Understanding the Components of Quality Improvement Collaboratives: A Systematic Literature Review

Abstract

Context:In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. Methods:A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. Findings:We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

“…However, there has been very limited systematic and independent analysis of the relationship between organisational factors, which shape the local context of health care, and the outcomes of patient safety interventions. 124,[216][217][218][219][220][221][222][223] In this study, guided by the established approach to realist inquiry, 228,241,242,247 we specified four main levels of contextual hierarchy: infrastructural system, institutional setting, interpersonal relations and individual. All levels except the individual are divided into substrata (see Figure 5).…”

“…Such legitimisation helps to overcome reluctance and resistance to engage, 127,414,415 and so aids its institutionalisation across NHS Wales. This end may be achieved through multidisciplinary team-based discussion, 169,189,219 including focus groups with patients 151,416 and health-care professionals, 417 together with dedicated support for interorganisational learning. 261,418 Such processes aid emancipation of staff, giving them the authority, whatever their rank, to insist on correct safety procedures being followed.…”

“…178,219 This method of service improvement has been advocated in health care for many years [420][421][422][423] and its widespread adoption in developed health-care systems promotes health-care actors' awareness of the MI-PDSA approach as accepted practice, 353 so aiding its embedding into day-to-day working. 186 …”

“…However, although public inquiries and research evidence now concur that patient safety is, in part, a matter of context, 168 there has been very limited systematic and independent analysis of the relationship between organisational factors which shape the local context of health care and the outcomes of patient safety interventions. 124,[216][217][218][219][220][221][222][223] Prior to this study, relationships between the recently advocated 'four high-priority' features of organisational context: 5,223 (1) external factors such as regulatory requirements; (2) organisational structural characteristics; (3) leadership, team work and patient safety culture; and (4) management priorities -and the outcomes of safety programmes were both undertheorised and poorly understood in empirical terms. 224 As a result, the context of patient safety remained amorphous 225 and ill defined.…”

More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care

“…Sites demonstrated commitment from the organization and core members of the unit team (e.g. director of care, lead nurse, physician, clinical nutrition manager, chief executive office of the hospital) as part of the site proposal process [48,50,[58][59][60][61]. Three of the five sites had participated in the Nutrition Care in Canadian Hospitals (NCCH) study, which was a prevalence investigation focused on describing the issues of malnutrition, outcomes and care practices in hospitals [3,7,17].…”