How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review

Zamboni, Karen; Baker, Ulrika; Tyagi, Mukta; Schellenberg, Joanna; Hill, Zelee; Hanson, Claudia

doi:10.1186/s13012-020-0978-z

Cited by 144 publications

(203 citation statements)

References 79 publications

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“…Our review builds on existing realist-based studies of healthcare collaboration (15,16,84). While these contributions draw attention to particular intervention types and contexts, our contribution provides much needed insight into the inter-organisational entities currently being promoted across healthcare settings.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have recently explored barriers to collaboration in integrated care (13), and others, the 'success factors' (14). A variety of evidence reviews have also documented different perspectives regarding inter-organisational innovations (15), improvement initiatives of all types (16), as well as collaborations between healthcare services and higher education organisations (17). However, to date, there remains limited understanding of how other inter-organisational entities such as strategic alliances, joint ventures, or buddying collaborations work.…”

Section: Rationale For Studymentioning

confidence: 99%

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Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Aunger

Millar

Greenhalgh

et al. 2020

Preprint

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BackgroundInter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, and enabling resource sharing, greater influence, and novel innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area, however further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.MethodsRealist review methodology was used, combining systematically searched papers and purposively searched ‘middle-range’ theories. The systematic review encompassed searches for reviews, commentaries, opinion pieces and case studies on HMIC, Medline, PsychINFO, and Social Policy and Practice databases and further searches were conducted using Google Scholar. Data were extracted from included studies according to relevance to the realist review.ResultsThirty-eight systematically-identified studies were included, in addition to twelve purposively-identified papers, informing the development of programme theories of how, why, and when partnerships in healthcare work. The findings led to the proposal of programme theories formulated as context-mechanism-outcome configurations, which outline what outcomes may be expected when partnerships are attempted in differing contexts. We found that it was essential to consider mechanisms underlying partnership functioning, such as building trust and faith in the collaboration, in a context of strong initial trust, to enable maximal synergy and thus collaborative performance.ConclusionAs the first realist review of inter-organisational collaborations in healthcare as an intervention for improvement, this review provides actionable evidence for policymakers and implementers, enhancing understanding of mechanisms underlying the functioning and performing of inter-organisational collaborations, as well as configuring context and entry point to aid success. Next steps in this research will test the results against further case studies and primary data to produce a further refined theory. Review registrationThis review is registered at PROSPERO with ID CRD42019149009.

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Section: Discussionmentioning

confidence: 99%

Section: Rationale For Studymentioning

confidence: 99%

Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Aunger

Millar

Greenhalgh

et al. 2020

Preprint

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“…Implementation of complex interventions in the emergency context have not had successful results in some cases [49][50][51][52], perhaps needing greater use of behaviour change theories to improve implementation design [53]. Further, this is one of few studies to examine behaviour change over an extended period (19 months).…”

Section: Methodsological Considerations and Limitationsmentioning

confidence: 99%

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

Kourouche

Curtis

Munroe

et al. 2020

Preprint

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Background: Ineffective or delayed treatment of patients with blunt chest wall injury results in high rates of morbidity and mortality. A blunt chest injury care bundle protocol (ChIP) was developed and implemented to improve evidence-based care for these patients at two regional hospitals in Australia. ChIP is an early notification system to notify specialist clinician ‘responders’ to prescribe and commence treatment for patients with blunt chest injury in the emergency department (ED). A multi-pronged implementation strategy developed using the Behaviour Change Wheel (BCW), including seven intervention functions and 15 behaviour change techniques, guided implementation. Fidelity to the implementation strategy was high, with 97.5% fully or partially implemented. Implementation fidelity is the extent to which an intervention has been implemented as intended; it affects the internal and external validity of implementation. This study evaluates the fidelity of intervention delivery (fidelity, dose and reach) at two hospitals. Methods: Pre-post implementation evaluation study. The characteristics of patients, rate of ChIP activations and components of ChIP received by eligible patients were compared pre (1 July 2015 to 21 November 2017) and post (22 November 2017 to 30 June 2019) intervention. Sample medians were compared using the non-parametric median test, with the 95% confidence of the difference estimated using the Hodges-Lehmann estimate. Differences in proportions for categorical data were compared with two-sample z-test. Logistic regression was used to adjust for group differences. Results: Overall, 97.1% of eligible patients received ChIP over the 19-month post-implementation period. Compared to the pre-implementation group the post-implementation group, were more likely to receive evidence-based treatments including high flow nasal cannula (OR=6.8 (4.8,9.6)), incentive spirometry in ED (OR=7.5 (3.2,17.6)), regular analgesia (OR=2.4 (1.5,3.8)), regional analgesia (OR=2.8 (1.5, 5.3)), Patient controlled analgesia (OR=1.8 (1.3,2.4)), and multiple specialist team reviews e.g. ICU liaison (OR=10.7 (6.9,16.7)). Conclusions: High fidelity of delivery was achieved and sustained for ChIP for the implementation of a complex intervention in the emergency context with a robust implementation plan based on theoretical frameworks. Findings from this evaluation can inform future implementation of ChIP and other multidisciplinary interventions in an emergency or acute care context. Trial registration: ANZCTR: ACTRN12618001548224, approved 17/09/2018

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“…A percentage of the maximum possible score was also calculated and 'high quality' was defined as any study achieving a score of 80% or greater. 12,14 'Low quality' was defined as any study with a score of <80%. Higher scores indicate studies with reporting of higher quality.…”

Section: Risk Of Bias (Quality) Assessmentmentioning

confidence: 99%

Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study

Zheng

Hébert

Chatziperi

et al. 2020

British Journal of Anaesthesia

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Background: Current guidelines for perioperative management of coronavirus disease 19 (COVID-19) are mainly based on extrapolated evidence or expert opinion. We aimed to systematically investigate how COVID-19 affects perioperative management and clinical outcomes, to develop evidence-based guidelines. Methods: First, we conducted a rapid literature review in EMBASE, MEDLINE, PubMed, Scopus, and Web of Science (January 1 to July 1, 2020), using a predefined protocol. Second, we performed a retrospective cohort analysis of 166 women undergoing Caesarean section at Tongji Hospital, Wuhan during the COVID-19 pandemic. Demographic, imaging, laboratory, and clinical data were obtained from electronic medical records. Results: The review identified 26 studies, mainly case reports/series. One large cohort reported greater mortality in elective surgery patients diagnosed after, rather than before surgery. Higher 30 day mortality was associated with emergency surgery, major surgery, poorer preoperative condition and surgery for malignancy. Regional anaesthesia was favoured in most studies and personal protective equipment (PPE) was generally used by healthcare workers (HCWs), but its use was poorly described for patients. In the retrospective cohort study, duration of surgery, oxygen therapy and hospital stay were longer in suspected or confirmed patients than negative patients, but there were no differences in neonatal outcomes. None of the 262 participating HCWs was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when using level 3 PPE perioperatively. Conclusions: When COVID-19 is suspected, testing should be considered before non-urgent surgery. Until further evidence is available, HCWs should use level 3 PPE perioperatively for suspected or confirmed patients, but research is needed on its timing and specifications. Further research must examine longer-term outcomes. Clinical trial registration: CRD42020182891 (PROSPERO).

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How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review

Cited by 144 publications

References 79 publications

Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Why do some inter-organisational collaborations in healthcare work when others do not? A realist review

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study

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