Determinants tested and their significant relation with success following participation in a collaborative
| Potential determinant as operationalised in the study | Number of significant comparisons (number of comparisons tested) | ||
|---|---|---|---|
| Short term | Maintenance | Spread | |
| Essential feature 1:there is a specified topic | |||
| Type of topic | 1 (3) | ||
| Clinical project vs operational improvement projects9 | ? (1) | ||
| Disease (asthma vs other chronic diseases)27 | 1 (2) | ||
| Essential feature 2: clinical experts and quality improvement experts provide ideas and support for improvement | |||
| Experts | 1 (1) | ||
| Helpfulness of collaborative faculty20 | 1 (1) | ||
| Ideas and support | 1 (9) | 1 (3) | 2 (5) |
| Helpfulness of change package20 | 0 (1) | ||
| Helpfulness of literature reviews20 | 0 (1) | ||
| New ideas and concepts21 22 | 1 (2) | 1 (1) | 0 (2) |
| Methods learned to test changes22 | 0 (1) | 0 (1) | 2 (2) |
| Added value in project21 | 0 (1) | ||
| New methods introduced in project21 | 0 (1) | ||
| Collaborative tools/systems simplified or tailored31 | 0 (2) | 0 (1) | 0 (1) |
| Essential feature 3: critical mass of teams from multiple sites willing to improve, share and participate | |||
| Obligatory vs voluntary participation | 0 (14) | ||
| Obligatory vs voluntary participation25 26 | 0 (14) | ||
| Organisational readiness and commitment | 3 (8) | 0 (2) | 0 (6) |
| Organisation culture27 | 0 (2) | ||
| Organisational commitment to quality improvement (focus on patient satisfaction)27 | 2 (2) | ||
| Participation has added value to our facility22 | 0 (1) | 0 (1) | 0 (2) |
| Facility ready to test changes in practice22 | 0 (1) | 0 (1) | 0 (2) |
| Part of organisation's key strategic goals21 23 | 1 (2) | 0 (2) | |
| Frontline staff support | 0 (2) | 0 (2) | |
| Support from frontline staff21 23 | 0 (2) | 0 (2) | |
| Leadership support | 2 (10) | 0 (3) | 0 (6) |
| Lack of leadership support31 | 1 (2) | 0 (1) | 0 (1) |
| Leadership support18 19 22 31 | 1 (6) | 0 (2) | 0 (3) |
| Mandate from senior leadership21 23 | 0 (2) | 0 (2) | |
| Resources | 1 (7) | 0 (3) | 1 (6) |
| Lack of funding or resources31 | 0 (2) | 0 (1) | 0 (1) |
| Obtaining appropriate funding or resources31 | 1 (2) | 0 (1) | 0 (1) |
| Sufficient resources to meet aim21–23 | 0 (3) | 0 (1) | 1 (4) |
| Time | 0 (5) | 0 (2) | 1 (5) |
| Time constraints31 | 0 (2) | 0 (1) | 1 (1) |
| Sufficient time to meet aim21–23 | 0 (3) | 0 (1) | 0 (4) |
| Baseline performance | 5 (15) | ||
| Baseline median17 18 25 29 | 5 (15) | ||
| Involving staff | 1 (7) | 0 (2) | 0 (4) |
| Specific plan to spread the information21 23 | 0 (2) | 0 (2) | |
| Regular or persistent feedback to staff about changes31 | 0 (2) | 0 (1) | 0 (1) |
| Extra effort or working with physician staff on changes31 | 1 (2) | 0 (1) | 0 (1) |
| Helpfulness of solicitation of staff ideas20 | 0 (1) | ||
| Engagement of nurses | 4 (11) | ||
| Mediating effect of an HF nurse30 | 3 (9) | ||
| Engagement of nurses13 | 1 (2) | ||
| Team climate | 7 (17) | 0 (10) | |
| Non-punitive method of investigation21 23 | 0 (2) | 0 (2) | |
| Team understood one another23 | 0 (1) | 0 (2) | |
| Good way of solving conflicts21 | 0 (2) | 0 (2) | |
| Shared vision of how to improve23 | 0 (1) | 0 (2) | |
| Systemic view of problems21 23 | 0 (2) | 0 (2) | |
| Shared vision of team goals21 | 0 (1) | ||
| Team members can express opinions21 | 0 (1) | ||
| Worked as a team before21 | 1 (1) | ||
| Team members understand one another's strengths and weaknesses21 | 1 (1) | ||
| Mutual respect among team members21 | 1 (1) | ||
| Overall perceived team effectiveness27 | 2 (2) | ||
| Team functioning19 | 2 (2) | ||
| Team composition | 3 (14) | 0 (2) | 0 (7) |
| Team size27 | 1 (1) | ||
| Team composition (percentage of physicians)27 | 0 (2) | ||
| Physician is an active participant21–23 | 0 (3) | 0 (1) | 0 (4) |
