Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

Implementation Science, Jan 2012

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 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.

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Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

Implementation Science Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study Marleen H Versteeg 0 Miranda GH Laurant 0 Gerdien C Franx 1 Annelies J Jacobs 0 Michel JP Wensing 0 0 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre , P.O. Box 9101, 114 IQ healthcare, 6500 HB Nijmegen , The Netherlands 1 Trimbos Institute , Da Costakade 45, 3521 VS Utrecht, Postbus 725, 3500 AS Utrecht , The Netherlands 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 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 practicebased 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. - Background Healthcare providers worldwide are looking to improve the quality of healthcare delivery. Quality improvement collaboratives (QICs) are currently being established on a widespread basis for this purpose. QICs bring together groups of healthcare providers to work in a structured manner to improve the quality of healthcare delivery in a specific domain. Ideal domains for QICs involve interventions derived from evidence-based guidelines or, when these are not available, other best-practice information [1]. There is considerable variation in how QICs are structured and run [2]. A well-known approach consists of the adoption of the Breakthrough Series (BTS) developed and promoted by the Institute for Healthcare Improvement in the United States [3,4]. Although QICs vary in their approach, generally five essential features are involved. There is: a specific topic; clinical and quality improvement experts provide ideas and support for improvement; multi-professional teams from multiple organizations participate; a specific model is used for improvement (e.g., set targets, collect data, test for change) [5]; and a series of structured collaborative activities is undertaken (e.g., national conferences) [6]. The establishment of QICs is a popular strategy with positive but limited evidence regarding its effectiveness [6,7]. The domain of the QIC, the methods used, the organizational context, and the general healthcare setting can all influence the effectiveness of a particular QIC [1,2,8,9]. In addition, the effects of QICs in mental healthcare settings are largely unknown. Insight into the QI process in the field of mental health care is therefore needed to identify which factors promote the success of QICs and thereby improved mental healthcare [6,7]. In the present study, we evaluated the impact of QICs that are part of a nationwide program to improve mental health care in the Netherlands. The domains of the QICs were the implementation of evidence-based multidisciplinary practice guidelin (...truncated)


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Marleen H Versteeg, Miranda GH Laurant, Gerdien C Franx, Annelies J Jacobs, Michel JP Wensing. Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study, Implementation Science, 2012, pp. 1, 7, DOI: 10.1186/1748-5908-7-1