An Exploratory Analysis of the Model for Understanding Success in Quality

Quality improvement (QI) efforts to improve delivery of health care and patient outcomes achieve different results in the context of different settings.

This study sought to quantify the role of context in the success of QI initiatives using the Model for Understanding Success I Quality (MUSIQ). The MUSIQ framework was developed by a panel of QI experts (including these authors) and identifies 25 contextual factors—within the external environment (community and society), organization, microsystem (small groups of people regularly working together), and QI team—and their relationship to QI success.

Some 74 QI projects were surveyed by questionnaire. QI staff, external project staff, or consults assessed QI initiative success by whether the project met its stated aim.

Contextual factors that exhibited significant effects on QI success include:

  • Resource availability, including financial support
  • QI team leadership and skills
  • Microsystem motivation, microsystem QI culture, and microsystem QI capability

Less evidence was found for the effects of senior leader project sponsors, organizational QI culture, QI team decision-making, and microsystem QI leadership.

Given these findings, the authors intend to refine their survey instrument. They encourage health care managers and administrators to use MUSIQ to test and modify their QI interventions.

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