Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Nov 17:4:74.
doi: 10.1186/1748-5908-4-74.

Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes

Michel L A Dückers  1 , Peter Spreeuwenberg, Cordula Wagner, Peter P Groenewegen
Affiliations

Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes

Michel L A Dückers et al. Implement Sci. .

Abstract

Introduction: Despite the popularity of quality improvement collaboratives (QICs) in different healthcare settings, relatively little is known about the implementation process. The objective of the current study is to learn more about relations between relevant conditions for successful implementation of QICs, applied changes, perceived successes, and actual outcomes.

Methods: Twenty-four Dutch hospitals participated in a dissemination programme based on QICs. A questionnaire was sent to 237 leaders of teams who joined 18 different QICs to measure changes in working methods and activities, overall perceived success, team organisation, and supportive conditions. Actual outcomes were extracted from a database with team performance indicator data. Multi-level analyses were conducted to test a number of hypothesised relations within the cross-classified hierarchical structure in which teams are nested within QICs and hospitals.

Results: Organisational and external change agent support is related positively to the number of changed working methods and activities that, if increased, lead to higher perceived success and indicator outcomes scores. Direct and indirect positive relations between conditions and perceived success could be confirmed. Relations between conditions and actual outcomes are weak. Multi-level analyses reveal significant differences in organisational support between hospitals. The relation between perceived successes and actual outcomes is present at QIC level but not at team level.

Discussion: Several of the expected relations between conditions, applied changes and outcomes, and perceived successes could be verified. However, because QICs vary in topic, approach, complexity, and promised advantages, further research is required: first, to understand why some QIC innovations fit better within the context of the units where they are implemented; second, to assess the influence of perceived success and actual outcomes on the further dissemination of projects over new patient groups.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study model: hypothesised relations between conditions, applied changes and outcomes.
Figure 2
Figure 2
Cross-classified data structure: project teams nested in QICs and hospitals.
See this image and copyright information in PMC

References

    1. Øvretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, McLeod H, Molfenter T, Plsek P, Robert G. Quality collaboratives: lessons from research. Quality and Safety in Health Care. 2002;11:345–351. doi: 10.1136/qhc.11.4.345. - DOI - PMC - PubMed
    1. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. The Milbank Quarterly. 2001;79:281–315. doi: 10.1111/1468-0009.00206. - DOI - PMC - PubMed
    1. Cretin S, Shortell SM, Keeler EB. An evaluation of collaborative interventions to improve chronic illness care: framework and study design. Evaluation Review. 2004;28:28–51. doi: 10.1177/0193841X03256298. - DOI - PubMed
    1. Mittman BS. Creating the evidence base for quality improvement collaboratives. Annals of Internal Medicine. 2004;140:897–901. - PubMed
    1. Øvretveit J. Health Evidence Network. Copenhagen, World Health Organisation Europe; 2003. What are the best strategies for ensuring quality of hospitals.

LinkOut - more resources