Common Barriers to Successful Improvement Collaboratives

The rewards of a successful improvement collaborative can be huge - often resulting in more efficient processes, better patient outcomes, reduced service costs and happier staff. Studies to evaluate the effectiveness of improvement collaboratives indicate that over 80% of improvement collaborative are successful in improving one or more of the collaboratives primary measures. How do you ensure your collaborative is destined for success?

If you’re reading this, you probably already have a great improvement idea in mind and are looking to take the next step in planning and implementing a collaborative across multiple sites. There’s no escaping the fact that collaboratives are complex – aligning teams to work together across multiple sites with varying levels of QI knowledge is a real challenge. Looking at past collaboratives tells us that there are some common barriers to overcome, which could otherwise reduce the chances of successfully achieving your aim.

We’ve created a list of these potential barriers – and ways to get around them - so that you can be prepared for any eventuality in your improvement collaborative journey.

Lack of staff and team engagement

Staff in healthcare are busy and unfortunately improvement collaboratives can sometimes be viewed as additional workload. However, getting this engagement is a critical element in success. A report by the National Institute for Health Research (NIHR) found that ‘those with high levels of engagement performed better on available measures of organisational performance than others.’ So, early engagement – and encouraging clinical ownership – could be a great way to drive success.

Not keeping it simple

When there are so many possible improvements to be made, it is tempting to cast the net wide and tackle multiple issues at once, but keeping it simple will improve the chance of success. Studies demonstrate that collaboratives addressing relatively straightforward aspects of care demonstrate more improvement and greater success. This might mean that, rather than tacking a whole discipline.

Ensure that the topic and aims of the collaborative are focussed and offer ample opportunity for improvement (i.e. where there is a large gap between current and ideal performance). Be realistic about what can be achieved – teams will remain motivated for longer if they are able to see progress toward the aim, but can rapidly become de-motivated if that goal is out of sight.

Lack of time

We all know that healthcare professionals are busy. Being actively involved in a collaborative may require learning new systems, methods and approaches – these all take time. Lack of time is often cited as a major impediment to improvement. Making involvement in the collaborative a simple as possible for participants will improve engagement. This means getting all your resources, support and data collection organised into an accessible shared workspace. Solutions like Life QI are perfect for this!

Being too restrictive

Having structure is important in any collaborative – using common QI methods, set timelines and reporting requirements all improve the chances of success. But, there is a point when structure becomes overbearing. If participants feel like they are being ‘dictated’ too and not allowed to work on their own initiative, it can remove the very ethos of the quality improvement collaborative. Where teams are keen, give them the flexibility to identify new change ideas, measure new metrics or run additional PDSAs – it might just provide the breakthroughs you are searching for!

Lack of support

Studies have demonstrated that access to improvement advisors and coaches as part of the collaborative faculty are the most valued feature of collaboratives for participants, and that the quality, intensity and appropriateness of QI support can positively influence outcomes. Regular learning sessions are a staple of most successful collaboratives, as is on demand support for participants. If teams are struggling to get up and running, more intensive support could be the answer. You could even think about providing this through different mediums – face-to-face, videos and virtual drop in sessions can all have a place.

Not being transparent

Collaboratives are all about shared learning. To get the most from the process, teams need to be able to see their progress toward improvement, along with that of their peers in other sites. Research illustrates several benefits of transparency in collaboration. Community practice improves engagement, friendly competition motivates teams, and sharing provides a platform for disseminating success stories.

Sharing works best when there is a culture of acceptance, where all contributions are equal. The Health Foundation note the success of a ‘flat structure’ when driving improvement, which can apply to organisations and collaboratives alike. Ensuring all participants from site have access to the project resources and have a platform for contributing ideas will help that.

Not getting senior level buy-in

Improvement collaboratives thrive on the enthusiasm of frontline staff to improvement the quality of care for the patients to serve. However, to maintain this commitment they will need to be supported by their leadership. Gaining buy-in from senior leaders within participating organisations is a key recommendation in making sustained improvements.

QI readiness of organisations and individuals

Whether your collaborative is run across hospital sites, primary care, nursing homes, or somewhere else – no two of your sites will be the same. Sites may vary in size, have different pressures and have varying competence in QI. Likewise, the individuals involved may have different experiences and competence in QI, particularly across multidisciplinary teams.

Accept that teams will show different levels of engagement and progress, and that some teams will need more support than others. As early as possible, identify your ‘QI champions’ who can motivate drive change in their local teams. Sharing of this narrative with the collaborative can result in the spread and adoption of a champion’s model in other teams.

The scale problem

Sometimes large collaboratives can struggle to build the community and sharing that they desire, and with it reduce their effectiveness. We’ve seen cases where national collaboratives have been split into regional sub-collaboratives to build more local community and momentum in those areas.

If you’re running a large collaborative and you’re not seeing the activity you were hoping for, you could look at dividing it up into more manageable chinks (by geography, organisation type, or some other logical split). Just be sure to have oversight of all the work so that you can share successes between those groups.

Conflicting priorities

Improvement collaboratives are a long-term commitment – generally running for at least 12 months, and sometimes significantly longer. Lots can happen over that time and the priorities of your participating site may change. Ensuring sites are on-board from the start and able to see real improvements will help to keep this high up on their priority list.

However, sometimes major events can result in sites reducing their engagement in the collaborative work. It is best to capture this as early (by actively tracking their engagement in projects and learning sessions) as possible and open a discussion with them about the best way forward. Maybe there are new people who can be involved, or support that can be provided to maintain their involvement.

Lack of infrastructure

Inadequate infrastructure to facilitate QI work in the teams, and to monitor their progress, can be a big barrier to success. Getting the right infrastructure ensures teams have everything they need, and that you maintain real-time oversight of all the great work (along with any issues that may arise!).

Studies show, for example, that a lack of effective data collection system or investment in IT can act as a barrier to successful collaboratives. There are, however, solutions that could help you that won’t break the bank. Life QI is a solution which helps to run collaboratives for a wide range of organisations across multiple 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.

Embrace the challenge and enjoy the improvement journey!

Improvement collaboratives are a key strategy to accelerate improvement. They have the ability to improve care and change lives for the better, at a population level. Like all good things in life, achieving that is never going to be easy – there will almost certainly be barriers to overcome along the way. At Life QI, we’ve been able to see the success of improvement collaboratives at all scales, all around the world. Hopefully these tips will help you achieve success in your own initiative!