Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives

Grace Gao, Lindsay Vaclavik, Alvin D Jeffery, Erica C Koch, Katherine Schafer, Jeannie P Cimiotti, Neha Pathak, Ingrid Duva, Christie L Martin, Roy L Simpson

Research output: Contribution to journalArticlepeer-review


BACKGROUND:  Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap.

OBJECTIVES:  This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process.

METHODS:  We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories.

RESULTS:  The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales.

CONCLUSION:  This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalApplied clinical informatics
Issue number1
StatePublished - Aug 24 2023

Bibliographical note

Publisher Copyright:
© 2023 Georg Thieme Verlag. All rights reserved.


  • Humans
  • Quality Improvement
  • Veterans

PubMed: MeSH publication types

  • Case Reports
  • Journal Article
  • Research Support, Non-U.S. Gov't


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