Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study.

BACKGROUND: A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering. METHODS: Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display. RESULTS: Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900-CAN$7285). Physicians had similar perceptions of the coalition's characteristics enabling their QI involvement and the factors influencing BUN test reduction. CONCLUSIONS: To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician-who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes-were factors influencing appropriate BUN test ordering.

Through the eyes of hospital-based healthcare professionals: exploring their lived experience during the COVID-19 pandemic.

OBJECTIVE: The spread of the COVID-19 virus has caused an unforeseen strain on the healthcare system and particularly on healthcare workers (HCW). In this study, 1 year after the COVID-19 pandemic began, we used photovoice, a visual photographic approach, to understand HCW needs, concerns and resilience and to determine improvement strategies aligned with the HCW-described challenges. METHODS: Using a qualitative design, HCW were recruited from a single Western Canadian hospital, voluntarily submitting a photographic image and narrative that depicts their experiences. An artist artistically enhanced the photovoice submissions, which were then displayed at the hospital-based art gallery for public display. A survey was used to collect feedback from gallery viewers. Inductive thematic analysis was completed identifying themes from the photovoice narratives and survey comments, aiding the identification of recommendations. RESULTS: There were 25 submissions, and 1281 individuals viewed the art exhibit. Six themes emerged: (1) hopeful and resilient, (2) pandemic fatigue-negative mental and physical states, (3) personal protective equipment is our armour but masks who we are, (4) human connection, (5) responsibility, preparation and obligation and (6) technology surge. According to survey results from the art exhibit, the use of photovoice was a creative method that personalised the HCW experience and validated viewers' perceptions of the difficulties faced by HCW. Ten improvement strategies that were aligned with the described challenges were identified. CONCLUSION: The ongoing COVID-19 pandemic continues to strain HCW. Photovoice has great potential in the professional clinical setting to provide unique insights that narrative language alone cannot capture. Future research exploring the longitudinal impact of COVID-19, reviewing photographs at different timepoints could be beneficial. Using this method as a creative outlet intervention and evaluating participation artistic experience may offer additional insights to further support both HCW and patients.