How collaborative are quality improvement collaboratives: a qualitative study in stroke care.

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Organizational Behavior

Background:

• Quality Improvement Collaboratives (QICs) are widely used but their effectiveness is debated.
• The Stroke 90:10 initiative aimed to enhance stroke care across 24 hospitals.
• This study incorporates insights from collective action and inter-organizational collaboration literature.

Purpose of the Study:

• To investigate the dynamics and outcomes of the Stroke 90:10 Quality Improvement Collaborative.
• To understand the varied experiences of participating hospitals and professionals.
• To identify factors influencing the success and challenges of inter-organizational collaboration in healthcare quality improvement.

Main Methods:

• Qualitative study involving interviews with 32 healthcare professionals.
• A focus group was conducted with the Quality Improvement Collaborative faculty team.
• Analysis utilized a modified Framework Analysis, integrating literature-based constructs and empirical themes.

Main Results:

• Participants attributed stroke care improvements to the collaborative, citing enhanced community and focus.
• Experiences varied due to differing starting performance levels and prior quality improvement experience.
• Observed behaviors included collaboration, competition, and free-riding, influenced by intra-organizational support and competing pressures.

Conclusions:

• Quality Improvement Collaboratives can exhibit diverse behaviors beyond pure collaboration, including competition and free-riding.
• Recommendations for QICs include setting realistic goals, considering context, allocating adequate resources, and managing collaborative dynamics.
• Organizations should evaluate the costs and benefits of collaborative approaches for quality improvement initiatives.