title: How team-based reflection affects quality improvement implementation:  a qualitative study.
abstract: Quality improvement (QI) interventions in health care organizations have produced mixed results with significant questions remaining about how QI interventions are implemented. Team-based reflection may be an important element for understanding QI implementation. Extensive research has focused on individual benefits of reflection including links between reflection, learning, and change. There are currently no published studies that explore how team-based reflection impact QI interventions. We selected 4 primary care practices participating in a QI trial that used a facilitated, team-based approach to improve colorectal cancer screening rates. Trained facilitators met with a team of practice members for up to eleven 1-hour meetings. Data include audio-recorded team meetings and associated fieldnotes. We used a template approach to code transcribed data and an immersion/crystallization technique to identify patterns and themes. Three types of team-based reflection and how each mattered for QI implementation were identified: organizational reflection promoted buy-in, motivation, and feelings of inspiration; process reflection enhanced team problem solving and change management; and relational reflection enhanced discussions of relational dynamics necessary to implement desired QI changes. If QI interventions seek to make changes where collaboration and coordination of care is required, then deliberately integrating team-based reflection into interventions can provide opportunities to facilitate change processes.
authors.affiliation: Department of Family Medicine & Community Health, UMDNJ-Robert Wood Johnson Medical School, Somerset, New Jersey 08873, USA. shawek@umdnj.edu
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shaw
authors.forename: Jenna
authors.initials: J
authors.lastname: Howard
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Etz
authors.forename: Shawna V
authors.initials: SV
authors.lastname: Hudson
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000517:prevention & control; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011361:Professional Competence; D015397:Program Evaluation; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D014481:United States