title: Applying the quality improvement collaborative method to process redesign: a multiple case study.
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.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, P,O, Box 1568, 3500 BN Utrecht, the Netherlands. l.vos@lumc.nl
authors.forename: Leti
authors.initials: L
authors.lastname: Vos
authors.forename: Michel L A
authors.initials: ML
authors.lastname: Dückers
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.forename: Godefridus G
authors.initials: GG
authors.lastname: van Merode