NEWS | August 6, 2020

How to support clinician engagement in quality improvement?

Time, teamwork and mentorship are key to boost clinicians’ self-efficacy and effectiveness in quality improvement


Frontline clinicians are crucial in implementing and spreading innovations in health care settings. Yet, their engagement in quality improvement (QI) remains low.

Key facilitators of clinician engagement in quality improvement Key facilitators of clinician engagement in quality improvement

A new study led by UC Davis Health found that dedicated time, mentorship and participation in a professional QI network are the most significant factors to nurture clinicians’ self-efficacy and effectiveness in leading and engaging in QI activities.

The study, published in International Journal for Quality in Health Care, measured self-efficacy and effectiveness of clinicians in conducting and leading QI activities. Quality improvement (QI) uses systematic and measurable strategies to continuously improve the way health care is delivered.

“Our goal was to identify enablers and barriers to the development and engagement of clinicians in quality improvement,” said Ulfat Shaikh, director for health care quality and professor of pediatrics at UC Davis Health.

The researchers analyzed survey responses of 212 clinicians who are members and fellows of the International Society for Quality in Healthcare. The respondents, mainly physicians and nurses, were from 50 countries.

The study identified five main factors that increased clinicians’ effectiveness in QI. The factors are:

  1. Dedicated time for quality improvement
  2. Working within multidisciplinary improvement teams
  3. Professional development in QI- including formal QI training inside and outside the organization, QI organizational membership and conferences
  4. Ability to select areas for improvement that the clinician views as high priority or that interests them
  5. Organizational values and culture that supports QI

In addition to organizational factors, the study revealed that key personal strength contributing to effectiveness in QI were clinicians’ ability to identify problems that need to be fixed, reflecting on and learning from experiences and facilitating sharing of ideas.

One surprising finding was that respondents with formal administrative titles in QI were significantly more likely to report lower self-efficacy and lower perceived effectiveness in QI compared to respondents without formal administrative titles.

“Respondents with more experience may be more conservative when evaluating their own self-efficacy and effectiveness compared to those with less experience,” Shaikh explained.

The study also identified key barriers related to clinicians’ engagement in quality improvement. These barriers are inadequate time, mentorship, organizational support, and resources for professional development.

Yet, some of the most successful clinical QI projects or initiatives that respondents were involved in resulted in:

  • improved patient safety and reduction in medical errors,
  • reduced waits and delays in care,
  • reduced overuse of unnecessary services,
  • improved patient- and family-centered care, and
  • reduced health disparities.

“Our findings highlighted areas that organizations and professional development programs should focus on to promote clinician development and engagement in quality improvement,” Shaikh said.


Co-authors on this study are Peter Lachman at the International Society for Quality in Healthcare (ISQua), Andrew Padovani at the Center for Healthcare Policy and Research at UC Davis, and Siobhán McCarthy at the Institute of Leadership, Royal College of Surgeons in Ireland.

Article: Shaikh, Lachman, Padovani and McCarthy. (2020). The Care and Keeping of Clinicians in Quality Improvement. International Journal for Quality in Health Care.

Learn more:

Healthcare quality improvement (video)