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Creating effective quality-improvement collaboratives: a multiple case study
  1. Mathilde M H Strating,
  2. Anna P Nieboer,
  3. Teun Zuiderent-Jerak,
  4. Roland A Bal
  1. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Mathilde M H Strating, Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands; strating{at}bmg.eur.nl

Abstract

Objective To explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness.

Study setting 182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy.

Study design Multiple case before–after study.

Data collection 75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers).

Principal findings The degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets.

Conclusions The effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs.

  • Quality improvement collaborative
  • effectiveness
  • patient safety
  • collaborative
  • healthcare quality improvement

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Footnotes

  • Funding The Care for Better programme and the evaluation study are funded by The Netherlands Organisation for Health Research and Development (ZonMw grantnr 5942). The researchers of the evaluation study are independent from this funding organisation.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.