Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care

Health Serv Res. 2009 Apr;44(2 Pt 2):665-83. doi: 10.1111/j.1475-6773.2008.00929.x.


Objectives: To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices.

Data sources: Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006.

Study design: Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability.

Data collection: Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability.

Principal findings: The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had.

Conclusions: Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Decision Making, Organizational
  • Diffusion of Innovation
  • Health Services Research / statistics & numerical data*
  • Humans
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data*
  • Outcome and Process Assessment, Health Care
  • Patient Care Team / organization & administration*
  • Personnel, Hospital / statistics & numerical data*
  • Quality Assurance, Health Care / organization & administration*
  • Safety Management / organization & administration*
  • Total Quality Management / organization & administration
  • United States / epidemiology
  • United States Agency for Healthcare Research and Quality