Ingrid M Nembhard1. 1. School of Public Health, School of Management, Yale University, New Haven, Connecticut, USA. ingrid.nembhard@yale.edu
Abstract
BACKGROUND: Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired. PURPOSE: This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants' performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices. METHODOLOGY: We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources. FINDINGS: The more collaborative teams used inter-OLAs, the more their organizations' performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams' use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use. PRACTICE IMPLICATIONS: Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile.
BACKGROUND: Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired. PURPOSE: This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants' performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices. METHODOLOGY: We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources. FINDINGS: The more collaborative teams used inter-OLAs, the more their organizations' performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams' use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use. PRACTICE IMPLICATIONS: Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile.
Authors: Thomas G Rundall; Stephen M Shortell; Margaret C Wang; Lawrence Casalino; Thomas Bodenheimer; Robin R Gillies; Julie A Schmittdiel; Nancy Oswald; James C Robinson Journal: BMJ Date: 2002-10-26
Authors: Jill A Marsteller; Stephen M Shortell; Michael Lin; Peter Mendel; Elizabeth Dell; Stephanie Wang; Shan Cretin; Marjorie L Pearson; Shin-Yi Wu; Mayde Rosen Journal: Jt Comm J Qual Patient Saf Date: 2007-05
Authors: Stephen M Shortell; Jill A Marsteller; Michael Lin; Marjorie L Pearson; Shin-Yi Wu; Peter Mendel; Shan Cretin; Mayde Rosen Journal: Med Care Date: 2004-11 Impact factor: 2.983
Authors: Jeffrey D Horbar; Joseph H Carpenter; Jeffrey Buzas; Roger F Soll; Gautham Suresh; Michael B Bracken; Laura C Leviton; Paul E Plsek; John C Sinclair Journal: BMJ Date: 2004-10-30
Authors: Bruce E Landon; Ira B Wilson; Keith McInnes; Mary Beth Landrum; Lisa Hirschhorn; Peter V Marsden; David Gustafson; Paul D Cleary Journal: Ann Intern Med Date: 2004-06-01 Impact factor: 25.391
Authors: Alexander F Pimperl; Hector P Rodriguez; Julie A Schmittdiel; Stephen M Shortell Journal: Health Serv Res Date: 2017-04-06 Impact factor: 3.402
Authors: Hector P Rodriguez; Beth A Glenn; Tanya T Olmos; Alex H Krist; Stephanie L Shimada; Rodger Kessler; Suzanne Heurtin-Roberts; Roshan Bastani Journal: J Am Board Fam Med Date: 2014 May-Jun Impact factor: 2.657