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Table 3 Illustrative quotes from interviews with CIP participants

From: How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

Quote no. Quotes
Theme: An agreed and robust quality improvement methodology
 1 “I have to say it worked; we came out with some good outcomes and a project that was in small, biteable chunks that we could then actually deliver some change and then the learnings that we took from that, I presented to different divisions and it sort of stimulated a lot of work throughout the network and got a lot of attention.” (Interview no.1, doctor)
 2 “The CIP project taught me to identify the problem rather than just start with the solution. So you’re not just jumping straight into finding answers. What’s the data actually telling us now?” (Interview no.9, doctor)
 3 (in relation to brainstorming sessions …) “Seeing people getting engaged – that was quite rewarding and especially when they picked things up that I thought would work” (Interview no.1, doctor).
 4 “It was quality, it was enjoyable, it was good education and, I think again, just to get people together across the network and hospital working on a similar methodology and learning, I think’s really important” (Interview no.5, doctor).
 5 “There’s no doubt that there’s quite a few things that need attention and this kind of project can improve the quality of care. Now I – when I do my clinical work, I see a lot of areas that could use a continuous improvement project” (Interview no.12, doctor).
 6 “It’s not just me doing it for a nursing cohort, but it’s more so to the benefit of the patient and the outcomes going to benefit the service” (Interview no.15, nurse).
 7 “I think it’s a different way of looking at things and I think it’s a good way and I think we can use it in our environment” (Interview no2, doctor).
 8 “… another tool in the toolbox…and the more tools you’ve got, the more options you have” (Interview no.7, nurse).
A skilled faculty to assist teams and other skills to support projects
 9 “Having the facilitator was great. Just having someone go through processes, for example, with the Pareto chart, you get one graph and you think, I need to go another round of voting. And just having someone there … being able to soundboard … who’s done it before. Having a coach was fantastic.” (Interview no.16, nurse)
 10 “I think we also were given a lot of ongoing support which made the project and information more relevant, so I could check in and ask questions if I needed to” (Interview no.7, nurse).
 11 One interviewee valued the ability “to soundboard from someone who’s done it before, and being given a little bit of guidance, I think, was very helpful for me” (Interview no.16, nurse).
 12 “I think it would be helpful in the long-run if you could have assistance in data collection and things like that, because it’s difficult to do that when you’re also doing your job” (Interview no.4, nurse).
 13 (referring to previous CIP graduates …) “So they bring a greater knowledge and research base to projects that you engage in” (Interview no.6, nurse).
Active involvement of leadership and management
 14 “It showed good leadership right from the start, and that people at the higher levels were committed, which I think was good” (Interview no.8, nurse).
 15 “If the person right at the top of our organisation is engaging in the CIP project and allowing people in those executive roles to participate, then I think that’s leading by example” (Interview no.7, nurse).
 16 “It’s given some priority and some importance. And there’s been investment of time and effort to run the Program” (Interview no.14, doctor).
 17 “So I think that sends an important message that they support it and they think it’s worthwhile and that they were prepared to implement this across the network” (Interview no.5, doctor).
 18 “I think that executive probably need to be a bit more cognisant of the time this takes and being given the accessibility to be able to perform the process” (Interview no.6, nurse).
 19 “I can say that he (Director) was very supportive of the project, like exceptionally supportive, without his help it wouldn’t have gone ahead” (Interview no.9, doctor).
An understanding that teams matter
 20 “The various perspectives from different discipline and different areas (which) helped shape our project” (Interview no.14, doctor).
 21 “Having that multi-disciplinary atmosphere, where there’s people from all levels of clinical, managerial side of things, we probably talked a lot more and met with people that we wouldn’t have otherwise talked to at all. So we got a lot more perspectives on things. That was really good” (Interview no.3, nurse).
 22 “Seeing people getting engaged – that was quite rewarding and especially when they picked things up that I thought would work” (Interview no.1, doctor).
 23 “I enjoy the fact that the nurses got a sense of achievement when they saw that the work they put in actually brought them some improvement to a problem that they had been struggling with for a very, very long time” (Interview no.7, nurse).
 24 “I enjoyed hearing other people’s problems and how they solved them. That was probably the most enjoyable part of it and it was interesting seeing the process of other people going through the same thing and the challenges that they faced and they overcome them” (Interview no.10, pharmacist).
 25 “You need to get the right mix of people in the room and to have the right network, and to think ‘outside the square’ as to who’s actually going to be valuable in the room” (Interview no.1. doctor).
 26 “We tried to have a mix of nurses/medical staff or junior doctors/senior doctors, even GPs because they want to know different things and they all came with their own spin on things” (Interview no.1, doctor).
 27 “You need people that are invested in and interested in getting the outcome that you’re trying to achieve” (Interview no.8, nurse).
 28 “The key facilitator is access to the right people who have the tacit knowledge” (Interview no.7, nurse).
The relationship between safety culture and quality improvement
 29 “Everybody was engaged in the process, and I thought – actually this is how you facilitate or implement change; you get the people in the room, you get their buy-in, they were motivated, engaged, they were really proud of themselves like, oh, we thought of something like we can do this. And that’s when I was like, yeah, I can see it” (Interview no.1, doctor).
 30 “It’s making it part of a culture in a way of thinking, rather than just a process and education tool that you did once and you’re never going to use again” (Interview no.6, nurse).
 31 “But once I started, I realised that’s how people come together, to help to do this kind of project. So, I thought, that’s a very supportive culture that we have here” (Interview no.12, doctor).
 32 “How can they improve things is also enormously beneficial from a personal development perspective for them and it leaves people with their batteries a little bit recharged and feeling a bit better about the world, rather than sort of being rundown” (Interview no.7, nurse).
 33 “So I wanted to increase my understanding of how to actually lead an improvement project. Probably one of the goals was to kind of increase my confidence in actually kind of doing a project of that scale” (Interview no.4, nurse).
 34 “It strengthened my other aspects like teamwork and respecting each other, getting help from other as well” (Interview no.12, doctor)
Barriers to successful implementation at project level
 35 (There were) “some things that I had planned to do, but just haven’t got around to doing. I mean, there is pressure put on us for our clinical duties. That has to be a huge barrier” (Interview no.13, doctor)
 36 “Everyone is exhausted by change, nobody wants to face another something new and something different and like they’re just tired of it” (Interview no.9, doctor).