Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

Abstract

BackgroundQuality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.MethodsWe studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and process of care outcomes for 1,346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning, and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.ResultsNo consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results, although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.ConclusionsNo general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.

A Literature Review of Learning Collaboratives in Mental Health Care: Used but Untested

“…Very few details were provided on the techniques that were taught. In some studies, the LC purveyors had already identified potential areas for improvements that sites should consider for their QI projects (e.g., domains in the chronic care model, system improvements, known implementation barriers) (7, 18, 31, 33). In addition to didactic training related to practices and QI methods, four of the studies reported that individual sites presented information to other participating QI teams during the in-person sessions (7, 15, 27, 37).…”

“…Nine studies reported external support with data collection and feedback. With a few exceptions (7, 30, 33, 34, 38), most articles provided very little information about the data collected, how it was used, or how it informed quality improvement activities.…”

“…One study examined the relation between LC components and study outcomes in an RCT (34). Three of the studies examined how elements of the collaborative process may have contributed to the findings from the collaborative by exploring issues such as the relation between reported barriers/facilitators (31), social networks (31), and theoretically- or empirically-derived attitudinal and contextual factors (e.g., team effectiveness) (33, 40) and changes in outcomes. In addition, two articles provided cost estimates for participation in the collaborative (31, 34) (see Table 3).…”

Inspiration: the forgotten element in improving skin health and wound healing?

“…The experiences, knowledge, attitude and skills of healthcare professionals have been shown (7)(8)(9) to have an impact on the quality of wound care that they deliver to patients. Efforts to improve the quality of care have been shown to have a greater impact when healthcare professionals are provided with inspirational leadership (10). Therefore, it is important to consider how inspirational leadership can be utilised in to best effect with regards to ensure that high quality wound care is consistently delivered.…”

Improving the Quality of Care for Serious Mental Illness

“…Successful strategies included support from organizational management, active QI leaders, and QI team diversity (education levels, years of employment). In QI for schizophrenia, greater outcome monitoring was associated with improved patient outcomes (Versteeg et al, 2012 ).…”