SynthesisBMJ quality & safety2019
Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies.
Synthesis in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
77 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Process mapping in healthcare: a systematic review.BMC health services research · 2021Pooled it
- Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.BMJ open · 2021Pooled it
- Effectiveness of a virtual quality improvement training program to improve reach of weight management programs within a large health system.Health services research · 2024Trial
- The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings.Journal of general internal medicine · 2021Trial
- Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial.BMJ quality & safety · 2019Trial
- Organizational readiness for implementing infection control in European hospitals: insights from Coincidence Analysis.Implementation science communications · 2026Article
- Barriers and Facilitators to Self-Care Behaviors in People Living with Osteoporosis: A Qualitative Descriptive Study.Nursing reports (Pavia, Italy) · 2026Article
- Women's experiences of communication and supportive care during labour: a qualitative study in rural KwaZulu-Natal, South Africa.BMC pregnancy and childbirth · 2025Article
- Clinical quality registries: Establishing the socio-technical infrastructure for learning health systems.Learning health systems · 2025Article
- Advocating for Professional Advocates in Nursing and Midwifery.Policy, politics & nursing practice · 2025Article
- Quality of Work Life Determinants of Healthcare Professionals' Quiet Quitting: Towards Individual Difference.Healthcare (Basel, Switzerland) · 2025Article
- Relationships between internal facilitation processes and implementation outcomes among hospitals participating in a quality improvement collaborative to reduce cesarean births: a mixed-methods embedded case study.Implementation science communications · 2025Article
- Improving and supporting quality of care in Dutch nursing homes: a quantitative study.BMC health services research · 2025Article
- Continuous quality improvement across a South Australian health service and the role it plays in a learning health system: a qualitative study.BMC health services research · 2025Article
- Article
- Strategies for Promoting Doula Inclusivity in the Labor and Delivery Setting.Maternal and child health journal · 2025Article
- Developing and piloting a peer quality improvement coaching protocol for front-line healthcare staff.BMJ open quality · 2025Article
- Article
- Patients Safety Events at Philippine General Hospital.Acta medica Philippina · 2025Article
- Integrating Quality Improvement: A Qualitative Study of Leadership Approaches in Healthcare Services in Norwegian Municipalities.Health services insights · 2025Article
17 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
backgroundIdentifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains.
methodsSystematic review of qualitative studies that evaluated organisational characteristics of healthcare organisations that were struggling as defined by below-average patient outcomes (eg, mortality) or quality of care metrics (eg, Patient Safety Indicators). Searches were conducted in MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and Web of Science from database inception through February 8 2018. Qualitative data were analysed using framework-based synthesis and summarised into key domains. Study quality was evaluated using the Critical Appraisal Skills Program tool.
resultsThirty studies (33 articles) from multiple countries and settings (eg, acute care, outpatient) with a diverse range of interviewees (eg, nurses, leadership, staff) were included in the final analysis. Five domains characterised struggling healthcare organisations: poor organisational culture (limited ownership, not collaborative, hierarchical, with disconnected leadership), inadequate infrastructure (limited quality improvement, staffing, information technology or resources), lack of a cohesive mission (mission conflicts with other missions, is externally motivated, poorly defined or promotes mediocrity), system shocks (ie, events such as leadership turnover, new electronic health record system or organisational scandals that detract from daily operations), and dysfunctional external relations with other hospitals, stakeholders, or governing bodies.
conclusionsStruggling healthcare organisations share characteristics that may affect their ability to provide optimal care. Understanding and identifying these characteristics may provide a first step to helping low performers address organisational challenges to improvement. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42017067367.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.