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Quality improvement collaboratives (QICs) are a popular approach to improving healthcare services and patient outcomes. This paper evaluates a QIC implemented by a large, integrated healthcare organisation in Wales in the UK.

This evaluation study draws on two well-established evaluation frameworks: Kirkpatrick's approach to gather data on participant satisfaction and learning and Stake's approach to gather data and form judgements about the impact of the intervention. A mixed methods approach was taken which included documentary analysis, surveys, semi-structured interviews, and observation of the QIC programme.

Together the two frameworks provide a rounded interpretation of the extent to which the QIC intervention was fit-for-purpose. Broadly the evaluation of the QIC was positive with some areas of improvement identified.

This study is limited to a QIC conducted within one organisation. Further testing of the hybrid framework is needed that extends to different designs of QICs.

A hybrid framework is provided to assist those charged with designing and evaluating QICs.

Evaluation studies are limited on QICs and if present tend to adopt one framework. Given the complexities of undertaking quality improvement within healthcare, this study uniquely takes a hybrid approach.

The purpose of this paper is to posit that it is possible to identify contributing factors for “never events,” preventable adverse events in the healthcare setting, and to develop “best practices” to prevent them.

This paper focuses on three specific never events: patient falls, pressure ulcers, and hospital acquired pneumonia. A model is suggested to identify “gold standard best practice” protocols to be used to prevent these events. A literature review identifies two categories of factors: uncontrollable patient‐related factors and controllable environmental related factors. The methodology is to use the Institute for Healthcare Improvement (IHI) Breakthrough Series Collaborative Model to develop best practice protocols for controllable environmental factors.

Controllable environmental variables may be positively impacted by using Theory of Inventive Problem Solving (TRIZ), Value Stream Mapping, Kanban, 5S technique, Reduction of Complexity, Total Production Maintenance, Poke‐Yoke, and Quick Change Overs. Controllable environmental variables may then be positively impacted by these methodologies and tools.

The tools and methods indicated have been used individually in the healthcare sector, but this approach has never been used in an integrated manner. The concept is to work with patient safety organizations in order to reduce never events in healthcare; events that, to date, have significantly increased the costs of healthcare and reduced the quality of processes and outcomes in healthcare.

Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.

In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.

Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.

These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.

Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.

This study aims to clarify the effect of team effort allocation between knowledge exploration and exploitation on the generation of extremely good or poor innovations. The influence of previous collaborative experience among team members on the effect of team effort allocation is also investigated to understand the relationship between team members’ collaboration networks and knowledge learning.

This study uses data of all patents granted by the US Patent and Trademark Office between 1984 and 2010. The inventors involved in a patent are regarded as members of the focal team. Logistic regression is used to analyze the data.

Allocating greater effort to exploration than to exploitation is beneficial to achieving breakthrough innovations despite the risk of generating particularly poor innovations. This benefit increases with collaborative experience among team members. Placing an equal emphasis on knowledge exploration and exploitation is not particularly effective in achieving breakthrough innovations; it is, however, the best strategy for avoiding particularly poor innovations.

This research not only provides valuable insights for research on innovation and knowledge management by studying the team effort allocation strategy used to achieve breakthroughs and avoid particularly poor innovations but also represents an advancement in bridging two streams of research – knowledge learning and social networks – by highlighting the influence of the team members’ collaborative networks on the effect of team effort allocation between knowledge exploration and exploitation.

The purpose of this paper is to improve the Siloam Hospitals’ (SHs) patient satisfaction index (PSI) and overcome Indonesia’s geographical barriers.

The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman’s test.

The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman’s test, showed a statistically significant increase in the PSI, χ² = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases (Z=3.317, p=0.003) between the baseline and continuous improvement phases (Z=6.633, p<0.001), and between the action and continuous improvement phases (Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.

The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.

The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.

The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.

Improvements were delivered in the care of patients on anti‐coagulants through a collaborative improvement methodology within one primary care organisation. Although a key clinical governance priority, the project was conducted in a low‐key manner with minimal support. Practice teams were encouraged to apply evidence through small‐scale testing of changes, using measurements to monitor improvement and to share what they learned amongst themselves. No specific model of care was pursued and instead the emphasis was on demonstrating an improvement at the practice level, by whatever means worked best. The methodology used was similar to that applied in major national and regional collaborative programmes. This project demonstrates how it can be simplified and implemented within one primary care organisation to deliver improvements in care as well as to support the building of teams and learning about measurement and quality improvement.

The purpose of this paper is to delineate an approach to quality assurance in education called networked improvement communities (NICs) that focused on integrating the methodologies of improvement science with few of the networks. Quality improvement, the science and practice of continuously improving programs, practices, processes, products and services within organized social systems, is a still-evolving area in education. This paper is the first of seven elaborating upon different approaches to quality improvement in education[1]. It delineates a new methodology called the NICs model. Developed by the Carnegie Foundation for the Advancement of Teaching, the approach is aimed at continuously improving the quality of practices, processes and outcomes in targeted problem areas in education systems.

The paper presents the historical development, theoretical foundations, core principles and adaptation of key elements of the NICs model for quality improvement in education. A case study specifically examines the problem of fostering new teacher effectiveness and retention in large public school systems in the USA.

The six principles underlying the NICs model are as follows: make the work problem-specific and user-centered, focus on variation in performance, see the system that produces outcomes, improve at scale what you can measure, use disciplined inquiry to drive improvement and accelerate learning through networked communities.

Few theoretical treatments and demonstration cases are currently available that examine the application of common models of quality improvement in education. This paper elaborates on one promising approach. In addition to examining the NICs model, the paper derives added value by allowing comparisons with seven widely used quality improvement approaches treated in this volume.

To examine the nature and extent of commitment to supply chain collaboration. Also, to explore the state of supply chain governance structures.

A multi‐method survey and in‐depth interview methodology was employed to gather data. Content analysis was then used to identify the types and extent of managerial support for supply chain initiatives.

Four types of managerial support are needed to achieve the highest levels of supply chain success: top management support, broad‐based functional support, channel support, and infrastructural/governance support. None of the interview companies have put all four types of support in place. Leading‐edge governance relies on cross‐functional/inter‐organizational teams, executive governance councils, customer advisory boards, supplier advisory councils and a modified reporting structure that overseas all value‐added activities from product conceptualization to customer relationship management. Again, none of the interview companies have established all aspects of an effective supply chain governance structure.

Much has been written on the need to focus on supply chains and create more cooperative and integrative relationships with key organizations in the supply chain; however, little has been written concerning the commitment levels among those involved in the supply chain or the types of governance structures that should be utilized within a given organization or along the supply chain. This paper bridges this gap, providing a benchmark for managerial commitment and presenting a composite governance structure based on observed best practices. Both academics and practitioners can use the insights provided to work toward a better understanding of supply chain commitment and governance.

The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.

A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.

Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.

The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.

Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.