title: What impedes and what facilitates a quality improvement project for older hospitalized patients?
abstract: OBJECTIVE
  To gain insight into which factors impede, and which facilitate, the implementation of a complex multi-component improvement initiative in hospitalized older patients.
  
  
  METHODS
  A qualitative study based on semi-structured interviews. The three dimensions of Pettigrew and Whipp's theoretical framework, namely, Process, Content and Context, were used to undertake a structured data analysis.
  
  
  METHODS
  The study was conducted in 19 Dutch hospitals implementing the Frail Elderly Project.
  
  
  METHODS
  Sixty-five members of staff, including physicians, nurses and members of the policy team.
  
  
  METHODS
  The Frail Elderly Project, a Dutch quality improvement program, aims to decrease adverse events in frail older hospitalized people by implementing screening instruments and interventions targeting delirium, falls, malnutrition and physical impairment.
  
  
  METHODS
  The management of the process of implementation, participants' opinions of the program elements and contextual factors which influence the implementation.
  
  
  RESULTS
  Barriers to implementation included two process factors (insufficient involvement of clinicians and lack of time), two content factors (having divergent objectives and concerns about recommended program elements) and two contextual factors (a lack of knowledge of delirium and minimal insight into the purposes and effects of the program). Facilitating factors included one process factor (leadership), one content factor (flexibility in choosing methods) and two contextual factors (the program's guidance and the use of digital patient records).
  
  
  CONCLUSIONS
  We identified the barriers and the factors which facilitate implementing complex multi-component improvement programs concerning care for older patients. These barriers must be resolved in future improvement programs in order to ensure successful implementation.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands. m.langelaan@nivel.nl.
authors.forename: Roelie
authors.initials: R
authors.lastname: Ijkema
authors.forename: Maaike
authors.initials: M
authors.lastname: Langelaan
authors.forename: Lotte
authors.initials: L
authors.lastname: van de Steeg
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000368:Aged; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration / Q000592:standards; D006739:Hospital Administration / Q000379:methods / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009426:Netherlands / Q000453:epidemiology; D061214:Patient Safety; D010564:Personnel, Hospital; D016730:Program Development; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*
keywords: elderly; implementation; quality improvement