The latest in the CaHRU and Lincoln Institute for Health Improvement Science and Research Methods seminar series was given by Professor Siriwardena on ‘Quality Improvement Collaboratives (QICs): theory design and effects on 28 February 2018. The CaHRU team have led three large scale collaboratives over the past 12 years, including Resources for Effective Sleep Treatment (REST), the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and most recently Scaling up PINCER (a pharmacist and information technology intervention to reduce potential clinically important prescribing errors in general practice.
QICs are an organised, multifaceted approach to quality improvement involving five essential features: a specified topic; clinical experts and experts in quality improvement provide ideas and support for improvement; multi-professional teams from multiple sites participate; using a model for improvement (measurement, change, feedback); and a collaborative process involves series of structured activities. The talk described how QICs have been used to implement healthcare interventions at scale and referred to a recent systematic review suggesting that over 4 out of 5 reported improvement in one or more outcomes although the quality of studies was variably poor.
QICs were described in terms of their common features: a logic model and theory of change; the complex (pragmatic) contexts of the intervention, setting and participants; and the variation in effects and changes that the intervention can or will undergo during the process of the collaborative. It was proposed that there were different types of collaborative based on their purpose which could be for intervention development, increasing reliability of evidence based processes, or scaling up evidence based complex interventions. It was argued that reviews of QICs should consider these different purposes when describing the outcomes and effects of QICs.
By Professor Niro Siriwardena