Table 2 Summary of barriers and facilitators to CQI implementation
Dimensions | Barriers | Facilitators |
|---|---|---|
Cultural dimension | • Physician decline membership of CQI [27] • Non-involvement of all pharmacy staff [76] • Staff resistance to change [76] • Absence of celebration or rewards for achievement [77] • Hierarchical culture [32, 77] • Staffs’ reluctance to report errors [76] | • Development of a culture and group culture to CQI [32, 77] • Perception of feasibility, confidentiality, receptive attitudes, a sense of ownership, and perceptions of positive impacts [82] • Managers commitment for quality-related event reporting and learning [76] • Inviting physicians to join the quality journey [30] • Involving patients, families, leaders, and staffs [83] • Gather all personnel to collaborate for a common goal [71, 77] |
Technical dimension | • Inadequate capitalization of project and insufficient support for CQI facilitators and data entry managers [27] • Immature electronic medical records or poor information systems [27] • Lack of training opportunities and skills [77,78,79] • Difficulty of finding codes for conditions and procedures [80] • The high rate of non-codable items [80] • The lack of recommended measures [80] | • Continued seminar, education, and training [30, 33, 44, 60, 77, 81, 82] • Assessing a limited but essential number of quality indicators [82] • Data quality and availability [77] • Continuous and reliable information, including measurement, about test and current practice [83] • Developing a manual-online hybrid reporting system [76] |
Structural dimension | • Weak or absence of physician-to-physician cooperation and synergies [27] • Changed staff relationship [76] • Lack of mechanisms for disseminating knowledge [77] • Limited use of communication mechanisms [77] • Staff shortages and turnover [78] • Insufficient staffing [79] | • Effective forums of communication [77] • An infrastructure based on improvement in knowledge [83] • Learning systems and sustainability systems [83] • Improving information systems [84] • Adopting systematic problem-solving approaches [84] |
Strategic dimension | • Inability to select proper goals of CQI [27] • Poor planning [79] • Failure to integrate CQI into organizational planning and goals [27] • Unalignment of goals and priorities of leadership and management [77] • Fragmentation of quality assurance policies [78] • Inadequate financial or other positive reinforcement to staffs [27] • Lack of support [81] • Resource inadequacy [77] • work overload [77]. | • Strengthened leadership [77, 78] • CQI-based mentoring [85] • Periodic monitoring, supportive supervision, and coaching [34, 44, 78, 83, 86] • Participation, empowerment, and accountability [58] • Involving all stakeholders in decision-making [77, 78] • A provider-payer partnership [55] • Compensating staff for after-hours meetings on CQI [76] • The adoption of a formative approach to CQI implementation [82]. |