Redesigning the system from the bottom up: lessons learned from a decade of federal quality improvement collaboratives.

The Health Resources and Services Administration (HRSA) is a federal agency that provides support and resources for America's safety-net providers. For more than 10 years, HRSA has engaged in Quality Improvement Breakthrough Collaboratives that have brought together multiple stakeholders to improve quality of care and enhance patient outcomes for the most vulnerable populations. Many of these collaboratives followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative model and methodology to implement small tests of change that helped generate process improvements and clinical outcomes. This commentary summarizes HRSA's experience with these Quality Improvement Breakthrough Collaboratives, focusing on key lessons learned, in order to help inform and enhance future quality improvement efforts in both the public and the private sectors.