Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to quality improvement

J Crit Care. 2015 Aug;30(4):685-91. doi: 10.1016/j.jcrc.2015.03.022. Epub 2015 Apr 1.


Purpose: Despite the fact that Quality Improvement (QI) teams are widespread tools for improving performance in medical settings, little is known about what makes teams effective and successful. The goal of this study was to identify barriers and supportive conditions for QI teams to implement an effective and successful QI project to improve quality of care.

Materials and methods: Multicenter expert interviews with 17 team leaders were conducted in a cluster randomized trial. Interviews were based on a semistructured interview guide and were recorded and transcribed. Qualitative analysis was performed according to the principles of grounded theory.

Results: The major findings of our study can be summarized in a framework of conditions that support the implementation of changes by QI teams. This framework can be divided into 5 core categories: the availability of external support, an interdisciplinary QI team, staff characteristics such as dedicated employees who are aware and experienced, and generally supportive structural circumstances. Furthermore, the interviewees reported that changes should be disseminated through, for example, repeating key elements or addressing employees directly.

Conclusions: Using a grounded theory-based qualitative approach, we identified a framework of conditions supportive of QI-related change, which can help project initiators to create environments that are supportive of change.

Keywords: Critical care; Implementation research; Process evaluation; Qualitative research; Quality improvement; Sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Critical Care / organization & administration*
  • Critical Care / standards
  • Critical Illness
  • Early Diagnosis
  • Early Medical Intervention
  • Grounded Theory
  • Humans
  • Outcome and Process Assessment, Health Care / organization & administration*
  • Qualitative Research
  • Quality Improvement / organization & administration*
  • Sepsis / diagnosis*
  • Sepsis / drug therapy