The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement

TLDR

Quality improvement initiatives are widespread yet their success varies widely, largely due to differences in contextual factors. The study aims to create a conceptual model that helps organizations and researchers understand and optimize the contextual determinants of QI success. Ten QI experts reviewed systematic literature, participated in two rounds of structured opinion gathering, and then convened to map relationships among contextual factors and construct the model. The resulting MUSIQ framework, organized by system level, identifies 25 contextual factors—microsystem and team factors directly influencing success, while organizational and environmental factors exert indirect effects—and offers a basis for guiding QI practice and future research.

Abstract

Background Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen. Objective To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project. Methods 10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model. Results The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly. Conclusions The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.