Which Attributes of Credibility Matter for Quality Improvement Projects in Hospital Care—A Multiple Case Study among Hospitalists in Training
Abstract
:1. Introduction
- How does the credibility of hospitalists in training influence the outcome of their QI projects?
- What attributes of credibility are important for a hospitalist in training to successfully accomplish a QI project?
- What supportive contextual factors can contribute to the hospitalist in training’s championing role of successfully leading a QI project?
2. Materials and Methods
2.1. Design and Approach
2.2. Participants
- The QI project was conducted by a hospitalist in training since 2016 to reduce recall bias, and
- The QI project had been completed and presented to stakeholders of the hospital ward involved.
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Attributes of Credibility
3.1.1. Being Convincing about the Need for Change by Providing Supportive Clinical Evidence
“What she could convince us with were the data she had collected. She was able to rise above the numbers and understood what was going on. She was well prepared. (…) She was credible, mainly because—and especially medical specialists require that—she came up with good data.”(Quality officer03, hospital C)
“Within some departments, we encountered a lot more resistance, but at that time we could show how many errors had been eliminated by changing care practices. The availability of data made it easier to convince medical specialists.”(Hospitalist06, hospital C)
3.1.2. Displaying Competence in Their Clinical Work and Commitment to Their Tasks
“Right about the time I had all my data, which was about the fifth month of my rotation, I was in a position to voice my opinion. In the first month, or couple of months, I was not yet in a position to say anything, because you’ve not been there long enough. If you’re not yet part of a team, then it’s not really accepted that you’re going to tell them something you think they have to change.”(Hospitalist01, hospital A)
“You have to engage in and lead difficult conversations with the medical specialists about the subject of the QI project. (…) When hospitalist04 said something, every medical specialist listened. I noticed that medical specialists had a lot of respect for her because of her competence and intelligence. All of them had loads of experience, but they listen to her incredibly seriously.”(Supervisor03, hospital B)
“I think I was also able to convince the nurses because they appreciated my role as healthcare professional. Because they saw what I did for the patients, things that the ENT resident did not or could not do, the nurses also thought, “Well, if she can do all that, then the QI project will also be relevant”.”(Hospitalist01, hospital A)
3.1.3. Generating Shared Ownership of the QI Project with Other Healthcare Professionals
“The hospitalist in training was held in high esteem by the nursing team. Further, she took the team along with her to bring about the changes and they were so pleased with them, and that has continued ever since. This is because the team was so intensively immersed in the whole QI project. After the departure of the hospitalist in training, two nursing team leaders clearly took ownership of the QI project … and they also feel a real sense of ownership.”(Quality officer03, hospital C)
3.1.4. Acting as a Team Player to Foster Collaboration during the QI Project
“I am a real team player by nature. I think it helped a lot that I got to know the structure of that ward pretty quickly. As a team player, I have got to know people and also know the qualities they have and how to express appreciation for their contributions. In this way, I also knew how to convey the message what was great about the improvement from the perspective of the nurses and how to put this into words. I studied psychology before, so I can use words to motivate people quite well.”(Hospitalist01, hospital A)
“What I especially noticed with hospitalist05 is that he worked very much on his own from the start. Whereas hospitalist06 worked as member of a team, he worked much more as a loner. And, because of that, I noticed that his subject was supported much less by the team. (…) He had generated little support for the QI project.”(Quality officer03, hospital C)
“When you arrive at a ward for the first time, you are not inclined to say, “Can you do that for me?” Because you do not know the people, you are inclined to do everything yourself. (…) But I think that if I had given people a few more tasks, then it would have been more of a shared QI project and perhaps the subject would have gained more attention in the ward, and perhaps it would have continued a little longer after my departure, but that’s all hindsight. I think that this is a disadvantage of the way I approached my QI project. It was my project and I worked very hard on it, but I could not convey the urgency to others…. Everyone felt the urgency, but apparently not urgently enough.”(Hospitalist08, hospital E)
