Abstract
Introduction: Improving the quality of health services can hardly be done without questioning the quality of the healthcare system. The DEQuaP program ("Let's develop the quality of our practices"), co-constructed through an action-research with healthcare professionals, is a participatory self-evaluation program for primary care in Belgium. The program invited all care providers of community health centres (CHC) to question, as an interdisciplinary team, their practices and collective functioning in order to embark themselves, or to become more firmly anchored, in a process of continuous quality improvement (QI). CHC users were also invited to contribute to its evaluation. Through this collaboration, the aim of the DEQuaP program is to improve the practices and functioning of the structure, in order to provide care adapted to the community.
Aim: Although the context-sensitive nature of the QI programs is well known, it is still poorly understood how such programs target primary health care (2). Our study aim was to know why CHC teams sometimes engage in DEQuaP program whereas others do not. To do so, we investigated how contextual factors (at the individual, team and organisational levels) could explain the CHC team engagement. We further explored how these factors can be managed to support healthcare quality improvement.
Methods:We conducted semi-structured interviews with CHC team members in French-speaking Belgium. An in-depth thematic analysis of the data using an inductive coding approach was completed to examine aspects of the individual, team and organizational factors that influence engagement in QI evaluation.
Results: Preliminary results highlight themes representing contextual factors that motivate CHC teams to engage or not, in DEQuaP program. These included: 1) diversity in the definition of quality among care providers, mostly depending on their background and on characteristics of CHC users, 2) diversity in the perceived meaning and purpose of the evaluation process proposed by DEQuaP program among care prodivers and 3) diversity in motivations to work in the CHC. Above these three factors, a crucial element seems to be related to the organisational dynamics within the CHC. Although CHC are based on a non-hierarchical functioning, findings showed how power dynamics within CHC teams has been influential to QI program participation.
Conclusion: The contextual factors that were highlighted in this study relate to factors outlined in the literature on professional and organizational cultures. Such factors, and their interaction, appear to be essential to understand the engagement in a QI initiative like the DEQuaP program.
Implications: Exploring professional and organizational cultures should help us to better understand how and why QI interventions work in interdisciplinary teams, such as in community health centres.
1.Ploeg J, Wong ST, Hassani K, Yous ML, Fortin M, Kendall C, et al. Contextual factors influencing the implementation of innovations in community-based primary health care: the experience of 12 Canadian research teams. Primary health care research & development. 2019; 20: e107.