title: Creating effective quality-improvement collaboratives: a multiple case study.
abstract: OBJECTIVE
  To explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness.
  
  
  METHODS
  182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaboratives (QICs) focusing on patient safety and autonomy.
  
  
  METHODS
  Multiple case before-after study.
  
  
  METHODS
  75 team leaders completed a written questionnaire at the end of each QIC on achievability and degree of challenge of targets and measurability of progress. Main outcome indicators were collaborative-specific measures (such as prevalence of pressure ulcers).
  
  
  RESULTS
  The degree of effectiveness and percentage of teams realising targets varied between collaboratives. Collaboratives also varied widely in perceived measurability (F=6.798 and p=0.000) and with respect to formulating achievable targets (F=6.566 and p=0.000). The Problem Behaviour collaborative scored significantly lower than all other collaboratives on both dimensions. The collaborative on Autonomy and control scored significantly lower on measurability than the other collaboratives. Topics for which there are best practices and evidence of effective interventions do not necessarily score higher on effectiveness, measurability, achievable and challenging targets.
  
  
  CONCLUSIONS
  The effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands. strating@bmg.eur.nl
authors.forename: Mathilde M H
authors.initials: MM
authors.lastname: Strating
authors.forename: Anna P
authors.initials: AP
authors.lastname: Nieboer
authors.forename: Teun
authors.initials: T
authors.lastname: Zuiderent-Jerak
authors.forename: Roland A
authors.initials: RA
authors.lastname: Bal
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D019982:Organizational Case Studies; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D026684:Personal Autonomy; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D017751:Safety Management