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Table 1 Breakthrough collaboratives and external change agents within Better Faster pillar 3

From: Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes

Quality area Breakthrough project Programme targets Planned year-one projects per hospital
Patient logistics WWW: working without waiting lists Access time for out-patient appointments 2
  OT: operating theatre Increasing the productivity of operating theatres by 30% 1
  PRD: process redesign Decreasing the total duration of diagnostics and treatment by 40 to 90%, reducing length of in-hospital stay by 30% 2
Patient safety MS: medication safety
PU: pressure ulcers
Decreasing the number of medication errors by 50%
The percentage of pressure ulcers is lower than 5%
  POWI: postoperative wound infections Decreasing postoperative wound infections by 50% 1
  1. Programme hospitals participated for two years in Better Faster pillar 3 (Table 1). During the first year, multi-disciplinary teams in each hospital implemented the following projects that were to be disseminated further in the following year and afterwards [34].
  2. Overview of the breakthrough projects: targets and planned number per hospital in two years
  3. As well as having organisational support provided by the hospitals, each collaborative was organised and facilitated by a small team of external change agents: experts and advisors responsible for the general contents of the projects carried out by the teams in the hospitals. While the multi-level quality collaborative was in its preparation phase, the external change agents served as developers. Their task was to translate promising change ideas into a more or less generally applicable improvement concept, meeting the prerequisites for successful adoption (e.g., perceived advantage, low complexity, compatibility [15]). They combined a rapid cycle improvement model with a series of recommended topic related interventions plus performance indicators to monitor progress. Improvement concepts and best practices were transferred at several team training meetings. The teams were trained to apply breakthrough methods, requiring the application of plan-do-study-act improvement cycles and the answering of three questions: 'What are we trying to accomplish?' 'How will we know that a change is an improvement?' and 'What change can we make that will result in an improvement?'[41, 42] The one- or two-day training meetings took place at central locations in the county. The agendas contained presentations about background information on the project, team instruction sessions and group assignments, and guest speakers with knowledge about the topic or best practice experience as well as plenary discussion. On average, a delegation of four team members visited four QIC meetings [34].