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Determinants of success of quality improvement collaboratives: what does the literature show?
  1. Marlies E J L Hulscher1,
  2. Loes M T Schouten2,
  3. Richard P T M Grol1,
  4. Heather Buchan3
  1. 1Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Dutch Institute for Healthcare Improvement (CBO), Utrecht, The Netherlands
  3. 3Australian Commission on Safety and Quality in Health Care (ACSQHC), Darlinghurst, Australia
  1. Correspondence to Professor Dr Marlies Hulscher, Radboud University Nijmegen Medical Centre, 114 IQ Healthcare, PO Box 9101, Nijmegen 6500 HB, The Netherlands; m.hulscher{at}iq.umcn.nl

Abstract

Context The apparent inconsistency between the widespread use of quality improvement collaboratives and the available evidence heightens the importance of thoroughly understanding the relative strength of the approach. More insight into factors influencing outcome would mean future collaboratives could be tailored in ways designed to increase their chances of success. This review describes potential determinants of team success and how they relate to effectiveness.

Method We searched Medline, CINAHL, Embase, Cochrane, and PsycINFO databases from January 1995 to June 2006. The 1995–2006 search was updated in June 2009. Reference lists of included papers were reviewed to identify additional papers. We included papers that were written in English, contained data about the effectiveness of collaboratives, had a healthcare setting, met our definition for collaborative, and quantitatively assessed a relationship between any determinant and any effect parameter.

Findings Of 1367 abstracts identified, 23 papers (reporting on 26 collaboratives) provided information on potential determinants and their relationship with effectiveness. We categorised potential determinants of success using the definition for collaboratives as a template. Numerous potential determinants were tested, but only a few related to empirical effectiveness. Some aspects of teamwork and participation in specific collaborative activities enhanced short-term success. If teams remained intact and continued to gather data, chances of long-term success were higher. There is no empirical evidence of positive effects of leadership support, time and resources.

Conclusions These outcomes provide guidance to organisers, participants and researchers of collaboratives. To advance knowledge in this area we propose a more systematic exploration of potential determinants by applying theory and practice-based knowledge and by performing methodologically sound studies that clearly set out to test such determinants.

  • Quality improvement
  • Collaborative, breakthrough groups
  • Implementation science
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