A Qualitative Study of the Barriers and Facilitators Impacting the Implementation of a Quality Improvement Program for Emergency Departments

Abstract

Abstract Background: The implementation of intervention programs in Emergency Departments (EDs) is often fraught with complications due to the inherent complexity of the environment. Hence, the exploration and identification of barriers and facilitators prior to an implementation is imperative to formulate context-specific strategies to ensure the tenability of the intervention. Objectives: In assessing the context of four EDs prior to the implementation of SurgeCon, a quality improvement program for ED efficiency and patient satisfaction, this study identifies and explores the barriers and facilitators to successful implementation from the perspective of the providers, patients, researchers, and decision makers involved in the implementation. Settings: Two rural and two urban Canadian EDs with 24/7 on-site physician support. Methods: Data were collected prior to the implementation of SurgeCon, by means of qualitative and quantitative methods consisting of semi-structured interviews with 33 healthcare providers (e.g., physicians, nurses, and managers), patient-reported experience and satisfaction telephone interviews with 341 patients, and structured observations from four EDs. Interpretive description approach was utilized to analyze the data gathered from interviews, open-ended questions of the survey, and structured observations. Results: A set of five facilitator-barrier pairs were extracted. These key facilitator-barrier pairs were: (1) management and leadership, (2) available resources, (3) communications and network across organization, (4) previous intervention experiences, and (5) need for change. Conclusion: Knowledge of the barriers and facilitators in the implementation of the quality improvement program was found to be a vital precursor to its successful implementation. Given the dynamic and complex nature of ED environments, such an approach, prior to an implementation, may prove useful for other such interventions. Trial registration: Name of the registry: ClinicalTrials.gov Trial registration number: NCT04789902 Date of registration: 10/03/2021