Associations between organizational characteristics and quality improvement activities of clinics participating in a quality improvement collaborative.

Kellogg School of Management, Northwestern University, Evanston, Illinois 60208, USA.
Medical care (Impact Factor: 2.94). 09/2009; 47(9):1026-30. DOI: 10.1097/MLR.0b013e31819a5937
Source: PubMed

ABSTRACT Few studies have rigorously evaluated the associations between organizational characteristics and intervention activities of health care organizations participating in quality improvement collaboratives (QICs).
To examine the relationship between clinic characteristics and intervention activities by primary care clinics that provide HIV care and that participated in a QIC.
Cross-sectional study of Ryan White CARE Act (now called Ryan White HIV/AIDS Treatment Modernization Act) funded clinics that participated in a QIC over 16 months in 2000 and 2001. The QIC was originally planned to be a more typical 12 months long, but was extended to increase the likelihood of success. Data were collected using surveys of clinicians and administrators in participating clinics and monthly reports of clinic improvement activities.
Number of interventions attempted, percent of interventions repeated, percent of interventions evaluated, and organizational characteristics.
Clinics varied significantly in their intervention choices. Organizations with a more open culture and a greater emphasis on quality improvement attempted more interventions (P < 0.01, P < 0.05) and interventions that were more comprehensive (P < 0.01, P < 0.10). Presence of multidisciplinary teams and measurement of progress toward quantifiable goals also were associated with comprehensiveness of interventions (P < 0.01, P < 0.05).
Clinic characteristics predicted intervention activities during a QIC. Further research is needed on how these organizational characteristics affect quality of care through their influence on intervention activities.

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    ABSTRACT: : Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation. : To assess the capacity of Multicounty health districts to serve as "Quality Improvement Collaboratives" and support local health departments to meet accreditation standards. : The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia. : The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district. : Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices. : Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability. : Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.
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    ABSTRACT: : The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. : To evaluate the impact of collaborative membership on organizational climate for quality and service quality. : Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. : Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. : Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. : There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. : Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.
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    ABSTRACT: Background Given dismal attendance rates in community-based care for children and families, it is critical that evidence-informed attendance engagement strategies be implemented within community service systems. There is growing research on effective methods for training in evidence-based practices (EBPs), and one method that shows promise is the learning collaborative modeled after the Institute for Healthcare Improvement’s Breakthrough Series Collaborative framework. Objective This study examines implementation outcomes of a learning collaborative based on the Breakthrough Series Collaborative that was conducted to improve attendance engagement in community-based early childhood intervention programs using evidence-informed strategies. Methods A total of 29 providers from four programs within a large regional hospital participated. Qualitative and quantitative data collected prior, during, and at the completion of the 9-month learning collaborative as part of a process evaluation. Data were analyzed to examine the feasibility, acceptability, adoption and fidelity, and planned sustainability of strategies to facilitate attendance engagement as a result of the learning collaborative. Results Results indicate that: (1) using a learning collaborative implementation method with early intervention providers was feasible; (2) the method was acceptable based on perceived improvements in attendance and a significant increase in attitudes towards EBPs; (3) the method supported successful self-reported adoption and fidelity of engagement strategies; and (4) the method facilitated planned sustainability of practice changes. Conclusions The learning collaborative can be a useful implementation strategy within early childhood intervention programs to promote the use of EBPs, including enhancing attendance engagement through evidence-informed strategies.
    Child and Youth Care Forum 10/2013; 42(5). · 1.25 Impact Factor

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