Saving 20 000 Days and Beyond: a realist evaluation of two quality improvement campaigns to manage hospital demand in a New Zealand District Health Board

[摘要] Background The current paper reports on a realistevaluation of two consecutive quality improvementcampaigns based on the Institute for HealthcareImprovement’s Breakthrough Series. The campaignswere implemented by a District Health Board to managehospital demand in South Auckland, New Zealand. A realistevaluation design was adopted to investigate what workedin the two campaigns and under what conditions.Methods A mixed-methods approach was used, involvingthree phases of data collection. During the first phase,a review of campaign materials and relevant literature,as well as key informant interviews were undertaken togenerate an initial logic model of how the campaign wasexpected to achieve its objective. In phase II, the modelwas tested against the experiences of participants inthe first campaign via a questionnaire to all campaignparticipants, interviews with campaign sponsors andcollaborative team leaders and a review of collaborativeteam dashboards. In phase III, the refined model wastested further against the experiences of participants inthe second campaign through interviews with collaborativeteam leaders, case studies of four collaborative teams anda review of the overall system-level dashboard.Results The evaluation identified four key mechanismsthrough which the campaigns’ outcomes were achieved.These were characterised as ‘an organisationalpreparedness to change’, ‘enlisting the early adopters’,‘strong collaborative teams’ and ‘learning frommeasurement’. Contextual factors that both enabled andconstrained the operation of these mechanisms were alsoidentified.Conclusions By focusing on the explication of a theoryof how the campaigns achieved their outcomes and underwhat circumstances, the realist evaluation reported inthis paper provides some instructive lessons for futureevaluations of quality improvement initiatives.

[学科分类] 药学