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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