Barriers and facilitators of Canadian quality and safety teams: a mixed-methods study exploring the views of health care leaders

Figures & data

Figure 1 Participants flow diagram

Abbreviation: CEO, chief executive officer.

Table 1 Distribution of survey and interview participants by region, N (%)

	West	East	Ontario
Surveys
Overall (n=249)	91 (36.5)	58 (23.3)	100 (40.2)
Senior leaders (n=105)	34 (32.4)	17 (16.2)	54 (51.4)
Team leaders (n=144)	57 (39.6)	41 (28.5)	46 (31.9)
Interviews
Overall (n=89)	38 (42.7)	14 (15.7)	37 (41.6)
Senior leaders (n=44)	10 (22.7)	9 (20.5)	25 (56.8)
Team leaders (n=45)	28 (62.2)	5 (11.1)	12 (26.7)

Table 2 Characteristics of senior leader and team leader survey respondents, N (%)

Senior leaders	Overall (N=105)	West (N=34)	East (N=17)	Ontario (N=54)
Position within organization
Chief executive officer	28 (32.9)	6 (20.7)	3 (23.1)	19 (44.2)
Vice president	25 (29.4)	13 (44.8)	1 (7.7)	11 (25.6)
Director	13 (15.3)	5 (17.2)	4 (30.8)	4 (9.3)
Chief nursing officer	6 (7.1)	2 (6.9)	0 (0.0)	4 (9.3)
Manager/coordinator	6 (7.1)	2 (6.9)	2 (15.4)	2 (4.7)
Other (eg, CFO, CMO, COO, medical director)	7 (8.2)	1 (3.5)	3 (23.1)	3 (7.0)
No. of acute care hospitals in organization
1	45 (45.9)	7 (21.2)	2 (11.8)	36 (75.0)
2–5	29 (29.6)	11 (33.3)	7 (41.2)	11 (22.9)
6–9	7 (7.1)	3 (9.1)	3 (17.6)	1 (2.1)
10+	17 (17.4)	12 (36.4)	5 (29.4)	0 (0.0)
Team leaders	Overall (N=144)	West (N=57)	East (N=41)	Ontario (N=46)
Position within organization
Director	26 (24.1)	7 (18.0)	6 (16.7)	13 (39.4)
Other	24 (22.2)	10 (25.6)	9 (25.0)	5 (15.2)
Patient care manager	14 (13.0)	4 (10.3)	9 (25.0)	1 (3.0)
Allied health professions staff	13 (12.0)	6 (15.4)	6 (16.7)	1 (3.0)
Senior executive	10 (9.3)	2 (5.1)	0 (0.0)	8 (24.2)
Nursing staff	8 (7.4)	5 (12.8)	2 (5.6)	1 (3.0)
Medical staff	7 (6.5)	5 (12.8)	0 (0.0)	2 (6.1)
Support staff	6 (5.6)	0 (0.0)	4 (11.1)	2 (6.1)
Professional designation
Registered nurse	52 (36.6)	23 (40.4)	13 (32.5)	16 (35.6)
Other (eg, financial, support staff)	39 (27.5)	13 (22.8)	12 (30.0)	14 (31.1)
Allied health professions	39 (27.5)	11 (19.2)	15 (37.5)	13 (28.9)
Physician	12 (8.5)	10 (17.5)	0 (0.0)	2 (4.4)
No. of current QS team memberships
1	47 (32.9)	24 (42.1)	12 (29.3)	11 (24.4)
2	30 (21.0)	10 (17.5)	11 (26.8)	9 (20.0)
3	17 (11.9)	5 (8.8)	5 (12.2)	7 (15.6)
4	22 (15.4)	8 (14.0)	6 (14.6)	8 (17.8)
5+	27 (18.9)	10 (17.5)	7 (17.1)	10 (22.2)

Abbreviations: CFO, chief financial officer; CMO, chief medical officer; COO, chief operating officer; QS, quality and safety.

Table 3 Facilitators and barriers to establishing/implementing QS teams, N (%)

	West (N=91)	East (N=58)	Ontario (N=100)	P*
Facilitators
Management/supervisor leadership	66 (72.5)	47 (81.0)	87 (87.0)	0.042
Board/senior leadership support	70 (76.9)	30 (51.7)	79 (79.0)	0.001
Multidisciplinary team membership	68 (74.7)	33 (56.9)	64 (64.0)	0.067
Clinician buy in	53 (58.2)	22 (37.9)	52 (52.0)	0.052
Data availability and IT	40 (44.0)	17 (29.3)	52 (52.0)	0.022
Time availability to meet with the team	36 (39.6)	27 (46.6)	30 (30.0)	0.100
Financial resources to support work	31 (34.1)	12 (20.7)	22 (22.0)	0.093
Barriers
Human resources to support work	50 (54.9)	34 (58.6)	40 (40.0)	0.037
Clinician buy in	39 (42.9)	14 (24.1)	29 (29.0)	0.034
Culture of organization	35 (38.5)	14 (24.1)	22 (22.0)	0.030
Empowerment of clinicians/staff to implement initiatives	31 (34.1)	13 (22.4)	20 (20.0)	0.068
Clear and defined objectives for initiative	18 (19.8)	17 (29.3)	14 (14.0)	0.066
Communication between team members	11 (12.1)	13 (22.4)	10 (10.0)	0.078
Board/senior leadership support	12 (13.2)	12 (20.7)	8 (8.0)	0.071

Notes:

* p-Value comparing differences in proportions between regions. A significance level of 0.01 was used to adjust for post hoc multiple comparisons.

Abbreviations: QS, quality and safety; IT, information technology.

Table 4 Facilitators and barriers to measuring the impact of QS teams, N (%)

	West (N=91)	East (N=58)	Ontario (N=100)	p*
Facilitators
Leadership support	56 (61.5)	30 (51.7)	74 (74.0)	0.015
Barriers
Appropriate IT	48 (52.7)	29 (50.0)	35 (35.0)	0.033
Evaluation expertise	38 (41.8)	23 (39.7)	27 (27.0)	0.076
Leadership support	19 (20.9)	14 (24.1)	10 (10.0)	0.040
Geographic distance	23 (25.3)	10 (17.2)	6 (6.0)	0.001

Notes:

* p-Value comparing differences in proportions between regions. A significance level of 0.01 was used to adjust for post hoc multiple comparisons.

Abbreviations: QS, quality and safety; IT, information technology.