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Abstract
Objectives 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.
Design Qualitative case study involving interviews with purposively sampled participants, observations and analysis of documents.
Setting The Michigan Collaborative Quality Initiatives programme.
Participants 38 participants, including clinicians and managers from 10 collaboratives, and staff from the University of Michigan and Blue Cross Blue Shield of Michigan.
Results 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.
Conclusions 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.
- Quality in health care
- HEALTH SERVICES ADMINISTRATION & MANAGEMENT
- Organisation of health services
- Health policy
- Public Hospitals
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. All data relevant to the study are included in the article or uploaded as online supplemental information. No additional data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- Quality in health care
- HEALTH SERVICES ADMINISTRATION & MANAGEMENT
- Organisation of health services
- Health policy
- Public Hospitals
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. All data relevant to the study are included in the article or uploaded as online supplemental information. No additional data are available.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Twitter @jgmcgowan, @Graham_P_Martin, @krapohlg, @MichaelEnglesbe, @jdimick1, @MaryDixonWoods
Contributors MD-W is the guarantor of the study. Concept and design: JGM, GLK, DAC and MD-W. Acquisition, analysis or interpretation of data: JGM, GPM, GLK and MD-W. Drafting of the manuscript: JGM, GPM and MD-W. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: not applicable. Obtained funding: JGM and MD-W. Administrative, technical or material support: JGM, GLK, DAC, MJE and MD-W. Supervision: MD-W.
Funding This study was funded by James McGowan’s NIHR Academic Clinical Fellowship (ACF-2016-14-011), by MD-W’s Wellcome Trust Investigator award (WT097899) and by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS institute is supported by the Health Foundation—an independent charity committed to bringing about better health and healthcare for people in the UK. MD-W is a National Institute for Health Research (NIHR) senior investigator (NF-SI-0617-10026).
Disclaimer The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Competing interests The Michigan Quality Collaboratives are supported by Blue Cross and Blue Shield of Michigan. MJE receives salary support from Blue Cross and Blue Shield of Michigan as well as the NIH and the Michigan DHHS. DAC, GLK and MJE’s institution (University of Michigan) receives a partial salary paid for by the Blue Cross Blue Shield of Michigan Value Partnerships for the Michigan Surgical Quality Collaborative. GLK, DAC and MJE are employed by the Michigan Surgical Quality Collaborative. MJE and JBD were interviewed as participants in the study.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.