Table 3.

Facilitators and barriers to implementing quality indicators: N = 5 articles.

CATEGORY	FACILITATORS	BARRIERS
Indicator characteristics	Well-recognized definitions Clear definitions Evidence-based Inclusive (cover important areas) Reflect current knowledge Based on reliable, complete data Represent an “open” agenda	Lack of precision
Promotional strategies	Focus on services endorsed by a government task force Can be used to demonstrate clinical competence Credible indicators Indicators linked to performance incentives Existence of a “product” champion to enthuse and educate Develops capacity to monitor care	Viewing indicators as a threat to autonomy Viewing indicators as not credible Viewing indicators as tools to penalize bad performance Financial penalties based on performance areas beyond the scope of professional control
Implementation strategies	Use assessors with medical or research expertise Indicators selected sparingly Indicator information is part of documenting care Documentation method is user-friendly and guides care delivery Documented data are computer-ready Use previously developed tools Use of an audit tool There is an implementation plan Create a multidisciplinary quality improvement team	Using government-associated assessors Lack of definitive diagnoses in charts Difficult-to-define intervention thresholds
Resources	Information technology is current or resources available for upgrading Time is available for interpreting and acting on indicator data Practical support for data entry Capital available for extra costs	Incompatible computer systems Generating indicators is costly Labour intensive Requirement for external staff Lack of computer training Increased workload
Individual-level factors	Staff are competent in documentation Staff have good communication and collaboration skills Indicators are a personal interest or responsibility Staff have good computer skills	Staff have limited computer skills Difficulties understanding indicator-related terminology or concepts Confusion in applying Read codes Reduced professional autonomy and trust Short-term expectations of improved quality of care
Organizational-level factors	Multistakeholder involvement Board members are aligned with implementation plan Team agreement on purpose, benefits, and importance of indicators	Some services not recorded in medical record or are difficult to find No clear responsibility for data entry Perceived lack of time to plan Lack of team approach to change Limited interprofessional communication
External factors	Access to expert advice about clinical issues Indicators “fit in” with local initiatives and policies	Competition between practices