Table 1

Descriptions of managerial collaboration in selected quality improvement (QI) interventions

QI interventionImplementation phase (proof of concept/trial/scaling up)Managerial collaborationOutcome
Surgical safety checklistTrial11 12 80Systems changes facilitated by the local investigator—essentially fulfilling a dedicated managerial role.11 Hospital administration/management leaders required to ‘support the intervention’11 80Reduced in-hospital complications
Scaling up13No assessment of managerial involvement in mandatory checklist implementation. Meaningful local implementation unlikely to have taken place52No significant change in patient outcomes
Program to reduce central line infectionsTrial15Program targeted middle managers and senior hospital leaders as well as front-line staff.24 Chief executives wrote ‘commitment letter’ to the program team. Nurse manager led the project locally; project team also included a hospital executive advocateReduced infection rates
Scaling up17Chief executives agreed organisations would participate, and that a director would join the local project team. In practice, most units struggled to involve executives25No improvement compared with controls
Program to detect and mitigate organisational weaknessesProof of concept81Executive sponsor for each site team. Managerial staff less often directly involved as project team membersSystem defects not tractable to small clinical teams’ QI methodology
Program to improve interprofessional coordinationScaling up78Spectrum of managerial involvement. In ‘bottom-up’ hospitals, administrators delegated and served as resources. In ‘top-down’ hospitals, managers primarily drove the change effortCo-leadership of top-level administrators and front-line champions best facilitated implementation and spread of the intervention