Designing quality improvement collaboratives to disseminate evidence-based practices

Abstract

Quality Improvement Collaboratives (QICs) are often utilized to implement innovations in health care, yet how they function to promote sustained practice change remains a black box. Guided by the Complex Innovation Implementation Framework, we designed a comparative case study of three QICs funded to implement obstetric emergency safety bundles in over 300 hospitals in five states in order to assess their implementation strategies. We conducted semi-structured one-on-one and group interviews with project administrators at the three partnering QICs (n=23). Additionally, each collaborative was asked to nominate four higher- and two lower-performing hospitals for further study. At each nominated hospital we interviewed the QI project leads (n=28). For all three QICs, a key element supporting ongoing implementation of the safety bundles and project engagement was leveraging existing partnerships and relationships. For the hospitals, collaborative participation strengthened clinician buy- in, and they reported that the education and implementation tools offered by the collaborative were effective approaches to promoting safety bundle implementation and overcoming contextual challenges. Our findings suggest that using QICs to support dissemination of evidence-based practice could help to overcome expected barriers to implementation effectiveness, such as challenges with physician and nursing engagement.