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Table 3 Activities per breakthrough project: changes implemented during the project (N = 159)

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

Intensified or new activities to... More actively or new since beginning of project
No. of teams (%)
Reduce pressure ulcers (28 teams)  
1. regularly changing patient's position 19 (68%)
2. risk assessment for each patient 18 (64%)
3. patient information brochure on pressure ulcers 16 (57%)
4. compliance to a pressure ulcers protocol 13 (46%)
5. updating the pressure ulcers protocol 12 (43%)
6. occupational and physiotherapy 9 (32%)
7. sufficient anti-pressure ulcers mattresses 6 (21%)
8. specialised pressure ulcer nurse 4 (14%)
Average number of changes (out of eight) applied by pressure ulcer teams 3.5
Improve medication safety (34 teams)  
1. clinical lesson in pain reduction 13 (38%)
2. spreading a simple card with 'switch' guidelines 12 (35%)
3. reducing postoperative pain; pain score on linear scale <4 11 (32%)
4. reduce degree of unnecessary intravenous antibiotics 10 (29%)
5. compliance to a medication prescription and administering protocol 8 (24%)
6. apply guideline to reduce unnecessary blood transfusion 6 (18%)
7. fixed medication times 4 (12%)
8. double check of all medication 2 (6%)
Average number of changes (out of eight) applied by medication safety teams 2.0
Optimise operating theatre productivity (18 teams)  
1. starting on time 11 (61%)
2. emergency procedures: re-definition of 'emergency' 8 (44%)
2. reallocate extra operating time based on the degree of utilisation 8 (44%)
4. tracking and solving disturbances in the operating theatre programme 7 (39%)
5. planning based on average surgery time 6 (33%)
5. reduce time between operations 6 (33%)
7. maintaining capacity for emergency available in the programme 5 (28%)
8. staff planning based on differences in surgery time of individual clinicians, differences in anaesthesiologists and assistants, and the experience of the team 2 (11%)
Average number of changes (out of eight) applied by operation theatre teams 2.9
Reduce postoperative wound infections (18 teams)  
1. limiting the number of persons in the operating theatre 16 (89%)
1. reducing number of door movements 16 (89%)
3. protocol for optimal administering of antibiotic prophylaxis 11 (61%)
4. participation in national wound infections surveillance network 8 (44%)
5. minimise refreshment of bandages 5 (28%)
6. staff reports (skin) infections and diarrhoea 5 (28%)
7. separate working tablet is used for each patient (bandages, instruments, gloves, deposit bags, etc; afterwards cleansing with alcohol) 4 (22%)
8. during wound care no beds are made, nor is the ward cleaned 2 (11%)
Average number of changes (out of eight) applied by wound infections teams 3.6
Reduce throughput times (33 teams)  
1. reserving slots for specific diagnosis 20 (61%)
1. reducing planning moments 20 (61%)
3. clear decision lines and division of responsibilities 19 (58%)
4. rational planning of demand on expected question 18 (55%)
5. introduction of one-stop shop 16 (48%)
6. admission on day of operation 12 (36%)
6. more flexible staff utilisation 12 (36%)
8. protocol for treatment groups (e.g., physiotherapy or informing patients) 11 (33%)
Average number of changes (out of eight) applied by process redesign teams 3.9
Reduce waiting list (36 teams)  
1. block agendas six or eight weeks in advance; cancellation only in case of emergency 26 (72%)
2. anticipate on fluctuations 23 (64%)
3. minimise types of consults 21 (58%)
3. plan patient consults not routinely but in the event of complaints 21 (58%)
5. perform diagnostics in fewer consults 20 (56%)
6. minimise vacations in busy periods 17 (47%)
7. increase the interval for consultations for chronic disorders 17 (47%)
8. plan realistically on the basis on actual consult length 16 (44%)
Average number of changes (out of eight) applied by waiting list teams 4.4