Background and aim: Continuous quality improvement (CQI) programs may result in quality of care and outcome
improvement. However, the implementation of such programs has proven to be very challenging.
This mixed methods systematic review identifies barriers and facilitators pertaining
to the implementation of CQI programs in colonoscopy services and how they relate
to endoscopists, nurses, managers, and patients.
Methods: We developed a search strategy adapted to 15 databases. Studies had to report on
the implementation of a CQI intervention and identified barriers or facilitators relating
to any of the four groups of actors directly concerned by the provision of colonoscopies.
The quality of the selected studies was assessed and findings were extracted, categorized,
and synthesized using a generic extraction grid customized through an iterative process.
Results: We extracted 99 findings from the 15 selected publications. Although involving all
actors is the most cited factor, the literature mainly focuses on the facilitators
and barriers associated with the endoscopists’ perspective. The most reported facilitators
to CQI implementation are perception of feasibility, adoption of a formative approach,
training and education, confidentiality, and assessing a limited number of quality
indicators. Receptive attitudes, a sense of ownership and perceptions of positive
impacts also facilitate the implementation. Finally, an organizational environment
conducive to quality improvement has to be inclusive of all user groups, explicitly
supportive, and provide appropriate resources.
Conclusion: Our findings corroborate the current models of adoption of innovations. However,
a significant knowledge gap remains with respect to barriers and facilitators pertaining
to nurses, patients, and managers.
