Themes (No. studies) | Evidence synthesis | Quality of Evidence [ref.] | ||||
---|---|---|---|---|---|---|
Description of relationship QIC component–mechanism–outcome | Contextual enablers of mechanism (or barriers) | Quantitative and mixed methods | Qualitative and review | |||
QIC component | Mechanism of change | Outcome | ||||
Shared community of practice (N = 7) | Collaboration with other hospitals | • Sense of community reinforced or created • Increased motivation, by supporting reframing of improvement topic as desirable, urgent and achievable | Health workers motivated and empowered to take action towards common goal | • Settings where a community of practice amongst clinicians exists or can be developed • Barrier: external pressures on hospitals incentivising competition v. collaboration. | ||
Platform for capacity building (N = 5) | Collaboration with other hospitals | • Platform to refine skills for improvement provided • Definition of standard care processes facilitated |  | • Settings with quality-focused HR systems, e.g. incorporating quality objectives in professional development and performance appraisals • Barrier: high performing hospitals have less to gain from collaboration • Barrier: Collaboration can be undermined by free-riding (not all facilities contribute equally) and social loafing (leaving it to others to support low performing hospitals) | ||
Demonstration role (N = 3) | Collaboration with other hospitals | • Feasibility of improving outcome of focus is demonstrated | Increased engagement in QIC | • Supportive leadership • External support to disseminate success stories • Barrier: Large hospitals may have less to gain from collaboration | Medium [71] | |
Friendly competition (N = 6) | Collaboration with other hospitals | • Reputational gain from improvement (or conversely risk of non-improvement) at individual and organisational level achieved. • Access to others’ data and benchmarking for internal gains enabled. | Normative pressures to conform (change practice and improve) created. | • Open sharing of data on mutual performance • Alignment with institutional priorities (lack of which contributes to perception that collaboration is stressful and time-consuming) • Geographically dense professional network • Non-hierarchical teams facilitating decentralised decision making • Barrier: competition for financial incentives linked to quality criteria |