{
  "abstract": "Background Every year, the NHS undertakes thousands of Quality Improvement (QI) projects, with the aim of improving care. QI can take many forms, ranging from a simple clinical audit to the restructuring of entire departments. In 2001, the Institute of Medicine defined quality care as that which is ‘safe, effective, patient-centred, timely, efficient and equitable’. If QI projects do not consider equity then they have the potential to maintain or even worsen health inequalities.We undertook a series of realist interviews to explore the following questions: What factors influence equity considerations amongst healthcare staff during QI? Which circumstances change equity considerations amongst healthcare staff during the process of a QI project, and in what context do these considerations change?Methods We undertook realist interviews lasting approximately 1 hour with NHS staff members who have experience undertaking QI. We recruited staff through online networks relating to QI and followed up with snowball sampling.The staff members were sampled from both clinical and non-clinicalbackgrounds and held a variety of job roles.We analysed the interviews using a realist logic to develop Context-Mechanism-Outcome-Configurations and programme theory.Results We interviewed 20 participants, 7 non-clinical and 13 clinical. We identifiedfour conflictswhich impact staff’s ability to considerequity in QI. These conflictingparadigms interact, shaping and influencing each other as they develop. They are 1) abstracted population-level inequalities vs seeing and managing patients in pressured systems; 2) the need for efficient QI in line with organisational driversvs the need for slow,careful and targeted equity-focused programmes;3) complex and idiosyncratic IT systems vs the need to have easy access to high quality equity-focused data; and 4) an organisational culture that makes decisions from the top down vs an organisational culture that values co-produced and citizen-led service design.Conclusion Health care staff experience several conflicts in their attempts to embed equity in QI. These conflicts require staff to make complex choices throughout their working days. Policymakers and practitioners should consider these conflicts when designing and implementing equity focused quality improvement.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Lucy Lara Johnson"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Geoff Wong"
    },
    {
      "affiliations": [
        "Q Community, Health Foundation, London, UK"
      ],
      "name": "Matthew Hill"
    },
    {
      "affiliations": [
        "South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK"
      ],
      "name": "Ryan Swiers"
    },
    {
      "affiliations": [
        "NHS Confederation, UK"
      ],
      "name": "Hashum Mahmood"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Angela Kam"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Kate Turner"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Sajeda Youssouf"
    },
    {
      "affiliations": [
        "Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Manish Gautam"
    },
    {
      "affiliations": [
        "EQUALQI PPI Representative, Sheffied, UK"
      ],
      "name": "Linda Jones"
    },
    {
      "affiliations": [
        "School of Clinical Medicine, University of Cambridge, Cambridge, UK"
      ],
      "name": "Lucy McCann"
    },
    {
      "affiliations": [
        "Department of Twin Research and Genetic Epidemiology, King’s College London, UK"
      ],
      "name": "Alice Macdonald Barrell"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "John Ford"
    }
  ],
  "title": "OP13 Embedding equity into quality improvement in hospitals: a realist interview study",
  "uid": "6121d6b6-6838-5e70-91f9-d1003a4eec77"
}