title: More black box to explore: how quality improvement collaboratives shape practice change.
abstract: BACKGROUND
  Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in health care. Evidence of their effectiveness is limited, prompting calls to "open up the black box" to better understand how and why such collaboratives work.
  
  
  METHODS
  We selected a cohort of 5 primary care practices that participated in a 6-month intervention study aimed at improving colorectal cancer screening rates. Using an immersion/crystallization technique, we analyzed qualitative data that included audio recordings and field notes of QICs and practice-based team meetings.
  
  
  RESULTS
  Three themes emerged from our analysis: (1) practice staff became empowered through and drew on the QICs to advance change efforts in the face of leader/physician resistance; (2) a mix of content and media in the QIC program was important for reaching all participants; (3) resources offered at the QIC did little to spur practice change efforts.
  
  
  CONCLUSIONS
  QICs offer a potentially powerful way of disseminating health care innovations through enhanced strategies for learning and change. Creating collaborative environments in which diverse participants learn, listen, reflect, and share together can enable them to take back to their own organizations key messages and change strategies that benefit them the most.
authors.affiliation: Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, NJ08873, USA. shawek@umdnj.edu
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shaw
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Chase
authors.forename: Jenna
authors.initials: J
authors.lastname: Howard
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003299:Cooperative Behavior; D004282:Documentation / Q000379:methods; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D007857:Leadership; D008403:Mass Screening / Q000458:organization & administration*; D009042:Motivation; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D011209:Power, Psychological; D020399:Practice Management / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*