Designing Quality Improvement Collaboratives for Dissemination: Lessons from a Multiple Case Study of the Implementation of Obstetric Emergency Safety Bundles

Abstract

Background: Quality improvement collaboratives (QICs) can help to disseminate evidence-based practices, but there is limited guidance from the perspectives of QIC organizers and participants of best practices to support practice change. To address this gap, this study aimed to identify key structures and processes of QICs that support dissemination and implementation of quality improvement projects.

Methods: Semistructured one-on-one and group interviews were conducted from December 2017 to May 2018 with project administrators (n = 28) at three QICs that had been funded to develop and disseminate obstetric emergency safety bundles in more than 300 hospitals across five states. For further study, the project leads (n = 25) at six hospitals nominated by each QIC were interviewed. A multiple case study design was used to evaluate the dissemination strategies of each of the three QICs. For the QIC interviews, questions asked about dissemination approach, and for the hospital interviews, questions asked about implementation facilitators and barriers. All interviews were transcribed, coded, and analyzed using both deductive and inductive methods.

Results: A key element supporting the dissemination strategy of each QIC was leveraging existing partnerships and relationships and promoting a shared vision with participating hospitals. A robust data infrastructure to support the project was identified as a critical element to support dissemination, yet was a challenge for the QICs.

Conclusion: These findings highlight specific elements of a dissemination approach that QICs can deploy to support their dissemination efforts. In particular, building data infrastructure may be a useful strategy to support ongoing quality improvement projects.