The Influence of a Process Improvement Program on Perceptions of Organizational Context and Understanding of Quality Improvement

Wednesday, 1 August 2012

Alison M. Hutchinson, RN, BAppSci, MBioeth, PhD1
Tracey K. Bucknall, RN, ICUCert, BN, GradDip, (AdvNurs), PhD1
Fran Brockhus, RN, BComm, MHRM2
Claire Weeden, BASc, BSc (Hons)1
Susan O'Neill, RN, GradDipNurs, MNsgSc2
(1)School of Nursing and Midwifery, Deakin University, Melbourne, Australia
(2)Nursing Services, Cabrini Health, Melbourne, Australia

Learning Objective 1: The learner will be able to recognise the association between perceptions of organisational context and the success of interventions to improve care processes and quality.

Learning Objective 2: The learner will be able to gain an understanding of the value of education regarding quality improvement and the sustainability of the respective knowledge.

Purpose: Nursing Services of a large not-for-profit health service in Australia adopted a vision to achieve 100% right care, 100% patient satisfaction and 100% nurse engagement in order to provide an outstanding patient experience. To this end, a hospital-wide process improvement program was initiated to provide staff with skills in problem-solving and system re-design. The purpose of this pilot study was to determine if the program, at the unit level, was associated with a sustained change in nurses’ (1) perceptions of the unit context (leadership, culture, evaluation, formal interactions, informal interactions, social capital, and structural and electronic resources); and (2) knowledge and attitudes towards safety and quality improvement.

Methods: Nurses were surveyed prior to introduction of the program (Time 0), 1-month following commencement of the program (Time 1); and at 6-months (Time 2) and 12-months (Time 3) following collection of baseline data. The Alberta Context Tool was administered to elicit perceptions of unit context (Times 0, 2 and 3), and the Continuous Quality Improvement (CQI) survey was administered to determine staff knowledge of quality improvement (Times 0, 1, 2 and 3).    

Results: Baseline average scores for dimensions of organisational context were indicative of a positive perception of unit context. A statistically significant improvement in knowledge and understanding of CQI was evident at Time 1 (p<0.00). At Time 2 a significant improvement in perceptions of evaluation was found (p<0.00). Time 3 data collection has just been completed.

Conclusion: Initial results indicate (1) nurses’ perceptions of evaluation processes improved significantly following introduction of the program, and (2) the program was associated with a significant improvement in nurses’ knowledge of CQI. Differences in perceptions of unit context between Times 0, 2 and 3, a comparison of knowledge scores across the four time points, and examination of their relevance for practice will be presented.