The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
BMJ Open. 2023 Dec 13;13(12):e076648. doi: 10.1136/bmjopen-2023-076648.
Despite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about 'what good looks like' in collaboratives remains a persistent problem. We aimed to identify the distinctive features of a state-wide collaboratives programme that has demonstrated sustained improvements in quality of care in a range of clinical specialties over a long period.
Qualitative case study involving interviews with purposively sampled participants, observations and analysis of documents.
The Michigan Collaborative Quality Initiatives programme.
38 participants, including clinicians and managers from 10 collaboratives, and staff from the University of Michigan and Blue Cross Blue Shield of Michigan.
We identified five features that characterised success in the collaboratives programme: learning from positive deviance; high-quality coordination; high-quality measurement and comparative performance feedback; careful use of motivational levers; and mobilising professional leadership and building community. Rigorous measurement, securing professional leadership and engagement, cultivating a collaborative culture, creating accountability for quality, and relieving participating sites of unnecessary burdens associated with programme participation were all important to high performance.
Our findings offer valuable learning for optimising collaboration-based approaches to improvement in healthcare, with implications for the design, structure and resourcing of quality improvement collaboratives. These findings are likely to be useful to clinicians, managers, policy-makers and health system leaders engaged in multiorganisational approaches to improving quality and safety.
尽管质量改进合作在实践中被广泛应用，但它们的有效性证据仍然参差不齐。合作中“什么是好的”缺乏明确性仍然是一个持续存在的问题。我们旨在确定一项全州范围的合作计划的独特特征，该计划在很长一段时间内一直在一系列临床专业领域提高护理质量方面取得持续进展。
涉及有针对性抽样参与者访谈、观察和文件分析的定性案例研究。
密歇根州合作质量倡议计划。
包括来自 10 个合作组织的临床医生和管理人员以及密歇根大学和蓝十字蓝盾密歇根州的工作人员在内的 38 名参与者。
我们确定了使合作计划取得成功的五个特征：从正向偏差中学习；高质量的协调；高质量的衡量和比较绩效反馈；谨慎使用激励杠杆；以及调动专业领导力并建立社区。严格的衡量、确保专业领导力和参与、培养合作文化、为质量负责以及减轻参与站点与参与计划相关的不必要负担，对于高绩效都是至关重要的。
我们的研究结果为优化以合作方式改进医疗保健提供了宝贵的经验教训，对质量改进合作的设计、结构和资源配置具有启示意义。这些发现对于参与多组织质量和安全改进的临床医生、管理人员、政策制定者和卫生系统领导者来说可能是有用的。
