title: Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study.
abstract: OBJECTIVE
  The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.
  
  
  METHODS
  Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.
  
  
  RESULTS
  Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.
  
  
  CONCLUSIONS
  This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.
authors.affiliation: Department of Gastroenterology,Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK.
authors.forename: Praveen T
authors.initials: PT
authors.lastname: Rajasekhar
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Rees
authors.forename: Catherine
authors.initials: C
authors.lastname: Nixon
authors.forename: James E
authors.initials: JE
authors.lastname: East
authors.forename: Sally
authors.initials: S
authors.lastname: Brown
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D058996:Quality Improvement; D018570:Risk Assessment
keywords: Adenoma detection rate; Evaluation; Implementation; Qualitative interview study; Quality improvement; Service improvement