You may well have heard of Improvement Collaboratives in your Quality Improvement work. Improvement Collaboratives are groups which usually span different healthcare organisations – and sometimes different countries - with their main objective being to work together to bring about healthcare improvement across multiple settings.
In the Health Foundation’s 2009 report, Improvement Collaboratives are described as having: ‘a multi-organisational structured approach with five essential features: 1. there is a specified topic; 2. clinical experts and experts in quality improvement provide ideas and support for improvement; 3. multi-professional teams from multiple sites participate; 4. there is a model for improvement (setting targets, collecting data and testing changes); and 5. the collaborative process involves a series of structured activities.’
Essentially, Improvement Collaboratives bring together groups of healthcare professionals from different organisations to work in a structured way, in order to improve an area of quality within their settings. Changes are then quickly implemented to improve performance.
What’s the thinking behind Improvement Collaboratives?
One of the key ideas behind Improvement Collaboratives in healthcare is to use a target-setting and structured approach. Working with other teams across different organisations can create the motivation to make patient safety improvements and – when targets are set - teams can carry out quick cycles of change which will lead to improved patient outcomes and reduced costs. Those taking part in Improvement Collaboratives learn from others’ experience while observing and acting on their own results.
What’s the difference between a collaborative and a traditional quality improvement project or team?
There are subtle differences between an Improvement Collaborative and a traditional quality improvement project. While a quality improvement project or team may only cover one aspect of Quality Improvement (QI) and be based in one healthcare setting, there are many types of Improvement Collaboratives, and they can vary in size, duration, as well as geographical location!
An Improvement Collaborative provides an immediate framework and structure – as a topic to focus on will already have been set. The collaborative team will then be supported in making quality improvement changes using a range of effective strategies that can be put into practice quickly and easily.
An Improvement Collaborative gives participants the time and space to work on a set theme or topic. Parameters and guidelines can be set – as well as benchmarking - and participants can draw on expert help from a facilitating organisation.
What types of learning do Improvement Collaboratives use?
There is a range of learning types that collaboratives can use within healthcare, of which, the Breakthrough Model - which was developed by the Institute for Healthcare Improvement (IHI) - is arguably the most well-known and widely used.
There are also different types of Learning Networks that can be used to great effect. These include Learning Networks such as: clinical networks, improvement networks and social networks.  The network model supports the transformation of the healthcare system.
Learning networks have a so called ‘actor-orientated’ network organisational structure – ‘actors’ being the people and involved in the work. This is a structure which is more adaptable and flexible than hierarchical or matrix organisations. Learning networks set out common goal for all ‘actors’ to improve health outcomes and provide a flexible system where collaboration is actively encouraged.
The Cincinnati Children’s Hospital has successfully designed and used network-based Learning Healthcare Systems (Learning Networks) to improve the health of populations of children and young people.
How effective are Improvement Collaboratives?
While the Health Foundation report found that there was mixed evidence about the effectiveness of Improvement Collaboratives, one randomised trial and 98 other studies fed back that taking part in a collaborative had led to positive changes in care processes. Anecdotal feedback in the same area showed that teams taking part in collaboratives often felt processes had been adapted for the better and that they had learned from the experience.
There is also support for those leading Improvement Collaboratives - in the form of benchmarking and improvement experts – such as Life QI – who run collaboratives for any number of organizations at any number of locations. For example, an international 18-month long collaborative covering 17 hospitals across 3 countries is using Life QI. to facilitate its Joy in Work programme.
I’m really interested in carrying out an Improvement Collaborative within my organisation – how do I go about it?
That's great! Improvement Collaboratives can play a major role in spreading best practice and supporting Quality Improvement. They can also help to spread knowledge and innovation, as well as developing the abilities of members to make and test changes in healthcare.
As a start, you might want to look in more detail at examples of other Improvement Collaboratives, such as those mentioned in this piece. You could also get in touch with expert solution providers, such as Life QI, who have tools and expertise to support quality improvement, however you chose to implement it.
 Hulscher M, Schouten L, Grol R. Collaboratives. London: The Health Foundation, 2009