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13 Trialists views on sustaining, spreading and scaling-up quality improvement interventions
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  1. Celia Laur1,
  2. Ann Marie Corrado2,
  3. Jeremy Grimshaw3,
  4. Noah Ivers4
  1. 1Women’s College Hospital Institute for Health System Solutions and Virtual Care, and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario
  2. 2The Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON, Canada
  3. 3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; and the Department of Medicine, University of Ottawa, Ottawa, ON, Canada
  4. 4Women’s College Hospital Institute for Health System Solutions and Virtual Care, and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario; and Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

Abstract

Background Quality Improvement (QI) evaluations rarely consider how a successful intervention can be sustained, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained.

Objectives To explore why and how the effective interventions were sustained, spread or scaled.

Methods A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for interviews. Authors were eligible if they had completed the survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed ‘effective’. Snowball sampling was used if the participant indicated someone could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people.

Results Eleven of 44 eligible trialist participated. Four reported that the intervention was ‘sustained’ and nine were ‘spread,’ however interviews highlighted that these terms were interpreted differently over time. Participant stories highlighted the trajectories of how projects evolved and how research careers adapted to increase impact. Three interacting themes were identified: i) understanding the concepts of implementation, sustainability, spread and scale; ii) having the appropriate competencies; and iii) the need for individual, organisational and system capacity.

Conclusions Trialists need to think beyond local effectiveness to achieve population-level impact. Early consideration of whether an intervention is feasible and sustainable once research funding ends is necessary to plan for sustainability, spread and/or scale of effective QI programs. The competencies required for these goals are distinct from those required to implement or evaluate QI programs.

https://doi.org/10.1136/bmjoq-2020-IHI.13

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