Process evaluation of a person-centred outcome measures-based quality improvement program in a hospital-based palliative care in mainland China.

Purpose: This study aimed to understand Chinese palliative care clinicians' experience in integrating the Palliative Care Outcome Collaboration (PCOC) model into their clinical practice and to learn lessons for sustainability.

Methods: An explanatory mixed-methods study was conducted. Combing semi-structured in-depth interviews with palliative care clinicians guided by Normalization Process Theory (NPT) with analysis of clinical documents to examine implementation outcomes. Qualitative data were analysed using a combination of inductive and deductive content analysis, quantitative data were presented using frequencies and percentages.

Results: Twelve out of 16 clinicians participated in this study. Six months post-implementation, over half reported successful integration of the model into their unit. Implementation outcomes indicated strong clinician adherence, with all inpatients assessed and 75% of clinicians participating. Eleven sub-themes were identified within the NPT constructs, explaining the mechanisms contributing to its success and failure. These included clinicians' perception of the model's value and effectiveness (Coherence), accurate assessment and effective use of results and quality reports (Collective Action), and a supportive network that fully incorporated clinicians' views (Cognitive Participation), and aligning the PCOC model with existing workflows, reducing redundant tools, and streamlining documentation (Reflexive Monitoring).

Conclusions: To effectively implement a PCOMs-based quality improvement program into routine clinical practice, a "top-down" followed by a "bottom-up" implementation approach is recommended. Effectively utilizing the program to achieve its value and fit into existing workflows without adding unnecessary workload could ensure its sustainability. Furthermore, in countries and regions where palliative care is emerging, priorities should focus on enhancing clinicians' knowledge, self-efficacy, and supporting multidisciplinary collaboration.