QI Enablers Study

April 26, 2018

QI Enablers Study

April 26, 2018

Seven iterations of D2D data show that some teams tend to improve more over time compared to others. AFHTO members want to know what some of the “tricks of the improvement trade” are so they can try them out in their own teams. This QI enablers study is aimed at learning more about what makes it easier or harder to improve so that all teams can take advantage of the wisdom from the field.

What is the study about, and why? How will the study be done? When will the study happen?
What we want to talk with teams about What we won’t ask teams about Frequently Asked Questions


What is the study about and why?

The QI Enablers study will be based on in-person interviews with teams. It will provide a snapshot of how teams think and work to get better at what they do. We will ask teams to talk about how they work together as they continually try to get better at what they do. Details on the interview process are outlined below. The study will describe what is happening with teams at a single point in time – i.e. it is not ongoing, the way that D2D is. The data from the interviews will be compared to D2D performance. This will point out any patterns between the stories of how teams work and their D2D scores. This will provide hints about what works best to move beyond measurement to improvement. We will share what we are hearing first with the participating teams to confirm that we have heard them right. Then we will be sharing the collective wisdom with all members and also with external partners, so that everyone (AFHTO members and beyond) can learn together. The stories will be shared anonymously – unless a team is keen to see their name in lights, in which case we would happily oblige!


How will the study be done?

We are happy to report that we have the help of Dr. Judith Belle Brown from Western University. Dr. Brown has a long and impressive track record with primary care qualitative research and is, among other things, the incoming president of the North American Primary Care Research Group. Dr. Brown will be doing interviews along with Carol Mulder and Laura Belsito from the AFHTO QIDS program We will come to your team. We would like to talk to 6-8 people or as close as you can come to that. Candidates for the interviews are leaders (ED/clinical leads), admin or clerical staff, clinician (physician AND IHP) and QI staff.  We’ll do separate interviews, so you don’t have to find a time that works for everyone. We would like to do all the interviews on the same day though if at all possible. We are thinking we will do this in person (vs. phone) if we can.


When will the study happen?

We would like to come to your team before end of June 2018.


What we want to talk with teams about

We want to hear from teams about how they work together.  We will be using the “dimensions of teamwork” framework developed through an earlier study of FHTs by Dr. Brown and her colleagues. We are particularly interested in what works and why.  This approach is loosely grounded in theories of “appreciative inquiry”, “solutions focus” and “positive deviance.” In keeping with these theories, not all interviews will be the same. We will be starting from the same place but going to wherever you take us!  In case you are interested, the starting place of dimensions is as follows:

  • Common philosophy toward teamwork
  • Scope of practice
  • EMR use
  • Physical plant/team environment
  • Activities for team building
  • Conflict resolution
  • Change management strategies
  • Effective leadership
  • Team evolution
  • Using data to improve


What we won’t ask teams about

Teams will not be asked why they are doing better (or worse) than others in making things better over time. This is partly because they might not know – and partly because it doesn’t matter that much. For example, maybe all teams feel they get along well and respect each other. Yet some teams may find it easier to get better than other teams, even if they all get along well.  This might mean that getting along matters for other reasons but might not be the answer we thought it was in terms of making things better.


Frequently Asked Questions

Is this a formal research study?

Yes. This is an observational, qualitative cross-sectional study. AFHTO has approval from the Research Ethics Board for it.

Why do this as a formal research study?

AFHTO Board has recently affirmed its commitment to playing a leadership role in primary care and, more broadly, in the Ontario healthcare sector. AFHTO needs to be able to tell the story of its leadership in a wide variety of forums to demonstrate that leadership. A formal research study (with formal ethical approval) makes it possible to share the collective wisdom of AFHTO members in credible and high-profile way to support leadership activity.

Do members HAVE to participate?

Practically everything AFHTO does is voluntary and intended to serve the members. Members can choose not to be interviewed simply by not volunteering. Nobody but they themselves will ever know that.

Can I tell my story to AFHTO but not be in the research study?

We will only include the stories of teams who agree to be part of the published study but we will listen to and share ALL the stories among the members for their own use. And all the stories will be anonymous unless a team is keen to have their name in lights, in which case we would happily oblige!

What if our team is really struggling to improve?

You are so not alone! And your story is really important. You may be doing everything “right” and still be in the place you are. That is the kind of story that will help us all see what actually is important on the ground (vs in theory). If we only talk to teams who are making good progress, we will not get useful information for those who are in the trenches, pulling out all the stops and still frustrated. You (all of you!) really are the answer!

Who should be part of the interviews?

Bring whoever you want to the table. We have a hunch about some roles that tend to be important in a team’s efforts to get better – see our list above. You may have different ideas. It is your call.

What is the risk for our team?

All of your stories will be masked (i.e., “Team X”) unless you want to see your team’s name in lights. No team’s story will be shared without their consent with any external group (E.g. MOHLTC) except in an anonymous way as part of the collected stories from the study.

Why don’t we just go to the literature to find out what the enablers of Quality improvement are?

We would love to. If you have suggestions of studies we should look at, please tell us! So far, most studies about “high performing teams” describe the way teams work but don’t compare that to a measure of performance. Teams are identified as high performers mostly by self-report or nomination by peers. Teams that self-report as high performers may or may not be the same as those with high performance on measures of quality such as those in D2D. Other studies identify high performers on the basis of administrative data (e.g. cancer screening rates, readmissions etc.). These indicators do not reflect the overall quality of care provided nor the contribution of the team, which is problematic, given the interest in high performing teams. This study addresses those gaps by comparing team characteristics (such as those examined in other studies) with demonstrated ability to improve over several iterations of D2D (which we define as “high performance”).

What is a “high performing” team?

This study focuses on enablers for improvement. That means high performance is defined as “demonstrated improvement in D2D indicators over time”. D2D indicators reflect the patient perspective (patient experience survey indicators), the provider perspective (e.g. cancer screening etc.) and the system perspective (e.g., readmissions). This is not a perfect definition of performance. It is, however, the most broad, current and ongoing source of primary care performance data available to describe the performance of primary care teams.    


Click here for a link to the original QI Enablers post.