Kupu Taurangi Hauora o Aotearoa
QUALITY IMPROVEMENT COLLABORATIVES
Collaborate
• Collaboration – it literally
means labouring together. The
• 1. to work, one with another;
word raises visions of intention
cooperate, as on a literary work:
– people working together
They collaborated on a novel.
toward some worthy goal.
• 2. to cooperate, usually willingly,
There is a sense of purpose, of
with an enemy nation, especially
collegiality, of sweat and of
with an enemy occupying one's
joint learning. The word feels
country: He collaborated with
like hard yet rewarding work.
the Nazis during World War II.
For most in health care, it feels
familiar.
Charles M Kilo 1999
Collaborating
What is a quality improvement
collaborative?
IHI’s Collaborative Model for
Achieving Breakthrough Improvement
A Breakthrough Series Collaborative is a short-term
(6- to 15-month) learning system that brings
together a large number of teams from hospitals or
clinics to seek improvement in a focused topic area.
IHI White Paper 2003
A quality improvement collaborative is
A quality improvement methodology that “brings
together groups of practitioners from different
healthcare organisations to work in a structured
way to improve one aspect of the quality of their
service. It involves a series of meetings to learn
about best practice in the area chosen, about
quality methods and change ideas, and to share
their experiences of making changes in their local
settings”.
Ovretreit et al (2002)
A quality improvement collaborative is
an organised, multifaceted approach to quality
improvement that involves five essential features:
• there is a specified topic;
• clinical experts and experts in quality improvement
provide ideas and support for improvement;
• multi-professional teams from multiple sites participate;
• there is a model for improvement (setting targets,
collecting data and testing changes); and
• the collaborative process involves a series of structured
activities.
Hulscher et al (2009)
The Collaborative Model
Components of collaborative model
(essential)
• Ensuring leadership commitment
• Setting clear aims (including changes to be spread, target
level of performance, target population, and time frame)
• Identifying and packaging proved ideas and practices
• Developing and executing a plan to communicate and
implement the ideas
• Creating a system for measuring progress
• Establishing a process for refining the plan in response to
learning during implementation.
Components of collaborative model
• Selecting a topic for improvement
• Developing a consensus on standards of care
• Producing a “change package” (not what to do but how
to do it )
• Establishing an organisational structure to support buyin and shared responsibility with key stakeholders
• Enrolling participants
• Key learning sessions with intervening action periods
Early Collaborative Reviews
Schouten et al (2006) examined
the short and longer term effects
of a primary care/ambulatory care
collaborative aimed at improving
the management of diabetes
The quality improvement
collaborative approach was found
to be cost-effective: cost per
quality adjusted life year were
€1937 for men and €1751 for
women compared to usual care
costs.
Schouten et al (2008) explored the
effect of a collaborative in 23/69
stroke services in The Netherlands
using BTS methodology. The focus
of the study was improving stroke
care, reducing hospital length of
stay (LOS) and discharge delay (time
spent in hospital for non-medical
reasons).
LOS reduced from 18.3 to 13.3 days
(27% reduction) compared to 19.2 to
18.1 days for all other hospitals in
The Netherlands (5.7% reduction).
Discharge delay was collected in
15/17 sites and was reduced by 71%.
A Review of Published Papers
• Applied the Hulscher et al definition of a collaborative and counted how often a
significant relationship was found between any determinant and any effect
parameter eg clinical experts and quality improvement experts or teams from
multiple sites
• 121 eligible papers published between 2004 and 2007. Selected 23 papers
(describing 26 collaboratives) that assessed a relationship between any potential
determinant and any effect parameter
Highest relationships
• Organisational readiness and commitment – (organisation culture and
commitment to quality improvement)
• Leadership support
• Baseline performance
• Team climate (Engagement of nurses )
Determinants of success of quality improvement collaboratives:
what does the literature show? BMJ August 2012
Conclusions
• Quality improvement collaboratives are a widespread improvement
approach.
• Multidisciplinary teams participate in a structured process to
identify best practice and change strategies, apply improvement
methods, report results and share information about ways of
achieving improvement.
• Estimates of the total investment in collaboratives are unavailable,
but they represent substantial investments of time, effort and
funding from the healthcare system.
Determinants of success of quality improvement collaboratives:
what does the literature show? BMJ August 2012
Some advice from the NHSi
We suggest a blended change strategy with:
• A combination of top-down and bottom-up
initiatives.
• The use of social movement methodology plus
pragmatic approaches driving a lot of this
change.
• Creating frameworks for people to adapt the
national approaches locally.
• Measuring your baseline, measure constantly
over time and then use that for improvement.
NZ EXPERIENCE
Improving the Patient Journey
• 2007-08, all DHBs, acute admissions direct to
operating theatre or ward.
Central Line Associated Bacteraemia (CLAB)
• Current, all DHB ICUs, implementation insertion
and maintenance bundle.
• CMDHB 20,000 bed days
OVERSEAS EXPERIENCE
US -Save 100,000 Lives Campaign
Welsh - Save 1000 lives campaign
UK - Patient Safety Campaign