Key Themes and Representative Quotes on Reasons for Declining Participation in an Evidence-Based QI Project
| Theme | Representative Quotes |
|---|---|
| Staffing shortages; difficulty just maintaining usual operations (primary theme) | “Our staff is not the same either, they’re not the same performers that they were pre-COVID. We’re all seeing that, as I talked to my colleagues around the country.” “We are definitely short staffed, and if it required any amount of doing extra, that would have been put on my plate, and I have no extra to give.” “It’s been increasingly difficult to keep staff, everybody seems to be short staffed. We can’t seem to find enough people to work and people that are reliable.” “COVID has really put a lot of challenges on our health centers from a staffing perspective…no one’s back to where they need to be to pay the bills. I sit in lots of venues where that’s the conversation, and to be able to give people the time they need for these types of initiatives, to do it well and to embrace what is intended, is what we’re all struggling with.” |
| Clinicians’ and staff’s lack of time to engage in additional activities (primary theme) | “I already take home too much work, which ends up getting done late at night or early in the morning. There are many days when I feel like I’m barely keeping my head above water. This wouldn’t have been a healthy addition.” |
| Concern that QI project’s time requirement, although reasonable, would be more than stated (primary theme) | “The 1 hour a month or 1 hour a quarter is not that much. It’s not too much. It’s everything in between. Right? It’s the, ‘We’re making a plan, now we want to implement it, now we need to talk about how to do that. Bring in staff. We need to follow up on the action plan and track everything and do the PDSAs.’ That’s where the time commitment is.” |
| Confidence in practice’s current ability to care for patient group targeted by QI project (secondary theme) | “[The QI project] mirrored the processes that we already have in place, so we were already screening for substance use and utilizing the SBIRT process at our medical sites. It felt like it was an additional screening we were already doing and an additional process that we kind of felt like we were already doing on top of the fact that we are kind of underwater with too much stuff to do.” |
| Ongoing changes to EHR; concern that EHR lacked capability to extract necessary performance data (secondary theme) | “Our biggest barrier at the time was our transition from one electronic medical record to another. And at that time, we weren’t sure how to pull data from that new system. We didn’t know what access we would have to the data or how we could customize reporting or anything.” “We didn’t have the capacity to pull the data in the way they wanted it to be. So we have a lot of pretty sophisticated data functionality. But it was still not what we had the ability to do without going back to our Epic team, and our Epic team is not super keen on building reports, and so that was something that we decided was not going to be beneficial for us.” |
| Expectation of compensation for participation in QI projects that take time away from direct patient care (secondary theme) | “Right in the middle of all this, I lost my key person that helps manage this data and submit a lot of those data for the programs. Truthfully, my bandwidth was strapped and I think there was $4,000 incentive to get us to do this. It would cost me more than that to do it.” |
EHR = electronic health record; PDSA = plan-do-study-act; QI = quality improvement; SBIRT = screening, brief intervention, and referral to treatment.