“You are a guest on the ward, and thus also an outsider. And you are also the one who has come to change something, but this can only happen if they [the professionals on the ward] want the changes to happen. You don’t just get a project group or a fellow doctor who wants to change things with you, that can be quite difficult.”(Supervisor04, hospital C)
3.2. Contextual Factors Related to the Credibility of the Hospitalist in Training
3.2.1. Choosing a Subject for the QI Project That Was Perceived as Urgently Required by the Group of Stakeholders Involved
“For example, during the ward round with the medical specialist, I saw a patient who said, “I haven’t slept.” And then, a number of doctors would say, “That’s just how it is in a hospital”. (…) From a nursing perspective, they are the ones that have to deal with the patient night and day. Then nurses are often told by doctors that they accept sleeplessness in patients. (…) So I think that the urgency in solving this problem, ensuring a good night’s rest for the patient, lies mainly with the nurses. The doctor hangs up the phone, so to speak, and has already forgotten the patient. They are not bothered that much by a sleepless patient.”(Hospitalist02, hospital A)
3.2.2. Being Supported by the Board of Directors and Other Formal and Informal Leaders as the Leader of a QI Project
“I had been a supervisor in the internal medicine training programme for a while. So I reasoned that, with all that experience, it would be nice to help roll out the idea of the hospitalist myself. From the very start, I played a role as a direct supervisor/educator, but at the same time took responsibility for the quality of the training of the hospitalists. (…) We were prepared to finance the training for hospitalists ourselves because we also needed to appoint these hospitalists. And that’s why we trained many more hospitalists in the beginning than the other hospitals.”(Supervisor04, hospital C)
4. Discussion
4.1. Implications
4.2. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Hospital | Respondents |
---|---|
A | Hospitalist01 |
Hospitalist02 | |
Supervisor01 | |
Supervisor02 | |
Quality officer01 | |
B | Hospitalist03 |
Hospitalist04 | |
Supervisor03 | |
Quality officer02 | |
C | Hospitalist05 |
Hospitalist06 | |
Supervisor04 | |
Quality officer03 | |
D | Hospitalist07 |
Supervisor05 | |
Quality officer04 | |
E | Hospitalist08 |
Hospitalist09 | |
Supervisor06 | |
Supervisor07 | |
Quality officer05 | |
Quality officer06 | |
Quality officer07 |
Attributes of Credibility |
---|
Being convincing about the need for change by providing supportive clinical evidence |
Displaying competence in their clinical work and commitment to their tasks |
Generating shared ownership of the QI project with other healthcare professionals |
Acting as a team player to foster collaboration during the QI project. |
Contextual Factors |
Choosing a subject for the QI project that was perceived as urgently required by the group of stakeholders involved |
Being supported by the board of directors and other formal and informal leaders as the leader of a QI project |
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Hut-Mossel, L.; Ahaus, K.; Welker, G.; Gans, R. Which Attributes of Credibility Matter for Quality Improvement Projects in Hospital Care—A Multiple Case Study among Hospitalists in Training. Int. J. Environ. Res. Public Health 2022, 19, 16335. https://doi.org/10.3390/ijerph192316335
Hut-Mossel L, Ahaus K, Welker G, Gans R. Which Attributes of Credibility Matter for Quality Improvement Projects in Hospital Care—A Multiple Case Study among Hospitalists in Training. International Journal of Environmental Research and Public Health. 2022; 19(23):16335. https://doi.org/10.3390/ijerph192316335
Chicago/Turabian StyleHut-Mossel, Lisanne, Kees Ahaus, Gera Welker, and Rijk Gans. 2022. "Which Attributes of Credibility Matter for Quality Improvement Projects in Hospital Care—A Multiple Case Study among Hospitalists in Training" International Journal of Environmental Research and Public Health 19, no. 23: 16335. https://doi.org/10.3390/ijerph192316335
APA StyleHut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2022). Which Attributes of Credibility Matter for Quality Improvement Projects in Hospital Care—A Multiple Case Study among Hospitalists in Training. International Journal of Environmental Research and Public Health, 19(23), 16335. https://doi.org/10.3390/ijerph192316335