All teach, all learn, all improve?: the role of interorganizational learning in quality improvement collaboratives

Abstract

Background: Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired.

Purpose: This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants' performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices.

Methodology: We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources.

Findings: The more collaborative teams used inter-OLAs, the more their organizations' performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams' use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use.

Practice implications: Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile.

Figure 1

Hypothesized model of performance improvement in collaboratives

Figure 2

Percentage of organizations reporting regular use of collaborative-related interorganizational learning activities Note. Regular use was defined as a score of 2.5 or greater for teams’ reported use of an activity on a response scale in which 0 = never, 1 = rarely, 2 = sometimes, 3 = regularly, and 4 = a lot.

Figure 3

Effect of using interorganizational learning activities (inter-OLAs) and quality-focused human resources (Q-HR) practices on performance improvement Note. High use refers to a +1 SD in use above the mean, whereas low use refers to −1 SD in use below the mean. The figure is based on the results of the logit model, which allows us to show the impact of our variables on a linear scale, per the STATA command: vibl (visualizing interactions for binary logit models). The coefficients of the logit model indicate the degree of change in the logit of the outcome for a one-unit increase in the predictor (i.e., inter-OLAs). —▲—Low use of Q-HR practices; ----●---- Mean use of Q-HR practices; ––■–– High use of Q-HR practices.