Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network
Abstract Background Unwarranted clinical variation presents a major challenge in contemporary healthcare, indicating potential inequalities and inefficiencies, and unrealised potential for better outcomes. Despite an increasing focus on unwarranted clinical variation, and consideration of efforts to...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-025-12267-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832585892384997376 |
|---|---|
| author | Kym Warhurst Zephanie Tyack Michael Beckmann Bridget Abell |
| author_facet | Kym Warhurst Zephanie Tyack Michael Beckmann Bridget Abell |
| author_sort | Kym Warhurst |
| collection | DOAJ |
| description | Abstract Background Unwarranted clinical variation presents a major challenge in contemporary healthcare, indicating potential inequalities and inefficiencies, and unrealised potential for better outcomes. Despite an increasing focus on unwarranted clinical variation, and consideration of efforts to address this challenge, evidence-based strategies which achieve this are limited. Audit and feedback of healthcare processes (process auditing) and clinician engagement are important tools which may help to reduce unwarranted clinical variation, however their application in maternity care is yet to be thoroughly explored. We describe the development and implementation of a program to address unwarranted clinical variation across a multi-site maternity network termed Practice Improvement with Clinicians eNgaged in Improving Care (PICNIC). The goals of the program were to engage clinicians to identify and reduce unwarranted clinical variation and enhance the delivery of evidence-based care, with the intention of improving care quality, clinical outcomes, and efficiency of the health service. Methods A theory-informed approach was used to design and implement the four-phase program, underpinned by implementation science and quality improvement methodologies. It utilised clinician-performed process auditing, built upon existing evidence for audit and feedback, and employed evidence-based implementation strategies to promote clinician behaviour change. Results The intervention was implemented across the five maternity network sites in 2020 with around 300 clinicians participating in 18 audit topics over four years (2020–2023). A diverse array of evidence-based strategies were utilised to support implementation over this period and are mapped to the Behaviour Change Taxonomy and Expert Recommendation for Implementing Change (ERIC) compilation. Observed benefits of the program include the development and implementation of clinician co-designed system-level improvements that are tailored to context, to improve the delivery of best-practice healthcare and improve outcomes. Conclusions Implementation science theory and quality improvement processes can be integrated pragmatically to engage clinicians to address unwarranted clinical variation, with the objective of creating meaningful behaviour change, and system-level improvements for better healthcare outcomes. The replicability of this approach in other disciplines and hospital networks should be explored. Trial registration Not applicable to this report. |
| format | Article |
| id | doaj-art-0a1cc91ed4124d7582ddb061ee1141bd |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-0a1cc91ed4124d7582ddb061ee1141bd2025-01-26T12:22:01ZengBMCBMC Health Services Research1472-69632025-01-0125111310.1186/s12913-025-12267-xTheory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service networkKym Warhurst0Zephanie Tyack1Michael Beckmann2Bridget Abell3Mater Misericordiae LtdAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of TechnologyMater Misericordiae LtdAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of TechnologyAbstract Background Unwarranted clinical variation presents a major challenge in contemporary healthcare, indicating potential inequalities and inefficiencies, and unrealised potential for better outcomes. Despite an increasing focus on unwarranted clinical variation, and consideration of efforts to address this challenge, evidence-based strategies which achieve this are limited. Audit and feedback of healthcare processes (process auditing) and clinician engagement are important tools which may help to reduce unwarranted clinical variation, however their application in maternity care is yet to be thoroughly explored. We describe the development and implementation of a program to address unwarranted clinical variation across a multi-site maternity network termed Practice Improvement with Clinicians eNgaged in Improving Care (PICNIC). The goals of the program were to engage clinicians to identify and reduce unwarranted clinical variation and enhance the delivery of evidence-based care, with the intention of improving care quality, clinical outcomes, and efficiency of the health service. Methods A theory-informed approach was used to design and implement the four-phase program, underpinned by implementation science and quality improvement methodologies. It utilised clinician-performed process auditing, built upon existing evidence for audit and feedback, and employed evidence-based implementation strategies to promote clinician behaviour change. Results The intervention was implemented across the five maternity network sites in 2020 with around 300 clinicians participating in 18 audit topics over four years (2020–2023). A diverse array of evidence-based strategies were utilised to support implementation over this period and are mapped to the Behaviour Change Taxonomy and Expert Recommendation for Implementing Change (ERIC) compilation. Observed benefits of the program include the development and implementation of clinician co-designed system-level improvements that are tailored to context, to improve the delivery of best-practice healthcare and improve outcomes. Conclusions Implementation science theory and quality improvement processes can be integrated pragmatically to engage clinicians to address unwarranted clinical variation, with the objective of creating meaningful behaviour change, and system-level improvements for better healthcare outcomes. The replicability of this approach in other disciplines and hospital networks should be explored. Trial registration Not applicable to this report.https://doi.org/10.1186/s12913-025-12267-xUnwarranted clinical variationImplementation scienceQuality improvementAudit and feedbackClinician behaviour changeMaternity care |
| spellingShingle | Kym Warhurst Zephanie Tyack Michael Beckmann Bridget Abell Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network BMC Health Services Research Unwarranted clinical variation Implementation science Quality improvement Audit and feedback Clinician behaviour change Maternity care |
| title | Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| title_full | Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| title_fullStr | Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| title_full_unstemmed | Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| title_short | Theory-informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| title_sort | theory informed refinement and tailored implementation of a quality improvement program in maternity care to reduce unwarranted clinical variation across a health service network |
| topic | Unwarranted clinical variation Implementation science Quality improvement Audit and feedback Clinician behaviour change Maternity care |
| url | https://doi.org/10.1186/s12913-025-12267-x |
| work_keys_str_mv | AT kymwarhurst theoryinformedrefinementandtailoredimplementationofaqualityimprovementprograminmaternitycaretoreduceunwarrantedclinicalvariationacrossahealthservicenetwork AT zephanietyack theoryinformedrefinementandtailoredimplementationofaqualityimprovementprograminmaternitycaretoreduceunwarrantedclinicalvariationacrossahealthservicenetwork AT michaelbeckmann theoryinformedrefinementandtailoredimplementationofaqualityimprovementprograminmaternitycaretoreduceunwarrantedclinicalvariationacrossahealthservicenetwork AT bridgetabell theoryinformedrefinementandtailoredimplementationofaqualityimprovementprograminmaternitycaretoreduceunwarrantedclinicalvariationacrossahealthservicenetwork |