Multi-institutional Learning and Collaboration to Improve Quality and Safety

  • Julie K. Johnson
  • Christina A. Minami
  • Allison R. Dahlke
  • Karl Y. Bilimoria


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.


Quality improvement collaborative Learning organization Community of practice Implementation Teamwork 


  1. 1.
    Ayers LR, Beyea SC, Godfrey MM, Harper DC, Nelson EC, Batalden PB. Quality improvement learning collaboratives. Qual Manag Health Care. 2005;14:234–47.CrossRefPubMedGoogle Scholar
  2. 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. 3.
    Barach P, Winters M, Potter Forbes M. NSW trauma and rehabilitation improvement collaborative. NSW Life Time Care and Support Agency; 2011.Google Scholar
  4. 4.
    Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336:1491–4.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mittman BS. Creating the evidence base for quality improvement collaboratives. Ann Intern Med. 2004;140:897–901.CrossRefPubMedGoogle Scholar
  6. 6.
    Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in health services organizations. Oxford, UK: Blackwell Publishing Inc; 2005.CrossRefGoogle Scholar
  7. 7.
    Overtveit J, Bate P, Cleary P, et al. Quality collaboratives: lessons from research. Qual Saf Health Care. 2002;11:345–51.CrossRefGoogle Scholar
  8. 8.
    Wenger E, McDermott R, Synder W. Cultivating communities of practice. Boston, MA: Harvard Business School Press; 2002.Google Scholar
  9. 9.
    Kislov R, Harvey G, Walshe K. Collaborations for leadership in applied health research and care: lessons from the theory of communities of practice. Implement Sci. 2011;6:64.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Young JQ, et al. Advancing the next generation of handover research and practice with cognitive load theory. BMJ Qual Saf. 2016;25:66–70. doi: 10.1136/bmjqs-2015-004181.CrossRefPubMedGoogle Scholar
  11. 11.
    Davis K, Drey N, Gould D. What are scoping studies? A review of the nursing literature. Int J Nurs Stud. 2009;46:1386–400.CrossRefPubMedGoogle Scholar
  12. 12.
    Health at a Glance 2013: OECD indicators. OECD Publishing; 2013. Accessed 31 Aug 2015.Google Scholar
  13. 13.
    Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare services. BMJ Qual Saf. 2016;25:1–9.CrossRefGoogle Scholar
  14. 14.
    Campbell Jr DA, Kubus JJ, Henke PK, Hutton M, Englesbe MJ. The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri. Am J Surg. 2009;198:S49–55.CrossRefPubMedGoogle Scholar
  15. 15.
    SCOAP Collaborative, Writing Group for the SCOAP Collaborative, Kwon S, Florence M, et al. Creating a learning healthcare system in surgery: Washington State’s Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years. Surgery. 2012;151:146–52.CrossRefGoogle Scholar
  16. 16.
    Guillamondegui OD, Gunter OL, Hines L, et al. Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to improve surgical outcomes. J Am Coll Surg. 2012;214:709–14. discussion 14-6.CrossRefPubMedGoogle Scholar
  17. 17.
    Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg. 2005;190:9–15.CrossRefPubMedGoogle Scholar
  18. 18.
    Minami C, Sheils C, Bilimoria K, et al. Process improvement in surgery. Curr Probl Surg. 2016;52:49–96.Google Scholar
  19. 19.
    Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91:354–94.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nembhard IM. Learning and improving in quality improvement collaboratives: which collaborative features do participants value most? Health Serv Res. 2009;44:359–78.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hall B, Hamilton B, Richards K, Bilimoria K, Cohen M, Ko C. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250:363–76.PubMedGoogle Scholar
  22. 22.
    Hall B, Richards K, Ingraham A, Ko C. New approaches to the National Surgical Quality Improvement Program: the American College of Surgeons experience. Am J Surg. 2009;198:S56–62.CrossRefPubMedGoogle Scholar
  23. 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. 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
  25. 25.
    Ovretveit J, Bate P, Cleary P, et al. Quality collaboratives: lessons from research. Qual Saf Health Care. 2002;11:345–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Mohr J, Batalden P, Barach P. Integrating patient safety into the clinical microsystem. Qual Saf Health Care. 2004;13:34–8.CrossRefGoogle Scholar
  27. 27.
    Leape LL, Kabcenell AI, Gandhi TK, Carver P, Nolan TW, Berwick DM. Reducing adverse drug events: lessons from a breakthrough series collaborative. Jt Comm J Qual Improv. 2000;26:321–31.PubMedGoogle Scholar
  28. 28.
    Kaluzny A, Veney J, Gentry J. Innovation of health services: a comparative study of hospitals and health departments. Milbank Mem Fund Q. 1974;52:51–82.CrossRefGoogle Scholar
  29. 29.
    Lofland J, Lofland L. Analyzing social settings. Belmont, CA: Wadsworth Publishing Company; 2006.Google Scholar
  30. 30.
    Bogdan R, Biklen S. Qualitative research for education: an introduction to theory and methods. Boston: Allyn & Bacon; 1992.Google Scholar
  31. 31.
    Lilford R, Chilton PJ, Hemming K, Brown C, Girling A, Barach P. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points. BMJ. 2010;341:c4413.CrossRefPubMedGoogle Scholar
  32. 32.
    Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 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. 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

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Julie K. Johnson
    • 1
  • Christina A. Minami
    • 2
  • Allison R. Dahlke
    • 2
  • Karl Y. Bilimoria
    • 2
  1. 1.Department of Surgery, Center for Healthcare StudiesInstitute for Public Health and Medicine, Feinberg School of Medicine, Northwestern UniversityChicagoUSA
  2. 2.Department of SurgerySurgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern UniversityChicagoUSA

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