Dawn Bravata, M.D., talks about the need for research on sustaining quality initiatives long-term and scaling them across entire healthcare systems.
One area where we found a gap in the literature where we just didn’t find studies were in the very important topics of scalability and sustainability. So very commonly when teams engage in quality improvement, as they’re doing their work and they’re actively implementing their project, they’ll see improvements in quality of care. But then when that project comes to an end, sometimes that quality improvement does not sustain. And so we really need new research and new projects that are trying to help us to understand what we can do to sustain quality improvement. And the other area where we didn’t find much research was in the area of scalability. And so that would be particularly relevant to a healthcare system where if in one hospital, for example, a team engaged in quality improvement and it was really successful and you want to spread that across the healthcare system, then you need to understand issues around scalability. And so those are two domains – sustainability and scalability — where future research should be directed.
Most of the studies were coming from developed nations, predominantly the U.S. and Canada, European countries and China. And so what we recommend is that future researchers are being sure to engage in quality measurement in developing nations and also in rural settings. So there was one study that came from Israel that described quality of care in rural settings, but beyond that, really, the bulk of the research was coming from urban settings and from developed nations.