Descriptions of managerial collaboration in selected quality improvement (QI) interventions
| QI intervention | Implementation phase (proof of concept/trial/scaling up) | Managerial collaboration | Outcome |
|---|---|---|---|
| Surgical safety checklist | Trial11 12 80 | Systems changes facilitated by the local investigator—essentially fulfilling a dedicated managerial role.11 Hospital administration/management leaders required to ‘support the intervention’11 80 | Reduced in-hospital complications |
| Scaling up13 | No assessment of managerial involvement in mandatory checklist implementation. Meaningful local implementation unlikely to have taken place52 | No significant change in patient outcomes | |
| Program to reduce central line infections | Trial15 | Program 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 advocate | Reduced infection rates |
| Scaling up17 | Chief executives agreed organisations would participate, and that a director would join the local project team. In practice, most units struggled to involve executives25 | No improvement compared with controls | |
| Program to detect and mitigate organisational weaknesses | Proof of concept81 | Executive sponsor for each site team. Managerial staff less often directly involved as project team members | System defects not tractable to small clinical teams’ QI methodology |
| Program to improve interprofessional coordination | Scaling up78 | Spectrum of managerial involvement. In ‘bottom-up’ hospitals, administrators delegated and served as resources. In ‘top-down’ hospitals, managers primarily drove the change effort | Co-leadership of top-level administrators and front-line champions best facilitated implementation and spread of the intervention |