Objectives: Set within the California Stroke Registry/California Coverdell Program (CSR/CCP) - a stroke-care-related quality improvement (QI) program, this study sought to do as follows: (1) describe the program’s previous prevention efforts (through quarter 1 [Q1], 2015); (2) explore what factors were influential in bringing about this programmatic state; and (3) investigate what changes could occur, in order to usher in a better future state for the program.
Methodology: Starting in quarter 2, 2015, a systematic review of twenty-seven CSR/CCP documents preceded the conduct of fourteen key informant interviews. Subsequently, content and thematic analyses of the CSR/CCP documents and interview transcripts were performed in NVivo, and, using an action research approach, key stakeholders vetted the findings and translated them into recommendations for change.
Findings: (1) In terms of the CSR/CCP’s programmatic state through Q1, 2015, it was revealed that, with respect to (a) recruitment (of registry members), (b) program infrastructure, (c) partnerships, and (d) QI activities, there was misalignment not only with the program’s original guiding vision but also with the prevailing national healthcare trends at that time. Of concern was the program’s lack of a functional data collection system to monitor stroke care - a significant and far-reaching liability. (2) With regard to factors that gave rise to this sub-par programmatic state, this study suggested that certain tangible influences (e.g., historical decisions, staffing patterns, operational constraints) and intangible factors (e.g., held beliefs, a lack of visibility, a lack of programmatic fit within the larger organization) had been important. (3) With respect to changes that could enable the CSR/CCP to achieve a more optimal future state, two key recommendations emerged: (a) that the CSR/CCP ought to adopt more explicit knowledge management practices - i.e., capturing, sharing, and using informational assets; and (b) that the CSR/CCP ought to be working cross-functionally - i.e., establishing multi-disciplinary teams, intentionally-focused on specific aspects of the program’s work.
Implications: Out of this project came key findings related to knowledge management and cross-functional teams. Taking action in these areas could enable the use of timely, relevant data in driving the change-related efforts of dedicated human and other resources. Such change could lead to an improved programmatic state, one that (1) is more in line with the CSR/CCP’s original guiding vision; and (2) could serve as a model of clinical medicine and public health coming together to improve health at the community level. While becoming consistent with national healthcare trends, an improved programmatic state could also have immediate local benefits, as the CSR/CCP likely would be more effective in its work to improve the quality of stroke care.