Ten tips for running a national improvement collaborative

As a campaign manager, I have been involved in running three national collaboratives in the New Zealand healthcare sector. This article shares ten factors that were important in making the collaboratives a success.

1. Considering population size and the structure of the health system

New Zealand’s relatively small population of four million puts it in a good position to run national collaboratives. Evidence of successful national programmes run in other small countries, such as Wales, reinforces the idea that population size plays a role in making national efforts feasible.[1]

While national collaboratives have been run successfully in countries with much larger populations than New Zealand, such as the USA, they require much greater consideration of the resources available, how to manage the volume of work and how to engage with a large number of people.[2] They work over a longer period and they might adopt a staged approach or divide the work up into sub-projects to make it more manageable.

New Zealand’s centralised health system also facilitates national collaboratives. There is value in a single national organisation overseeing the whole collaborative, such as the Ministry of Health or the Health Quality & Safety Commission in New Zealand. People are familiar with the functions of these organisations and recognise their mandate to act nationally.

2. Using Breakthrough Series methodology

Breakthrough Series (BTS) methodology is designed for spreading a known quality improvement change package. BTS methodology develops the improvement capability of collaborative participants and makes it possible for participating teams to adapt a change package to local context.

3. Proving international evidence in the national context

Proving international evidence in the New Zealand environment before we tried to roll it out on a national scale made it much easier to get buy-in. Part of the success of all Ko Awatea’s national collaboratives was having a pilot site to show how a change package drawn from international evidence had already worked well in at least one New Zealand hospital.

4. A clear mandate for change

It’s important to have a mandate with a clear call to action. It needs to be clear from the beginning that there’s a real need to take action, why people should get involved and what the benefit is to healthcare practitioners and patients.

5. Leveraging clinical expertise and professional respect

It is impossible to overstate the importance of getting influential clinicians involved. Not only do they have expert clinical knowledge, they also have huge ability to influence others.  When they’re responsive and involved, it makes success much easier to achieve.

Part of planning a collaborative is to identify the experts who would be interested in becoming involved and understand what their views and opinions are. Getting an expert group together early creates expert buy-in from the beginning and is an important part of BTS methodology. Once in place, the expert group will know others in the field who are likely to take part and give advice on what will and won’t work. In addition, having the buy-in and advice of respected clinicians through an expert group gives participants a sense that the collaborative has substance – it’s not just another ‘flavour of the month’.

6. Involving diverse stakeholders

Collaboratives need the involvement of a mixed, multidisciplinary team. Senior leaders, clinical experts, project managers, improvement experts and frontline staff all need to be engaged for the collaborative to work well.

7. Sharing measurement data with teams promptly

It’s important to be disciplined about measuring improvement. In our collaboratives, having a national database made it possible to share measurement data across district health boards and at a regional and national level. People appreciated getting prompt feedback. A lot of district health board data is retrospective, so it’s motivating for people to be able to see how they’re doing much more immediately.

8. Being adaptable and responsive

The campaign can provide a framework and principles to create improvement, but participating teams need to find their own way of working that suits their local context. Avoid being prescriptive.

9. Setting clear roles and responsibilities

People need to know what’s expected of them, what role they will play and what their responsibilities are.

10. Putting an effective communications plan in place

Communication and relationship building need to be well-managed throughout the campaign. Communication channels should remain open so that anyone can contact the programme lead at any time, query anything, and speak freely without fear of repercussions. In Ko Awatea’s campaigns, learning sessions provided the opportunity to say what was working, what wasn’t working and what could be adapted.

Newsletters, monthly reports, interviews with stakeholders, site visits, a discussion forum, promotional materials, and regular education and coaching calls also served to keep participants informed.

The communication plan should keep people engaged with clear messages to remind participants of the campaign aim and call to action.

Target CLAB Zero has been published in the New Zealand Medical Journal. The full article can be accessed at: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1421-4-september-2015/6636

See also http://koawatea.co.nz/project/target-clab-zero/

For further information about the Enhanced Recovery After Surgery Collaborative, see: http://www.health.govt.nz/our-work/hospitals-and-specialist-care/enhanced-recovery-after-surgery

[1] Hancock C, Hope D, Bird D, et al. Welsh critical care improvement programme: Final report. Llanharan, Wales: National Leadership and Innovations Agency for Healthcare; 2007.

[2] Eliminating CLABSI: A national patient safety imperative: Second progress report on the national On the Cusp: Stop BSI project. Rockville, MD: Agency for Healthcare Research and Quality; 2014.