6
Breakout Groups

Workshop attendees were asked to split into two breakout groups: (1) research and (2) spread and implementation of research findings. The groups met for an hour before reconvening. Each group had a leader in charge of reporting the content of their discussions to the entire workshop. This chapter summarizes these reports.

SPREAD AND IMPLEMENTATION OF RESEARCH FINDINGS

Andrea Kabcenell of the Institute for Healthcare Improvement served as leader and reporter for the spread and implementation group, which discussed the following question: What do we need to know about strategies for change to foster spread and implementation? The group developed a three-part model, recognizing that information was needed in three general areas to foster spread of good ideas: the why (will), the what (ideas), and the how (execution).

A number of themes were addressed in discussing the will and motivation for spread. The discussion included leadership, which built off of the earlier notion of “What tribe are you in?” to figure out how to leverage people’s affiliations to motivate change. In discussing the ideas for spread, the conclusion was that the information gleaned from typical research studies was necessary but not sufficient. The common frustration was that current research



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The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary 6 Breakout Groups Workshop attendees were asked to split into two breakout groups: (1) research and (2) spread and implementation of research findings. The groups met for an hour before reconvening. Each group had a leader in charge of reporting the content of their discussions to the entire workshop. This chapter summarizes these reports. SPREAD AND IMPLEMENTATION OF RESEARCH FINDINGS Andrea Kabcenell of the Institute for Healthcare Improvement served as leader and reporter for the spread and implementation group, which discussed the following question: What do we need to know about strategies for change to foster spread and implementation? The group developed a three-part model, recognizing that information was needed in three general areas to foster spread of good ideas: the why (will), the what (ideas), and the how (execution). A number of themes were addressed in discussing the will and motivation for spread. The discussion included leadership, which built off of the earlier notion of “What tribe are you in?” to figure out how to leverage people’s affiliations to motivate change. In discussing the ideas for spread, the conclusion was that the information gleaned from typical research studies was necessary but not sufficient. The common frustration was that current research

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The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary is not as in depth as needed, Kabcenell said. Gaps in knowledge included how to get changes right and how to engage physicians. Making relevant knowledge accessible was identified as a systemic issue. In discussing the information marketplace, the group identified a number of ways to collect information, including the Internet, improvement networks, and social networks. Execution of spread covered a range of issues, from high-level policy issues to front-line practitioners, with an emphasis on the need to capitalize on opportunities for collaboration. Environments can foster teamwork and tools such as technology, and transparency can enhance data sharing. The group also explored the idea of a renewable organization for improvement, where the expertise and power built for one project could become the basis for future projects. One particular call was to disseminate the knowledge that is already known. Much of what is known already is not widely known or readily available to a broad audience. Competition was also identified as a barrier to collaboration. The importance of having linkages between the research and implementation communities was highlighted. Implementers could offer researchers the ability to test theories and ideas in real labs, while also providing expertise from an operational perspective. The need for research to have a user-oriented approach was also discussed. Additionally, allowing implementers to provide more input could be beneficial in research design and execution of change. Implementers could also be used a resource for funding. The group discussed what information implementers wanted from researchers. In particular, core elements or essential ingredients for implementing change were desired, ranging from measures of organizational readiness to context, from the tools available for change to who needs to participate. It was noted that a standard way of communicating across organizations is imperative. Another type of information centered on troubleshooting to help determine why a tool or mechanism did not achieve its desired effects. Although cost data and strength of evidence are necessary, rigorous evaluations also are required to move forward. Reports on failures and successes should ideally be about equal—documentation of failure is as important as documentation of success, although few may want their failures documented. Information is also needed to predict both short-term and long-term returns on investment.

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The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary RESEARCH Marita Titler from the University of Iowa summarized the research group’s discussion, which focused primarily on the challenges to be addressed to strengthen quality improvement research. Fundamental problems with quality improvement center on the fact that the research focuses on a wide range of evaluations, from reviews of individual interventions to entire systems. The heavily disease-oriented evaluations pose additional barriers to performing good research because positive findings cannot be generalized from one disease to another. Part of the inability to compare between interventions for different diseases is the lack of a standard language to share ideas and compare findings. Other problems in quality improvement research are the methods used. As mentioned throughout the workshop, the contexts in which interventions take place are not well studied or documented. Additionally, there is little guidance on how to balance tradeoffs, such as internal and external validity. It was also noted that multiple methods would be necessary to evaluate cultural change and transformational change. This would require strengthening of research methods, especially qualitative methods. Limited progress has been made in qualitative methods in part because guidelines for how to do so have not been developed and because of their limited acceptance in peer-reviewed journals. Most major journals have word limitations for articles, and qualitative research and comprehensive summaries of methods often exceed those limitations. It was suggested that specific components be written for a major journal and lengthier sections be published in other more focused journals. The current state of quality improvement research was compared to community-based partnership research a few years ago and clinical research 25 years ago. Sciences evolve and patience needs to be exercised as quality improvement researchers learn from the development of those fields. Collaboration is needed with researchers in other disciplines, including researchers studying human factors, engineering, and social science. Researchers also need to learn from social and behavioral theorists to better understand the mechanisms of organizational cultural relationships. The session ended with a note to consider both the costs of implementing interventions and the costs of not understanding the opportunities of quality improvement projects.