Multi-institutional Learning and Collaboration to Improve Quality and Safety
A quality improvement collaborative (QIC) is a broad-based approach to identifying and adopting best practices and implementing rapid organizational change. Participants share a commitment to making small, rapid tests of change that can be expanded to produce breakthrough results in a specific clinical or operational area. Historically, QICs have been effective in improving targeted topics, with evidence of positive spill-over effects on participating teams in other areas of care. State-wide surgical QICs, with varying degrees of involvement and components, have increased in prevalence in recent years with aim of decreasing complications after surgery. Such QICs have been formed in Washington, Tennessee, Florida, and Illinois and have achieved varying degrees of success in improving surgical outcomes. The Illinois Surgical Quality Improvement Collaborative has used a conceptual model to guide their QIC to influence the Hospital, Surgical QI Team, and Perioperative Microsystem levels, which translates to five major domains: guided implementation, education, comparative performance reports, networking, and funding.
A successful collaborative has been described as one that has a solid structural foundation (governance, funding, technological recourses, etc.), and one that is able to achieve collaborative learning across organizational boundaries (a multifaceted, noncompetitive team, varying levels of skill among facilitators, providing networking sessions and sustainment throughout program, etc.). Importantly, an effective team structure and strong leadership has been identified as key elements. Champions, for example, support acceptance of new ideas, have the clout to fight barriers to change and project completion.
Creating and maintaining a collaborative is resource intensive, requiring significant financial and labor support. Therefore, it is critical to evaluate the most effective way to learn and engage front line clinicians in the QIC process. Consolidated Framework for Implementation Research (CFIR) offers one such method of evaluating the effectiveness, cost-effectiveness, and success factors of a collaborative. The success and widespread adoption of collaborative methodology, and its evaluation, depends on meaningful exchanges and insights among experts and peers who apply best practices to improve care.
KeywordsQuality improvement collaborative Learning organization Community of practice Implementation Teamwork
- 2.Sollecito WA, Johnson JK, editors. McLaughlin and Kaluzny’s continuous quality improvement in health care. 4th ed. Burlington, MA: Jones and Bartlett Learning; 2013.Google Scholar
- 3.Barach P, Winters M, Potter Forbes M. NSW trauma and rehabilitation improvement collaborative. NSW Life Time Care and Support Agency; 2011.Google Scholar
- 8.Wenger E, McDermott R, Synder W. Cultivating communities of practice. Boston, MA: Harvard Business School Press; 2002.Google Scholar
- 12.Health at a Glance 2013: OECD indicators. OECD Publishing; 2013. http://dx.doi.org/10.1787/health_glance-2013-en. Accessed 31 Aug 2015.Google Scholar
- 18.Minami C, Sheils C, Bilimoria K, et al. Process improvement in surgery. Curr Probl Surg. 2016;52:49–96.Google Scholar
- 23.Wandling MW, Minami CA, Johnson JK, O’Leary KJ, Yang AD, Holl JL, Bilimoria KY. Development of a conceptual model for surgical quality improvement collaboratives facilitating the implementation and evaluation of collaborative quality improvement. JAMA Surg. 2016;151(12):1181–3. doi: 10.1001/jamasurg.2016.2817.CrossRefPubMedGoogle Scholar
- 24.Gauthier A. The challenge of stewardship: building learning organizations in healthcare. In: Chawla S, Renesch J, editors. Learning organizations. Portland, OR: Productivity Press; 1995.Google Scholar
- 29.Lofland J, Lofland L. Analyzing social settings. Belmont, CA: Wadsworth Publishing Company; 2006.Google Scholar
- 30.Bogdan R, Biklen S. Qualitative research for education: an introduction to theory and methods. Boston: Allyn & Bacon; 1992.Google Scholar
- 33.7th annual conference on the science of dissemination and implementation: transforming health systems to optimize individual and population health. Cohosted by AcademyHealth and the National Institutes of Health, 2014 December 8–9, Bethesda, MD; 2014.Google Scholar
- 34.Smith L, Laura Damschroder L, Lewis C, Weiner B. The consolidated framework for implementation research: advancing implementation science through real-world applications, adaptations, and measurement. 7th annual conference on the science of dissemination and implementation, Bethesda, MD; 2014.Google Scholar