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Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members
  1. Aleidis Skard Brandrud1,
  2. Ada Schreiner2,
  3. Per Hjortdahl3,
  4. Gro Sævil Helljesen4,
  5. Bjørnar Nyen5,
  6. Eugene C Nelson6
  1. 1Vestre Viken Health Trust Ringerike, Honefoss, Norway
  2. 2Oslo University Hospital, Oslo, Norway
  3. 3Faculty of Medicine, University of Oslo, Oslo, Norway
  4. 4South-Eastern Norway Regional Health Authority, Hamar, Norway
  5. 5Norwegian Knowledge Centre for the Health Services, Oslo, Norway
  6. 6Dartmouth Medical School, Lebanon, NH, USA
  1. Correspondence to Dr P Hjortdahl, Department of Family Medicine, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, NO-0318 Oslo, Norway; per.hjortdahl{at}


Introduction The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge.

Objectives To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered.

Method Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity.

Results The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements.

Conclusion A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

  • continuous quality improvement
  • patient safety
  • breakthrough collaboratives
  • infrastructure of improvement
  • critical incident technique, collaborative
  • leadership
  • organisation

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  • ASB is the research team leader, collected the data from the focus groups and had the main responsibility for the study and the manuscript, the database and its content. AS assisted with the data collection and organising of the database. She participated in data analysis and the translation process, and in the writing of the manuscript. PH supervised the study, the research process and the writing of the manuscript. GSH assisted in planning and organising the focus-group meetings, and participated in the data analysis, translation process and final preparation of the manuscript. BN collected data from one of the focus groups, participated in the data-analysis process, has an intimate knowledge of the database and participated in writing the manuscript. ECN assisted in planning the analysis of the qualitative information, outlining the contents of the article, and editing and reading the manuscript.

  • Funding The Norwegian Medical Association Quality Assurance Fund provided partial funding for this study.

  • Competing interests None.

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