UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Quality improvement through a leadership program : influential factors to design and implement QI project using the model of improvement Cote-Marcil, Camille


Background: Quality Improvement (QI) is a systematic approach to making changes that strengthen clinical practices, enhance professional and organisational development, and ultimately improve patient and population health outcomes. The Canadian healthcare system has encouraged QI by financing change and innovation initiatives and spreading ideas through knowledge translation and exchange. Nurses are key caregivers in the hospital setting and they can significantly influence the quality of healthcare. To build knowledge and engagement among front-line staff, a Leadership Program was developed in a Western Canadian hospital. This research aims to understand influential factors for the design and implementation of QI initiatives led by nurses using the Model of Improvement as the framework to guide improvement work. Methods: This case study is a descriptive investigation. Two cases were selected through purposeful sampling, which sought critical cases that would provide rich and thick description of the initiatives. Data collection methods included 14 semi-structured interviews, three participatory observation activities, and source documents. Data analysis was performed through thematic analysis. Participants in this study included the nurse leaders and team members including QI consultants and unit managers, and other healthcare providers impacted by those initiatives. Results: The results showed that the planning phase and the selection of appropriate interventions or tools was challenging for nurse leaders inexperienced in QI. Testing changes using the PDSA cycles was also not well understood by the majority of the participants. Factors such as the engagement of healthcare providers, increased complexity in cases with multi-professional and multi-unit involvement, and the lack of resources or incentives were perceived as barriers by the participants. Conclusions: QI is difficult to achieve as it implies changing organisational culture and requires both resources and support from organisational leadership. Institutional commitment with the support of senior management in parallel with QI competency building of professionals is paramount to facilitate nurses’ QI role and leadership. Because QI initiatives demand a high investment in healthcare providers’ time and institutional resources, their careful planning, organisational support and the evaluation of outcomes are needed in the future.

Item Citations and Data


Attribution-NonCommercial-NoDerivs 2.5 Canada