QUALITY IMPROVEMENT COLLABORATIVES

Kupu Taurangi Hauora o Aotearoa

CollaborateCollaborating • 1. to work, one with another;

cooperate, as on a literary work: They collaborated on a novel.

• 2. to cooperate, usually willingly, with an enemy nation, especially with an enemy occupying one's country: He collaborated with the Nazis during World War II.

• Collaboration – it literally means labouring together. The word raises visions of intention – people working together toward some worthy goal. There is a sense of purpose, of collegiality, of sweat and of joint learning. The word feels like hard yet rewarding work. For most in health care, it feels familiar.

Charles M Kilo 1999

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 isan 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 buy-in

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 EXPERIENCEImproving 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