Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Table 1 Stimulating organisational development, sustainability, and dissemination of healthcare innovations in hospitals: interventions and their specific components at different levels

Intervention	Level	Specific components
Implementation of the multilevel quality collaborative (MQC)	Unit/team (Micro)	- Six collaboratives: Breakthrough projects implemented by multidisciplinary teams (features: team training meetings, knowledge about best practices, plan-do-study-act cycles, performance monitoring), supported and facilitated by external change agents
	Hospital (Meso)	- Leadership programme (strategic and tactical management), facilitated by external change agents
		- Internal hospital programme structure (supporting congruence between levels and to track progress)
Arranging supportive conditions/incentives in the environment of hospitals	National (Macro)^a	- National focus/agenda setting (Better Faster topics)
		- Increased competition between hospitals (regulated market)
		- New reimbursement system for hospital care
		- Transparency (national set of performance indicators)

^aAlthough the focus of this study is restricted to the MQC (micro and meso level), interventions at the macro level are relevant. The MQC was embedded in a broader policy mix and implemented in a sector where incentives and other measures were brought in gradually to induce hospitals to deliver high-quality, safe, patient-oriented, and efficient care [9, 28–30].

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