title: Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study.
abstract: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice.
  
  
  
  Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews.
  
  
  
  A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department.
  
  
  
  Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.
authors.affiliation: EA 7438 MOS, EHESP (French School of Public Health), Rennes, France. mathias.waelli@ehesp.fr.|EHESP, 8 rue Maria Helena Vieira Da Silva - 75014, Paris, France. mathias.waelli@ehesp.fr.
authors.forename: Mathias
authors.initials: M
authors.lastname: Waelli
authors.affiliation: ESSEC Business School, Cergy Pontoise, France.
authors.forename: Marie-Léandre
authors.initials: ML
authors.lastname: Gomez
authors.affiliation: EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.|Montreal University, Montreal, Canada.
authors.forename: Claude
authors.initials: C
authors.lastname: Sicotte
authors.affiliation: ESSEC Business School, Cergy Pontoise, France.
authors.forename: Adrian
authors.initials: A
authors.lastname: Zicari
authors.affiliation: CNAM (International Institute of Management), Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Bonnefond
authors.affiliation: ESSEC Business School, Cergy Pontoise, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lorino
authors.affiliation: EA 7438 MOS, EHESP (French School of Public Health), Rennes, France.|Gustave Roussy Institute, Villejuif, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Minvielle
mesh_terms: D000761:Anesthesia Department, Hospital / Q000592:standards; D005602:France; D006123:Group Practice / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D010348:Patient Care Team / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*
keywords: Anesthesia; Health care organizations; Implementation; Quality indicators