title: Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders' perspectives.
abstract: BACKGROUND
  Translating promising research findings into routine clinical care has proven difficult to achieve; even highly efficacious programmes remain unadopted. Critical to changing care is an understanding of the context within which the improvement effort occurs, including the climate or culture. Health care systems are multicultural due to the wide variety of professionals, subgroups, divisions and teams within them. Yet, little work describes and compares different stakeholders' views on their and others' roles in promoting successful quality improvement implementation.
  
  
  OBJECTIVE
  To identify manager and frontline staff perspectives about which organizational stakeholders should play a role in implementation efforts as well as what implementation roles these stakeholders should perform.
  
  
  METHODS
  We conducted qualitative semi-structured interviews of a purposive sample of stakeholders at the clinic, medical centre and regional network levels. Participants included stakeholders across five clinics (n = 49), their four affiliated medical centres (n = 12) and three regional networks (n = 7). Working in coding teams, we conducted a content analysis utilizing Atlas.ti Version 5.
  
  
  RESULTS
  According to informants, individuals at each organizational level have unique and critical roles to play in implementing and sustaining quality improvement efforts. Informants advocated for participation of a wide range of organizational members, described distinct roles for each group, and articulated the need for and defined the characteristics of frontline programme champions.
  
  
  CONCLUSIONS
  Involvement of multiple types of stakeholders is likely to be costly for health care organizations. Yet, if such organizations are to achieve the highest quality care, it is also likely that such involvement is essential.
authors.affiliation: Mental Health Quality Enhancement Research Initiative, North Little Rock, AR 72114, USA. kirchnerjoanne@uams.edu
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.forename: Louise E
authors.initials: LE
authors.lastname: Parker
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bonner
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Fickel
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Mona J
authors.initials: MJ
authors.lastname: Ritchie
mesh_terms: D000288:Administrative Personnel; D006268:Health Facilities; D006801:Humans; D007407:Interviews as Topic; D008503:Medical Staff; D011320:Primary Health Care; D024382:Professional Role; D011785:Quality Assurance, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs