Spreading quality improvement in bronchiolitis care: A qualitative study of barriers and facilitators to de-implementation efforts across Alberta's healthcare settings.

Abstract

Low-value care remains prevalent in bronchiolitis management despite evidence-based guidelines. De-implementation initiatives face unique challenges compared with traditional implementation efforts, particularly when spreading across diverse healthcare settings. To identify barriers and facilitators to spreading a provincial de-implementation initiative targeting low-value bronchiolitis practices, as perceived by front-line clinician champions. This multicentre qualitative study used semistructured interviews with site champions (n = 15) across 11 facilities in Alberta, Canada, to explore barriers and facilitators to de-implementing low-value bronchiolitis practices. Interviews were conducted between January 2022 and December 2023 and analyzed using deductive thematic content analysis guided by the Consolidated Framework for Implementation Research (CFIR2.0). Five barrier themes emerged-expectations and assumptions, provider factors, contextual factors, order set use, and coronavirus disease 2019 (COVID-19) impact. Three facilitator themes were identified-project factors, individuals, and education. Common barriers across settings included staff burnout, competing organizational priorities, and misalignment between emergency department (ED) and inpatient providers. Common facilitators included interdisciplinary leadership support, well-designed data presentation with peer comparisons, and educational resources for families. Unique ED barriers involved assumptions about pretransfer testing; unique inpatient barriers also related to tests completed before admission. Successful de-implementation requires interdisciplinary approaches with supportive leadership and contextually tailored strategies. "One-size-fits-all" models are insufficient; future quality improvement initiatives should balance core intervention components with local adaptation to address system and individual capacity differences.