Barriers and Facilitators to the Implementation and Adoption of a Continuous Quality Improvement Program in Surgery: A Case Study.

INTRODUCTION: As postoperative adverse events (AEs) drive worsened patient experience, longer length of stay, and increased costs of care, surgeons have long sought to engage in innovative approaches aimed at reducing AEs to improve the quality and safety of surgical care. While data-driven AE performance measurement and feedback (PMF) as a form of continuing professional development (CPD) has been presented as a possible approach to continuous quality improvement (CQI), little is known about the barriers and facilitators that influence surgeons' engagement and uptake of these CPD programs. The purpose of this knowledge translation informed CPD study was to examine surgeons' perspectives of the challenges and facilitators to participating in surgical CQI with the broader objective of enhancing future improvements of such CPD interventions. METHODS: Using Everett Rogers diffusion of innovations framework as a sampling frame, the participants were recruited across five surgical divisions. An exploratory case study approach, including in-depth semistructured interviews, was employed. Interview transcripts were analyzed and directly coded using the Theoretical Domains Framework. RESULTS: Directed coding yielded a total of 527 coded barriers and facilitators to behavior change pertaining to the implementation and adoption of PMF with the majority of barriers and facilitators coded in four key theoretical domains environmental context and resources, social influences, knowledge, and beliefs about consequences. A key barrier was the lack of support from the hospital necessitating surgeons' self-funding their own PMF programs. Facilitators included having a champion to drive CQI and using seminars to facilitate discussions around CQI principles and practices. DISCUSSION: This study identified multiple barriers and facilitators to surgeons' engagement and uptake of a data-driven PMF system in surgery. A key finding of the study was the identification of the influential role of positive deviance seminars as a quality improvement and patient safety mechanism that encourages surgeon engagement in PMF systems.

Definitions of Physician Certification Used in the North American Literature: A Scoping Review.

INTRODUCTION: The authors sought to identify how physician specialty certification is defined in the North American literature. METHODS: A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. RESULTS: A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. DISCUSSION: Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.

Methods of nursing certification in North America-A scoping review.

BACKGROUND: Definitions of nursing certification are lacking in the research literature and research on certification in nursing is remarkably limited. METHODS: A six-stage scoping review framework was used to identify the nature, extent, and range of certification within the nursing literature. FINDINGS: Thirty-six articles were included in this scoping review. Most originated in the United States (89%), were classified as research articles (56%), and used a quantitative approach (90%). The majority focused on initial certification (50%), and written examination was the most prevalent approach to certification (39%). Missing and incomplete data were prevalent. DISCUSSION: The overall lack of nursing certification origin, focus, methodological rigor, and clear certification mastery criteria have hindered meaningful study of the relationship between nursing certification and patient outcomes. Common data elements, reporting standards, and observational studies linking common data elements and patient outcomes could guide future research and improve the transparency of certification processes and reporting.

Constructing a Sensitizing Definition of Certification in Nursing for Research Purposes: A Hybrid Methodology Using Consensus-Building Approach.

OBJECTIVE: The aim of this study was to construct a sensitizing definition of certification in nursing for research purposes that can provide a foundation from which to further develop a coherent research program building evidence about the impact of certification on healthcare outcomes. BACKGROUND: The lack of a single definition of certification in nursing makes it difficult to draw conclusions about the relationship between specialty certification and patient outcomes. METHODS: This study was guided by the Delphi-Chaffee hybrid methodology proposed by Grant et al. DISCUSSION: Constructing a single, sensitizing definition of certification: 1) provides coherency for direction of certification research; 2) serves as a guide for researchers; and 3) facilitates multimethodological approaches to exploring the relationship among the different components of the definition of certification. CONCLUSION: A sensitizing definition of certification provides an opportunity for researchers to study the relationship between nursing certification and patient outcomes.

Conceptualization and Operationalization of Certification in the US and Canadian Nursing Literature.

OBJECTIVE: To identify how certification is defined, conceptualized, and discussed in the nursing literature. BACKGROUND: Although it is hypothesized that credentialing is associated with better patient outcomes, the evidence is relatively limited. Some authors have suggested that the lack of consistency used to define certification in nursing literature may be one of the dominant obstacles in credentialing research. METHODS: This scoping review was guided by Arksey and O'Malley's framework, and quantitative and qualitative analyses were conducted. RESULTS: The final data set contained a total of 36 articles, of which 14 articles provided a referenced definition of certification. Thematic analysis of the definitions yielded 8 dominant themes. CONCLUSION: The lack of a common definition of certification in nursing must be addressed to advance research into the relationship between certification processes in nursing and healthcare outcomes.

Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scoping Review.

PURPOSE: This scoping review explored the barriers and facilitators that influence engagement in and implementation of self-directed learning (SDL) in continuing professional development (CPD) for physicians in Canada. METHOD: This review followed the six-stage scoping review framework of Arksey and O'Malley and of Daudt et al. In 2015, the authors searched eight online databases for English-language Canadian articles published January 2005-December 2015. To chart and analyze data from the 17 included studies, they employed a two-step analysis process composed of conventional content analysis followed by directed coding applying the Theoretical Domains Framework (TDF). RESULTS: Conventional content analysis generated five categories of barriers and facilitators: individual, program, technological, environmental, and workplace/organizational. Directed coding guided by the TDF allowed analysis of barriers and facilitators to behavior change according to two key groups: physicians engaging in SDL, and SDL developers designing and implementing SDL programs. Of the 318 total barriers and facilitators coded, 290 (91.2%) were coded for physicians and 28 (8.8%) for SDL developers. The majority (209; 65.7%) were coded in four key TDF domains: environmental context and resources, social influences, beliefs about consequences, and behavioral regulation. CONCLUSIONS: This scoping review identified five categories of barriers and facilitators in the literature and four key TDF domains where most factors related to behavior change of physicians and SDL developers regarding SDL programs in CPD were coded. There was a significant gap in the literature about factors that may contribute to SDL developers' capacity to design and implement SDL programs in CPD.