Quality Collaboratives: Lessons from Research

Harvard University, Cambridge, Massachusetts, United States
Quality and Safety in Health Care (Impact Factor: 2.16). 01/2003; 11(4):345-51. DOI: 10.1136/qhc.11.4.345
Source: PubMed

ABSTRACT Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

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Available from: Glenn Robert, Aug 25, 2015
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    • "Better understanding of supportive resources, specifically team coaching from different perspectives, may provide one missing link in successful improvement. The improvement collaborative (Øvretveit et al. 2002, Ayers et al. 2005, Nembhard 2009) modelled on the Institute for Healthcare Improvement Breakthrough Series (BTS) approach was first described by Kilo (1998). The BTS is grounded in Kolb's (1984) experiential learning theory, and emphasizes the central role that experience plays in the learning process by alternating learning sessions with workplace practice. "
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    ABSTRACT: AIM: To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives. BACKGROUND: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia. METHODS: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities. RESULTS: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support. CONCLUSIONS: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement.
    Journal of Nursing Management 06/2013; 22(4). DOI:10.1111/jonm.12068 · 1.14 Impact Factor
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    • "In Sweden, as in many countries, a number of QI interventions have been promoted nationally, regionally and locally over the past decades, often in parallel. The effectiveness of most such interventions is poorly understood (Grimshaw et al., 2004; Ovretveit and Gustafson, 2002; Shojania and Grimshaw, 2005). "
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    ABSTRACT: BACKGROUND: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time. OBJECTIVE: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example. DESIGN: Retrospective mixed method case study with time series diagrams. SETTING: An orthopaedic department at a Swedish university hospital. METHOD: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact. RESULTS: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained. CONCLUSIONS: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.
    International journal of nursing studies 02/2013; 50(4). DOI:10.1016/j.ijnurstu.2013.02.002 · 2.25 Impact Factor
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    • "First, the innovation should be perceived by prospective adopters as compatible with their values, norms and perceived needs (Rogers, 1995; Aubert and Hamel, 2001; Ferlie et al., 2001; Denis et al., 2002; Foy et al., 2002). Second, the benefits afforded by the innovation should be readily apparent and visible (Meyer and Goes, 1988; Grilli and Lomas, 1994; Denis et al., 2002; Øvretveit et al., 2002). Third, if an innovation is deemed compatible, and as such, involve minimal risk, it is more likely to be adopted (Meyer and Goes, 1988; Meyer et al., 1997). "
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