title: How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.
abstract: A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results.
authors.affiliation: Comprehensive Cancer Centre the Netherlands, Groningen, The Netherlands; Faculty of Economics and Business, University of Groningen, The Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: Gort
authors.forename: Manda
authors.initials: M
authors.lastname: Broekhuis
authors.forename: Gerdien
authors.initials: G
authors.lastname: Regts
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006126:Group Processes; D006801:Humans; D007400:Interprofessional Relations; D009426:Netherlands; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration*; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care
keywords: Breast cancer; Indicators; Multidisciplinary teams; Performance management; Quality improvement; The Netherlands