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A mixed-methods descriptive study on the role of CQI in rural surgical and obstetrical stability



Authors: Jude Kornelsen, Audrey Cameron, Kathrin Stoll, Tom Skinner, Nancy Humber, Kim Williams and Sean Ebert

Publication Date: June 2024



The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers’ experiences with CQI and the implications for service stability. Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to a lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative.


Qualitative findings from this study revealed participants’ perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships). Results found that instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care.

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