Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives

Grace Gao; Lindsay Vaclavik; Alvin D. Jeffery; Erica C. Koch; Katherine Schafer; Jeannie P. Cimiotti; Neha Pathak; Ingrid Duva; Christie L. Martin; Roy L. Simpson

doi:10.1055/a-2207-7396

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2024; 15(01): 026-033
DOI: 10.1055/a-2207-7396

Case Report

Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives

Grace Gao

¹Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States

²Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States

³School of Nursing, St Catherine University, St Paul, Minnesota, United States

,

Lindsay Vaclavik

⁴Department of Internal Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, United States

,

Alvin D. Jeffery

⁵Office of Nursing Services, Tennessee Valley Healthcare System, Nashville, Tennessee, United States

⁶Vanderbilt University School of Nursing, Nashville, Tennessee, United States

⁷Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Erica C. Koch

⁸Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States

⁹Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States

,

Katherine Schafer

⁸Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States

,

Jeannie P. Cimiotti

¹Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States

²Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States

,

Neha Pathak

¹Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States

,

Ingrid Duva

¹Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States

²Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States

,

Christie L. Martin

¹⁰School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States

,

Roy L. Simpson

²Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States

› Author Affiliations

Abstract

Background Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap.

Objectives This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process.

Methods We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories.

Results The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales.

Conclusion This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.

Keywords

evidence - quality improvement - standardized taxonomy - implementation barriers - implementation facilitators

Full Text

References

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