The Impact of Healthcare Delivery Complexity on Practices for Clinical Quality Improvement: A Case of Healthcare Workers’ Hand Hygiene Compliance

Healthcare providers often implement quality improvement (QI) practices to improve clinical quality, which may be measured as the extent to which healthcare workers (HCWs) comply with standardized procedures designed for ensuring patient safety. Unfortunately, the effectiveness of QI practices to improve clinical quality varies from facility to facility because of healthcare delivery complexity. In this paper, we consider the contextual complexity and the provider complexity arising from healthcare delivery processes, and we propose an exploratory study based on discrete choice experiments to examine their roles in the relationship between QI practices and clinical quality. By collecting and analyzing data from 320 HCWs at a university hospital in Taiwan, we found that healthcare delivery complexity significantly moderated the effectiveness of QI practices and how they improved clinical quality. We found that the contextual complexity influenced the level of effectiveness of the QI practices, whereas the provider complexity influenced whether a QI practice may be effective or not. We also studied the effect of implementing multiple QI practices simultaneously to counter the provider complexity. We found that implementing more QI practices does not necessarily lead to better outcomes, but implementing the right ones would. Our findings provide healthcare facilities with ex ante insights for designing QI practices to improve clinical quality. Funding: W. Chen was supported by the National Natural Science Foundation of China [Grant 71902017], and C.-L. Tseng was supported by the University of New South Wales UNOVA Knowledge Hub. Supplemental Material: The online appendix is available at https://doi.org/10.1287/serv.2023.0323 .