Abstract for: Implementing and Sustaining Healthcare Quality Improvement: Case Study Examining Feedback Structure and Dynamics
Thinking of quality improvement (QI) as a simple negative feedback is insufficient. Due to challenges in sustaining improvements and concerns about importing a potentially-inappropriate paradigm, healthcare institutions develop custom QI approaches. We report on a case study (2015-2019) in one Neonatal Intensive Care Unit (NICU). This NICU was focused on developing and implementing a front-line oriented approach to QI training and project development: the unit-based approach (UBA). This improved quality and met staff’s high expectations for overcoming prior failings. Using mixed methods simulation modeling, we document feedbacks both in and between this intervention and its context and present simulation scenarios which enable an improved understanding of what it takes to sustain QI. Using comparisons with similar theories, we suggest that a parsimonious feedback structure can usefully explain dynamics occurring across situations. Nevertheless, our research suggests that sustaining UBA’s success will require innovations in management and systems design.