 's insights, experiences and narratives. The qualitative data was thematically analysed to identify the key themes emerging from the data. Questions were drawn from the Institute of Healthcare Improvement (IHI) and the NHS Institute for Innovation and Improvement to identify key factors that influence the sustainability of QI initiatives. Result(s): A number of barriers to sustaining microsystems included 1. Staffing- absence of capacity building 2. ED Environment 3. Impact of shift work 4. Competing Priorities 5. Organisation and Infrastructure Impediments Facilitators described key success factors to embedding CM in EDs. 1. Coaches as Champions 2. Staff Engagement 3. Multi-Disciplinary Involvement 4. Teamwork 5. Communication 6. Staff Training and Development 7. Local control The attached table summarises the findings of barrieRs to sustainability. Image: Conclusion(s): We have described both barriers and facilitators that will assist health service providers to maximise the likelihood of embedding and sustaining QI initiatives, whether they use clinical microsystems or other approaches. This will assist both front line staff and executives in informing their QI strategy.