Learning and improving in quality improvement collaboratives: which collaborative features do participants value most?

Abstract

Objective: To understand participants' views on the relative helpfulness of various features of collaboratives, why each feature was helpful and which features the most successful participants viewed as most central to their success.

Data sources: Primary data collected from 53 teams in four 2004-2005 Institute for Healthcare Improvement (IHI) Breakthrough Series collaboratives; secondary data from IHI and demographic sources.

Study design: Cross-sectional analyses were conducted to assess participants' views of 12 features, and the relationship between their views and performance improvement.

Data collection methods: Participants' views on features were obtained via self-administered surveys and semi-structured telephone interviews. Performance improvement data were obtained from IHI and demographic data from secondary sources.

Principal findings: Participants viewed six features as most helpful for advancing their improvement efforts overall and knowledge acquisition in particular: collaborative faculty, solicitation of their staff's ideas, change package, Plan-Do-Study-Act cycles, Learning Session interactions, and collaborative extranet. These features also provided participants with motivation, social support, and project management skills. Features enabling interorganizational learning were rated higher by teams whose organizations improved significantly than by other teams.

Conclusions: Findings identify features of collaborative design and implementation that participants view as most helpful and highlight the importance of interorganizational features, at least for those organizations that most improve.

Figure 1

Participants' Ratings of Overall Feature Helpfulness^§ Notes:^§Helpfulness ratings were compared using one-sample t-tests to a score of 3.5, the upper limit score for a moderately helpful feature. A rating significantly higher than 3.5 indicates a feature was more than moderately helpful to teams as they carried out their improvement work. They were a great help. ** = p<.01 *** = p<.001 Cohen's (1977) effect size index (d) for statistically significant features is as follows: 0.98 for collaborative faculty, 1.22 for solicitation of staff ideas, 1.00 for change package, 0.95 for PDSA cycles, 0.80 for Learning Session interactions, 0.71 for collaborative extranet, and 0.43 for literature reviews. An effect size of 0.20 suggests a small effect, 0.50 a medium effect, and 0.80 a large effect.

Figure 2

Comparison of Helpfulness Ratings by Participants that Improved Significantly and Participants that Did Not ^†=p<.10; *=p<.05; ^**=p<.01