Paper: Improving organizational climate for quality and quality of care: does membership in a collaborative help?

I'm always banging on about the need to publish "negative" results - well, I'm pleased to see this paper has received some air time. The authors investigated whether teams that were a member of a collaborative improvement process ended up with changes in their local organisational culture.  The answer is mostly a "no".

"There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics."

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

Report: Virtual QI Collaborative

It seems to have taken years for the QI family round the world to gain their trust in virtual improvement programs. My personal experience is they can work as effectively as face-to-face programs, although they need to be designed to work in a different way and need proper virtual facilitation.

There's a useful report about a virtual QI collaborative from the Robert Wood Johnson Foundation. The results look pretty good to be.

Paper: Three Collaborative models for scaling up evidence-based practices

In "101 ways to improve your collaborative" I described a number of ways to spread / scale up innovations using the collaborative model in different formats.  In this paper

Adm Policy Ment Health. 2012 Jul;39(4):278-90.
Three collaborative models for scaling up evidence-based practices.
Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM.

... the authors explore the merits and demerits of the Rolling Cohort, The Cascading Dissemination Model, and the Community Development Team.

Paper: Strategies for sustaining a quality improvement collaborative and its patient safety gains

Int J Qual Health Care. 2012 Jun 4. [Epub ahead of print]
Strategies for sustaining a quality improvement collaborative and its patient safety gains.Parand A, Benn J, Burnett S, Pinto A, Vincent C.

In their words, the conclusions are

"This study has presented what principle programme coordinators across 20 NHS organizations considered to be the key strategies to sustain their own improvement programme and its successes, during the supported phase of the programme and 1 year on. Recommendations are to consider these practical strategies in order to improve chances of maintaining changes and continuing a quality improvement programme beyond the formal cessation of the intervention."

I'm not sure what this means other than 'watch and wait' and 'learn' - which is fine.

Self Management Support Tools and Resources

Hoorah! We're finally moving from what often feels the patronising approach of "empowering patients" to finding ways to truly be partners in their care process.  There are multiple projects and programs round the world which demonstrate what can be done.  I've put together a list of resources which you may find useful.

1. My favourite are from The Health Foundation. Their package is comprehensive and includes materials for training staff so is excellent for getting the message out there in a practical way. They've also got resources for improving patient skills.

2. The Institute for Improvement has a short guide which is useful if you want to check what you may need to do to get some benefits.

3. There's an excellent write up about the long term conditions collaborative in Scotland where they identify the top high impact changes you can make.

4. Selfmanagement,.co.uk also has resources and it's one of the few places I've seen where there's information on relevant published literature.  In fact, the more I look at this website, the more I feel it is perhaps the most comprehensive and useful...

Do you have any favourite self management support resource links you'd like to share? Please comment below and I'll add to this blog.

Quality Improvement Collaboratives - New Paper

There's a new paper out (see below) which comes to a conclusion similar to ones found a few years ago - namely, in Quality Improvement Collaboratives, teams where the members have low knowledge of the topic or improvement science, are the ones which come out best. It also demonstrates that good leadership trumps the teaching of theory.

I've always thought that the more we push theory under the guise of "Improvement Science" at these short term interventions, the more we may confuse participants and in fact create a type of "performance anxiety" where they become afraid of doing what comes naturally, because it has been turned into what appears to them as a right-wrong application.

Implement Sci. 2012 Jan 9;7(1):1. [Epub ahead of print]
Factors associated with the impact of quality improvement collaboratives in mental healthcare: an exploratory study.
Versteeg MH, Laurant MG, Franx GC, Jacobs AJ, Wensing MJ.

ABSTRACT:
BACKGROUND:
Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.

METHODS:
We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and a number of process of care outcomes for 1.346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.

RESULTS:
No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.

CONCLUSIONS:
No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.

Three Collaborative Models for Scaling Up Evidence-Based Practices

A new paper is out is Adm Policy Mental Health (See abstract below). Two of the models are those I've presented on and published about - the rolling cohort and the cascading dissemination model. There are also subsets of these methods - see my book 101 ways to improve your collaborative. 


Three Collaborative Models for Scaling Up Evidence-Based Practices

Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM.

Source

Abstract

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed.