THE MODEL TO AMPLIFY THE MISSING POTENTIAL (AMP) OF HEALTHCARE ORGANIZATIONS STRUGGLING TO IMPROVE QUALITY: RESULTS FROM A SYSTEMATIC REVIEW

Valerie Vaughn, MD, MSc1, Sanjay Saint, MD, MPH2, Sarah Krein, PhD, RN3, Jane Forman, ScD, MHS4, Jennifer Meddings, MD, MSc5, Jessica Ameling, MPH5, Suzanne Winter, MS6, Vineet Chopra, MD, MSc7, 1University of Michigan, Ann Arbor, MI; 2VA Ann Arbor Healthcare System; Division of Hospital Medicine, Department of Medicine, University of Michigan; VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, MI; 3VA Ann Arbor Healthcare System and University of Michigan, ANn Arbor, MI; 4Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; 5Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; 6Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI; 7University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, MI

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: Top 15 Research & Innovations

Categories: Hospital Medicine 2018, Top 15 Research and Innovation Oral Abstracts

Keywords: , , , ,

Background: Some healthcare organizations struggle to improve quality. Identifying characteristics associated with underperformance may help inform approaches to improvement. Therefore, we sought to: (a) Identify organizational factors associated with low-performing healthcare organizations and (b) propose a conceptual framework with actionable domains, which we present as AMP (The Model to Amplify the Missing Potential), to inform improvement.

Methods: A systematic review of qualitative studies was completed on the following databases: MEDLINE (1950–), EMBASE (1946–), Cochrane Library (1948–), CINAHL (1960–), and Web of Science (1996–) through May 22, 2017. Included studies used qualitative methods to evaluate characteristics of healthcare organizations with below-average patient outcomes or quality of care. Data from included studies were abstracted independently and in duplicate and analyzed using framework-based thematic synthesis to generate AMP. Study quality was evaluated using the Critical Appraisal Skills Programme tool.

Results: Twenty-two studies (25 articles) from multiple countries (United States, United Kingdom, Canada, Ethiopia) and settings (e.g. acute care, outpatient), with a diverse range of employees (e.g. nurses, leadership, staff) were included in the final analysis. Five domains consistently characterized struggling healthcare organizations: poor organizational culture, inadequate infrastructure, lack of a cohesive mission and vision, system shocks (i.e. an organization-wide event detracting from daily operations, e.g., leadership turnover, new electronic health record), and dysfunctional external relations (see Table for representative quotes). AMP serves as a model to identify and target barriers to improvement in struggling organizations (Figure).

Conclusions: Struggling healthcare organizations share characteristics that may affect their ability to provide optimal care and improve patient outcomes. These domains may be amenable to interventions or systematic analysis when problem solving low-performance. Thus, AMP provides a potential roadmap to anticipating barriers and designing improvement action plans for under-performing organizations.

IMAGE 1: Table. Domains Characterizing Struggling Healthcare Organizations

IMAGE 2: AMP (The Model to Amplify the Missing Potential): Characteristics Associated with Struggling Healthcare Organizations

To cite this abstract:

Vaughn, VM; Saint, S; Krein, S; Forman, J; Meddings, J; Ameling, J; Winter, S; Chopra, V. THE MODEL TO AMPLIFY THE MISSING POTENTIAL (AMP) OF HEALTHCARE ORGANIZATIONS STRUGGLING TO IMPROVE QUALITY: RESULTS FROM A SYSTEMATIC REVIEW. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract Top 15 Research & Innovations. https://www.shmabstracts.com/abstract/the-model-to-amplify-the-missing-potential-amp-of-healthcare-organizations-struggling-to-improve-quality-results-from-a-systematic-review/. Accessed December 14, 2018.

« Back to Hospital Medicine 2018; April 8-11; Orlando, Fla.