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Applying the quality improvement collaborative method to process redesign: a multiple case study.

Vos L, Dückers ML, Wagner C, van Merode GG - Implement Sci (2010)

Bottom Line: First, project teams did not use the provided standard change ideas, because of their need for customized solutions that fitted with context-specific causes of waiting times and delays.Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour.Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIVEL, Netherlands Institute for Health Services Research, P,O, Box 1568, 3500 BN Utrecht, the Netherlands. l.vos@lumc.nl

ABSTRACT

Background: Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.

Methods: We evaluated a Dutch process redesign collaborative of seventeen project teams using a multiple case study design. The goals of this collaborative were to reduce the time between the first visit to the outpatient's clinic and the start of treatment and to reduce the in-hospital length of stay by 30% for involved patient groups. Data were gathered using qualitative methods, such as document analysis, questionnaires, semi-structured interviews and participation in collaborative meetings.

Results: Application of the QIC method to process redesign proved to be difficult. First, project teams did not use the provided standard change ideas, because of their need for customized solutions that fitted with context-specific causes of waiting times and delays. Second, project teams were not capable of testing change ideas within short time frames due to: the need for tailoring changes ideas and the complexity of aligning interests of involved departments; small volumes of involved patient groups; and inadequate information and communication technology (ICT) support. Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour. Besides, a number of project teams reported that organisational and external change agent support was limited.

Conclusions: This study showed that the perceived need for tailoring standard change ideas to local contexts and the complexity of aligning interests of involved departments hampered the use of the QIC method for process redesign. We cannot determine whether the QIC method would have been appropriate for process redesign. Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent. In conclusion, project teams felt that necessary preconditions for successful use of the QIC method were lacking.

No MeSH data available.


Related in: MedlinePlus

Applying the model for improvement, an example
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Figure 2: Applying the model for improvement, an example

Mentions: Quality improvement collaboratives (QICs) are used increasingly in many countries to achieve large-scale improvements in performance and to provide specific remedies to overcome the typically slow diffusion of medical and healthcare innovations [1-3]. A QIC is a multifaceted method that seeks to implement evidence-based practice through sharing knowledge with others in a similar setting over a short period of time [4]. Within the QIC method, external change agents provide collaborative project teams from different healthcare departments or organisations with a clear vision for ideal care in the topic area and a set of specific changes that may improve system performance significantly [5,6]. Project teams also learn from the external change agent about the model for improvement. The model for improvement incorporates four key elements [6]: specific and measurable aims; measures of improvement that are tracked over time; key changes that will result in the desired improvement; and series of parallel testing plan-do-study-act (PDSA) cycles. Each series involves a test of one change idea (Figure 1, part A) [7]. On the basis of the results of the first test of one series, a project team can decide to refine the change idea (in case the change idea works in their context) or to start a new test series of a new change idea (in case the test did not lead to the desired result). These PDSA cycles should be short but significant, testing a big change idea in a short timeframe so that a team can identify ways to improve or change the idea [8]. In Figure 2, an example is given to illustrate the model for improvement.


Applying the quality improvement collaborative method to process redesign: a multiple case study.

Vos L, Dückers ML, Wagner C, van Merode GG - Implement Sci (2010)

Applying the model for improvement, an example
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2837614&req=5

Figure 2: Applying the model for improvement, an example
Mentions: Quality improvement collaboratives (QICs) are used increasingly in many countries to achieve large-scale improvements in performance and to provide specific remedies to overcome the typically slow diffusion of medical and healthcare innovations [1-3]. A QIC is a multifaceted method that seeks to implement evidence-based practice through sharing knowledge with others in a similar setting over a short period of time [4]. Within the QIC method, external change agents provide collaborative project teams from different healthcare departments or organisations with a clear vision for ideal care in the topic area and a set of specific changes that may improve system performance significantly [5,6]. Project teams also learn from the external change agent about the model for improvement. The model for improvement incorporates four key elements [6]: specific and measurable aims; measures of improvement that are tracked over time; key changes that will result in the desired improvement; and series of parallel testing plan-do-study-act (PDSA) cycles. Each series involves a test of one change idea (Figure 1, part A) [7]. On the basis of the results of the first test of one series, a project team can decide to refine the change idea (in case the change idea works in their context) or to start a new test series of a new change idea (in case the test did not lead to the desired result). These PDSA cycles should be short but significant, testing a big change idea in a short timeframe so that a team can identify ways to improve or change the idea [8]. In Figure 2, an example is given to illustrate the model for improvement.

Bottom Line: First, project teams did not use the provided standard change ideas, because of their need for customized solutions that fitted with context-specific causes of waiting times and delays.Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour.Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIVEL, Netherlands Institute for Health Services Research, P,O, Box 1568, 3500 BN Utrecht, the Netherlands. l.vos@lumc.nl

ABSTRACT

Background: Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.

Methods: We evaluated a Dutch process redesign collaborative of seventeen project teams using a multiple case study design. The goals of this collaborative were to reduce the time between the first visit to the outpatient's clinic and the start of treatment and to reduce the in-hospital length of stay by 30% for involved patient groups. Data were gathered using qualitative methods, such as document analysis, questionnaires, semi-structured interviews and participation in collaborative meetings.

Results: Application of the QIC method to process redesign proved to be difficult. First, project teams did not use the provided standard change ideas, because of their need for customized solutions that fitted with context-specific causes of waiting times and delays. Second, project teams were not capable of testing change ideas within short time frames due to: the need for tailoring changes ideas and the complexity of aligning interests of involved departments; small volumes of involved patient groups; and inadequate information and communication technology (ICT) support. Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour. Besides, a number of project teams reported that organisational and external change agent support was limited.

Conclusions: This study showed that the perceived need for tailoring standard change ideas to local contexts and the complexity of aligning interests of involved departments hampered the use of the QIC method for process redesign. We cannot determine whether the QIC method would have been appropriate for process redesign. Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent. In conclusion, project teams felt that necessary preconditions for successful use of the QIC method were lacking.

No MeSH data available.


Related in: MedlinePlus