High quality diabetes care: testing the effectiveness of strategies of regional implementation teams

Anat Drach‐Zahavy (University of Haifa, Haifa, Israel)
Efrat Shadmi (University of Haifa, Haifa, Israel)
Anat Freund (University of Haifa, Haifa, Israel)
Margalit Goldfracht (Clalit Health Services, Tel Aviv, Israel)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Publication date: 2 October 2009



The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients.


The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In‐depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000‐34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task‐interdependence, goal‐interdependence, reliance on top‐down standardised processes and team‐learning. These strategies were used to predict the mean percentage performance of eight evidence‐based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure ≤ 130/80 and cholesterol≤100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations.


Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple‐process indicators, reliance on top‐down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter‐effective. For outcome measures, team‐learning was more beneficial.

Practical implications

The findings have implications for the management of chronic diseases.


The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.



Drach‐Zahavy, A., Shadmi, E., Freund, A. and Goldfracht, M. (2009), "High quality diabetes care: testing the effectiveness of strategies of regional implementation teams", International Journal of Health Care Quality Assurance, Vol. 22 No. 7, pp. 709-727. https://doi.org/10.1108/09526860910995047

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