| Active engagement of a senior administrator13 | 1 (2) | ||
| Strong team leadership21 23 | 1 (2) | 0 (2) | |
| Team has a champion27 | 0 (2) | ||
| Team characteristics (eg, composition and group dynamics)31 | 0 (2) | 0 (1) | 0 (1) |
| Team stability | 1 (1) | 2 (2) | |
| Team intact at 6-month follow-up22 | 1 (1) | 2 (2) | |
| Quality-improvement experience | 1 (4) | ||
| Previous quality-improvement experience18 19 21 | 1 (4) | ||
| Essential feature 4: teams use a model for improvement | |||
| Team targets | 5 (10) | ||
| Goal setting14 | 5 (10) | ||
| Team measurement | 4 (17) | 1 (4) | 4 (13) |
| Automation and usability of an ICU's information system, ie, index score for clinical information technology15 | 1 (1) | ||
| Information systems provided useful data21 23 | 0 (2) | 0 (2) | |
| Technology or technical systems cause difficulty31 | 0 (2) | 0 (1) | 1 (1) |
| Team gathers data from patients21 23 | 0 (2) | 1 (2) | |
| Preparedness: team is familiar with measurement21 | 0 (1) | ||
| Preparedness: team has capacity to test changes22 | 0 (1) | 0 (1) | 0 (2) |
| Preparedness: team is ready to test changes in practice22 | 0 (1) | 0 (1) | 0 (2) |
| PDSA: frequency of data collection is increased13 | 1 (2) | ||
| PDSA: small tests of change are used (frequent PDSA cycles)13 | 1 (2) | ||
| PDSA: PDSA cycles are helpful20 | 0 (1) | ||
| PDSA: team quickly completes their first tests of change21 23 | 1 (2) | 0 (2) | |
| Team continued to collect data22 | 1 (1) | 2 (2) | |
| Essential feature 5: collaborative process involves a series of structured activities | |||
| Intensity of collaborative activities | 7 (36) | ||
| Traditional approach vs approach requiring less time and fewer resources11 | 0 (5) | ||
| Standard vs high-intensity arm after participation in a collaborative16 | 6 (22) | ||
| High vs medium vs low activity participants12 | 0 (1) | ||
| Engagement of the various practices10 | 1 (7) | ||
| Number of face-to-face meetings: 2 vs 3 meetings21 | 0 (1) | ||
| Specific collaborative activities | 7 (8) | 0 (2) | 0 (6) |
| Team participation in precollaborative scheduled conference calls22 23 | 2 (2) | 0 (1) | 0 (4) |
| Timeliness of submission of reports22 | 1 (1) | 0 (1) | 0 (2) |
| Helpfulness of monthly report exchange20 | 1 (1) | ||
| Helpfulness of learning session interactions20 | 1 (1) | ||
| Helpfulness of monthly conference calls20 | 1 (1) | ||
| Helpfulness of collaborative extranet20 | 0 (1) | ||
| Helpfulness of listserv discussions20 | 1 (1) | ||
| Exchange and sharing | 6 (22) | 1 (2) | 1 (4) |
| Collaborative interaction: number of ties to other teams28 | 2 (6) | ||
| Collaborative interaction: number of ties with ‘how-to’ content28 | 1 (6) | ||
| Collaborative interaction: number of leadership nominations28 | 3 (6) | ||
| Information shared with other teams21 | 0 (1) | ||
| Information from other teams used21 | 0 (1) | ||
| Information about tests of change shared22 | 0 (1) | 0 (1) | 0 (2) |
| Information shared by other teams on tests of change used22 | 0 (1) | 1 (1) | 1 (2) |
| Overall | 59 (220) | 4 (26) | 11 (76) |
One study was not included in this table. The chosen effect parameter ‘team performance at 1 year follow-up’, combining short-term and long-term effectiveness, made it impossible to disentangle the determinants of these different effects. Neily et al24 describe how ‘leadership support’, and ‘prior experience with quality improvement and teamwork’—as reported in the first face-to-face meeting—correlated closely with team performance at 1 year. There was a trend towards ‘teamwork skills’. At follow up they describe continued significant correlations between team performance and measures of ‘leadership support’, ‘teamwork skills’ and ‘skills gained from the project’ as reported at the 1-year follow-up.
HF, heart failure; ICU, intensive care unit; PDSA, Plan–Do–Study–Act.