Evaluating a quality improvement collaborative: a hybrid approach

PURPOSE

Quality improvement collaboratives (QICs) are a popular approach to improving healthcare services and patient outcomes. This paper evaluates a QIC implemented by a large, integrated healthcare organisation in Wales in the UK.

DESIGN/METHODOLOGY/APPROACH

This evaluation study draws on two well-established evaluation frameworks: Kirkpatrick's approach to gather data on participant satisfaction and learning and Stake's approach to gather data and form judgements about the impact of the intervention. A mixed methods approach was taken which included documentary analysis, surveys, semi-structured interviews, and observation of the QIC programme.

FINDINGS

Together the two frameworks provide a rounded interpretation of the extent to which the QIC intervention was fit-for-purpose. Broadly the evaluation of the QIC was positive with some areas of improvement identified.

RESEARCH LIMITATIONS/IMPLICATIONS

This study is limited to a QIC conducted within one organisation. Further testing of the hybrid framework is needed that extends to different designs of QICs.

PRACTICAL IMPLICATIONS

A hybrid framework is provided to assist those charged with designing and evaluating QICs.

ORIGINALITY/VALUE

Evaluation studies are limited on QICs and if present tend to adopt one framework. Given the complexities of undertaking quality improvement within healthcare, this study uniquely takes a hybrid approach.

In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data-possible factors contributing to sustained improvement in outcomes beyond the project time

BACKGROUND

Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

METHODS

Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

RESULTS

The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

CONCLUSIONS

Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.

Building collaborative capability between law enforcement and civil society leaders to prevent urban violence

OBJECTIVES

This research paper analyses how applying a Place-Based Leadership Development (P-BLD) programme adds value to an ongoing intersectoral Urban Violence Prevention Programme (IUVP) in Kenya building trust within collaboratives in the intersection between the historically adversarial law enforcement and civil society sectors.

METHODS

Data on participants' experience of the P-BLD programme were systematically collected through detailed pre- and post-session questionnaires which included a series of challenging but open questions. A framework analysis was undertaken to draw out the common themes.

RESULTS

By surfacing emotional, relational and structural tensions between law enforcement and civil society within the context of IUVP, the P-BLD programme has enabled leaders to become more open to and respecting others' perspectives as a first step towards a more collaborative mindset.

CONCLUSIONS

The P-BLD programme is having a positive impact, explicitly addressing the tensions and enabling leaders to share their concerns and challenges in working towards violence prevention at the intersection between law enforcement and civil society. Moreover, this approach is replicable creating new knowledge and sustainable mechanisms for violence prevention within urban areas across the world.

Surgical Collaboratives for Quality Improvement

How best to improve the surgical quality remains unknown. Historically, most efforts were either top down national policy efforts or local hospital/practice level efforts. This article reviews the limitations of these methods and how collaborative quality improvement a mix of local, regional, and national efforts is the most effective means of achieving sustainable, meaningful improvement in surgical care.