Friday, 10 February 2012

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 MHLaurant MGFranx GCJacobs AJWensing MJ.

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.

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.

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.

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.