Table 4

Challenges aligned to the IHI Quality Improvement Competency Framework

Donabedian model of quality
Practice-based learning and improvement competency
 DomainStructure (staffing/infrastructure)Process (care processes/knowledge exchange)Outcomes (clinical outcomes/sustainable change)
 Customer knowledge—patients’ perspectives and needsEffectively engaging patients in the implementation of the bundleEnsuring the COPD care bundle meets the needs of the patientsDemonstrating the COPD care bundle improves outcomes aligned to the needs of the patients
 Variation and measurement—collection and analysis of dataConnectedness of IT systems to collect data at the patient levelAccuracy and resource to collect data on care processesLinkage of process data and outcome data at a patient level
 Leading, following and making changes in healthcare—demonstration of change management skillsEngaging and training staff with the necessary skills for implementation and evaluation of complex interventionsDelivering required care processes to reduce variationSustaining change
 Developing new, locally useful knowledge—demonstrating development and use of PDSA cycles/model for improvementStaff capacity to develop skills required for iterative design and feedbackUnderstanding the connectivity between care processesLinking data to behaviour change and demonstrating causal linkage
Systems-based practice competency
 Healthcare as process/system—engaging all patients in the healthcare systemRepresentativeness of patient involved and engagedCapturing all patients eligible for interventionDemonstrating population level health benefits
 Collaboration—networking, joint working and sharing knowledge and ideas within and across organisations and between similar servicesEngagement between care providers and third sector organisationsSharing information about patient care Competition versus collaboration
 Social context and accountability—understanding conditions from a social perspective linking with health and social care modelRange of issues affecting disease beyond the biomedical model of healthcare Conflicting priorities between different health and social care organisations and third sector providersDemonstrating and sustaining system wide changes
  • IHI, Institute for Healthcare Improvement; PDSA, Plan-Do-Study-Act.