title: Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to quality improvement.
abstract: OBJECTIVE
  Despite the fact that Quality Improvement (QI) teams are widespread tools for improving performance in medical settings, little is known about what makes teams effective and successful. The goal of this study was to identify barriers and supportive conditions for QI teams to implement an effective and successful QI project to improve quality of care.
  
  
  METHODS
  Multicenter expert interviews with 17 team leaders were conducted in a cluster randomized trial. Interviews were based on a semistructured interview guide and were recorded and transcribed. Qualitative analysis was performed according to the principles of grounded theory.
  
  
  RESULTS
  The major findings of our study can be summarized in a framework of conditions that support the implementation of changes by QI teams. This framework can be divided into 5 core categories: the availability of external support, an interdisciplinary QI team, staff characteristics such as dedicated employees who are aware and experienced, and generally supportive structural circumstances. Furthermore, the interviewees reported that changes should be disseminated through, for example, repeating key elements or addressing employees directly.
  
  
  CONCLUSIONS
  Using a grounded theory-based qualitative approach, we identified a framework of conditions supportive of QI-related change, which can help project initiators to create environments that are supportive of change.
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: claudia.matthaeus@med.uni-jena.de.
authors.forename: Claudia T
authors.initials: CT
authors.lastname: Matthaeus-Kraemer
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: daniel.thomas@med.uni-jena.de.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Thomas-Rueddel
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: daniel.schwarzkopf@med.uni-jena.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwarzkopf
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: hendrik.rueddel@med.uni-jena.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Rueddel
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: bernhard.poidinger@med.uni-jena.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Poidinger
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: konrad.reinhart@med.uni-jena.de.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: frank.bloos@med.uni-jena.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Bloos
mesh_terms: D003422:Critical Care / Q000458:organization & administration* / Q000592:standards; D016638:Critical Illness; D042241:Early Diagnosis; D061345:Early Medical Intervention; D066296:Grounded Theory; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy
keywords: Critical care; Implementation research; Process evaluation; Qualitative research; Quality improvement; Sepsis