Mapping the Status of Healthcare Improvement Science through a Narrative Review in Six European Countries

What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme

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.

Qualitative evaluation of an educational intervention about healthcare improvement for nursing students

Objective: To explore the meaning of the experience and knowledge acquired by nursing students trained in healthcare improvement. Material and methods: A phenomenological approach based on the Giorgi method was made through a group discussion of 21 European students from four countries in July 2019. The data was triangulated with the testimonies of key informants and with the use of an evaluation tool specific to this topic. The analysis was also triangulated with three experienced researchers who reduced the data by consensus to eight units of meaning. Results: Nursing empowerment and horizontal health organizations were two of the most recurrent units of meaning along with professional values such as teamwork and humanization of care. Conclusions: The knowledge, attitudes and values acquired are evidence of the shortcomings in the training of future nursing professionals in Europe. The theoretical and practical approach of the sessions, as well as the mixture of cultures, were strengths for the students. It is necessary to follow up on more cases that show the return on the training investment in substantial improvements in real contexts and its impact on the quality of care.

Transforming the Future Healthcare Workforce across Europe through Improvement Science Training: A Qualitative Approach

Healthcare improvement science (HIS) is the generation of knowledge to cultivate change towards improving health systems performance. Our purpose was to evaluate the experience of European nursing students after an intensive one-week summer program conducted in 2019 at the University of Alicante in Spain. The educational intervention combined theoretical and practical HIS contents, with students from different countries, educational programs, and health systems. The intervention was evaluated under a qualitative approach through the open discussion group technique based on the method of participatory action research (PAR), with a total of 25 students who reflected about their experiences and perceptions during the intervention. The responses were used to improve the program’s contents, its didactics, and organization. Nursing empowerment, professional recognition, and healthcare research were some of the seven main categories identified through the systematic content analysis method triangulated by three experienced researchers. According to the students’ replies, values like compassion, respect, or empathy were identified as key elements of care. Promoting international students’ networking emerged as the key to creating a positive provision for change and the generation of improvement initiatives. Building a HIS culture may potentially provide future healthcare professionals with critical thinking skills and the resources needed to improve their future work settings.