Project management

Challenges Involved with Quality and Safety Implementation and Sustainability

When integrating change into practice, it’s important to understand the challenges involved with quality and safety implementation and sustainability. This will allow for adequate planning and preparation.  This is the second article in a series describing challenges encountered in this area, and it highlights lack of upper-level support, project fatigue, inadequate personnel, and competing priorities. These represent an organizational commitment to quality and safety, adequate support, and the use of an organized approach with careful consideration of the current state of project work and what is being asked of all staff involved. 

Upper-Level Support

Hospital leadership, consisting of a board of directors and senior leadership, is responsible for keeping safety at the forefront. This is accomplished through developing a culture of safety, supporting quality and safety work, and regularly monitoring progress. Hospital leadership plays a key role in establishing the hospital vision and mission and ensuring alignment with quality and safety. Literature supports the positive influence of boards on quality in high-performing hospitals through the organized use of data, including goal setting and regular tracking of data performance (Agency for Healthcare Leadership and Quality, n.d.).  

Here are a few examples of what upper-level support looks like for quality and safety work:  

  • Supporting and providing resources for obtaining and analyzing data including the development of dashboards
  • Project management support 
  • Funding approval for various quality and safety initiatives (i.e. electronic record optimization, technology to enhance safety, training/education)
  • Leadership walkarounds- involves executive leaders regularly visiting units and discussing safety concerns with frontline staff. This can help to improve the safety culture by demonstrating upper-level support. 

In contrast, a lack of hospital leadership support can lead to insufficient support for the previously stated elements, along with a disconnect between frontline staff and executive leadership around safety concerns, barriers, and the day-to-day reality. 

Project fatigue, Competing priorities, and Lack of personnel

Project fatigue describes a state in which there are multiple simultaneous ongoing projects being conducted. For example, a clinical unit may be striving to improve hand hygiene, improve perinatal care core measures, and increase patient experience. The additional work brought about, as a result, can be overwhelming for frontline staff and leadership involved, especially if they are already being stretched thin (Pronovost, 2015). 

Competing priorities describe a state in which there are many “asks” being requested and different project work will need to be prioritized. For example, if a serious safety event has occurred and quality improvement changes need to be made as a result, priority would shift to this over other initiatives, at least initially. 

Lastly, a lack of personnel to conduct the work poses a significant barrier to implementation. This may be a result of not having adequate quality support staff in place to lead the work and monitor progress, along with a lack of frontline staff available due to staffing shortages and turnover. As mentioned earlier, project fatigue can also lead to a lack of personnel to do the work, and those left may be overburdened with tasks.

Ideally, the team should consist of multidisciplinary members to ensure all perspectives are captured. In addition, utilizing staff in various areas of expertise enables more resources. This may include quality, data analytics, informatics, project management, frontline staff, and any other pertinent focus areas. 


In summary, awareness of the challenges encountered in quality and safety implementation will help to inform adequate planning and preparation. It starts at the top, with hospital leadership promoting and supporting these efforts. In addition, the key to success is careful consideration and organization around current quality work, competing demands, and the increased workload required by staff that may already be overburdened.

*If this article interests you, you may also enjoy my book titled: Obstetric and Neonatal Quality and Safety (C-ONQS) Study Guide: A Practical Resource for Perinatal Nurses, available on amazon: Amazon_obneonatalstudyguide


Agency for Healthcare Leadership and Quality (n.d.). Leadership Role in Improving Safety. Retrieved from

Pronovost, P. (2015, June 10). A cure for ‘initiative fatigue’?: Voices for Safer Care. Retrieved from

Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS

2 thoughts on “Challenges Involved with Quality and Safety Implementation and Sustainability”

  1. Samantha Kenning

    Perinatal Quality Nurse here– I truly appreciate your dedication to this realm of obstetrical and neonatal nursing. Thank you! 🙂

    1. Thank you Samantha! I am also a former Perinatal Safety Nurse :). My goal is to educate, help to elevate practice, get people excited about all the good that can come about as a result of Q&S efforts, and ultimately contribute on a broad scale to improve patient outcomes. I appreciate your feedback!

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