Posted: May 24th, 2022

Osf Case Study Barriers to Qi Implementation

barriers may interfere with implementing or revising the quality measures described in the study?

Barriers that can interfere with implementing or revising the quality measured described in the case study include natural resistance to change. Any change initiative, no matter how worthwhile or beneficial, will be met with resistance from people who are naturally reluctant to change. Beyond this fundamental barrier, though, was the need to change the organizational culture that was in place to one that placed a high premium on developing a “culture of safety” that embedded the need for safety throughout the organizational structure (Jinkerson & Vardiman, 2011).

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Another potential barrier to implementation were the daily obligatory “safety visibility” briefings required of all staff members. Even those these meetings were intended to last just 5 to 10 minutes, it is reasonable to suggest that clinicians must plan and prepare for these meetings, travel to the meeting location and back to their workplace again, thereby consuming as much as a half an hour out of a busy day — every day. Dedicated clinicians may be reluctant to subject themselves to this daily regimen of “harping” about safety when they have better things to do — at least from their perspectives.

The most poignant barrier to implementation of the quality measures described in the case study was the “walk-through” by senior leaders in an effort to gather safety-related information from staff. It is also reasonable to suggest that staff members who are seen divulging sensitive information about safety issues to these senior leaders may be perceived as whistleblowers rather than well-intentioned. The fear of being perceived in this fashion by peers and subordinates may represent a profound barrier to implementation. Moreover, these walk-throughs might be negatively regarded by staff members who perceive them as being spied on instead of inspected. These events would likely be highly disruptive to clinical care processes and would not be well received during periods of high patient volume or emergencies.

How could the organizations overcome those barriers?

The best way to overcome the barriers to implementation would be to first eliminate the daily safety meetings and replace them with a weekly entry in the health care facility’s newsletter. The entry should include the results of the periodic survey of organizational culture climate, as well as the results of the quality improvement measures described in the case study, with successes and failures highlighted. This approach is also congruent with Joint Commission guidelines that require all services to discuss quality assurance issues of interest to them in their staff meetings as codified in their minutes. This move would likely be perceived by clinicians as respect for the daily rigors of delivery high quality health care services in a tertiary health care facility where every minute counts.

The second way to mitigate the barriers to implementation would be to eliminate the periodic walk-throughs by senior staff. These senior staff walk-through should be replaced by including safety issue reporting in the existing hospital-wide intranet that would allow any staff members, visitor or others to immediately report safety issues that represent an immediate danger and assign a priority to their resolution. These reports would be aggregated and trends identified for targeting with specific interventions.

Finally, assuming the daily briefing and walk-throughs continue, the need for these steps should be carefully and completely explained to all affected staff members so they will understand the need for their participation and that there will be no repercussions for divulging safety-related information about their services or units. Indeed, some organizations have elected to reward such reporting in an effort to collect as much relevant safety-related data as possible (Zahlis 2008).


Jinkerson, D.L. & Vardiman, P.D. (2011, Annual). Building a culture of safety. Journal of Critical Incidents, 4, 37.

Zahlis, D. (2008, July). Incentives: Let their paychecks be their incentive! Occupational

Hazards, 70(7), 19.

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