Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study

Praveen T. Rajasekhar, Colin J. Rees, Catherine Nixon, James E. East, Sally Brown*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Purpose – The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study. Design/methodology/approach – Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants. Findings – Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups. Originality/value – This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.

Original languageEnglish
Pages (from-to)5-15
Number of pages11
JournalInternational Journal of Health Care Quality Assurance
Issue number1
Publication statusPublished - 8 Feb 2016

Keywords / Materials (for Non-textual outputs)

  • adenoma detection rate
  • evaluation
  • implementation
  • qualitative interview study
  • quality improvement
  • service improvement


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