Evaluation and Program Planning ( IF 1.886 ) Pub Date : 2020-11-07 , DOI: 10.1016/j.evalprogplan.2020.101876 Ejemai Amaize Eboreime 1 , John Olajide Olawepo 2 , Aduragbemi Banke-Thomas 3 , Rohit Ramaswamy 4
Background
The Plan-Do-Study-Act (PDSA) cycle is fundamental to many quality improvement (QI) models. For the approach to be effective in the real-world, variants must align with standard elements of the PDSA. This study evaluates the alignment between theory, design and implementation fidelity of a PDSA variant adapted for Nigeria’s health system performance improvement.
Methods
An iterative consensus building approach was used to develop a scorecard evaluating new conceptual indices of design and implementation fidelity of QI interventions (design and implementation index, defects and gaps) based on Taylor’s theoretical framework.
Results
Design (adaptation) scores were optimal across all standard features indicating that design was well adapted to the typical PDSA. Conversely, implementation fidelity scores were only optimal with two standard features: prediction-based test of change and the use of data over time. The other features, use of multiple iterative cycles and documentation had implementation gaps of 17 % and 50 % respectively.
Conclusion
This study demonstrates how both adaptation and implementation fidelity are important for success of QI interventions. It also presents an approach for evaluating other QI models using Taylor’s PDSA assessment framework as a guide, which might serve to strengthen the theory behind future QI models and provide guidance on their appropriate use.
中文翻译:
评估改进的计划-实施-研究-行动方法的设计和实施保真度,以改善尼日利亚州的卫生系统绩效
背景
计划-执行-研究-行动 (PDSA) 循环是许多质量改进 (QI) 模型的基础。为了使该方法在现实世界中有效,变体必须与 PDSA 的标准元素保持一致。本研究评估了适用于尼日利亚卫生系统绩效改进的 PDSA 变体的理论、设计和实施保真度之间的一致性。
方法
基于泰勒的理论框架,使用迭代共识建立方法来开发记分卡,评估 QI 干预的设计和实施保真度的新概念指标(设计和实施指数、缺陷和差距)。
结果
设计(适应)分数在所有标准特征中都是最佳的,表明设计很好地适应了典型的 PDSA。相反,实施保真度分数只有在两个标准特征下才是最佳的:基于预测的变化测试和随时间推移的数据使用。其他功能、使用多个迭代周期和文档的实施差距分别为 17% 和 50%。
结论
本研究证明了适应和实施保真度对 QI 干预的成功至关重要。它还提出了一种使用 Taylor 的 PDSA 评估框架作为指导来评估其他 QI 模型的方法,这可能有助于加强未来 QI 模型背后的理论并为其适当使用提供指导。