Tailoring quality improvement interventions to identified barriers: a multiple case analysis.

The prevailing view on implementation interventions to improve the organization and management of health care is that the interventions should be tailored to potential barriers. Ideally, possible barriers are analysed before the quality improvement interventions are developed to influence both type and content of the implementation intervention. While tailoring educational improvement interventions generally requires the assessment of professional knowledge and skills, less is known about methods to tailor organizational interventions. In the present study, the results of previous studies on the development of educational and organizational interventions to improve the quality of health care are examined. Qualitative analyses were conducted on a purposeful sample of 20 quality improvement studies reporting barrier analyses and covering both educational and organizational interventions. Several methods were used to identify barriers, including focus group discussions, face-to-face interviews and telephone interviews. Attention to barriers prior to the development of the intervention did not always mean that the choice of a specific type of intervention was based on such, although identified barriers were often used to adjust the specific content of the intervention. A few methods to link improvement interventions to identified barriers were described, including theory-based reasoning and iterative design processes. Results suggest there is often a mismatch between the level of identified barriers and the type of interventions selected for use. No differences in the tailoring of educational or organizational interventions could be identified. The design of quality improvement interventions appears to still be in its infancy. The translation of identified barriers into tailor-made implementation interventions is still a black box for both educational and organizational interventions.