Intended for healthcare professionals


Effects of quality improvement collaboratives

BMJ 2008; 336 doi: (Published 26 June 2008) Cite this as: BMJ 2008;336:1448
  1. Peter K Lindenauer, director and associate professor of medicine
  1. 1Center for Quality and Safety Research, Baystate Medical Center and Tufts University School of Medicine, Springfield MA, 01199, USA
  1. peter.lindenauer{at}

Are difficult to measure using traditional biomedical research methods

In the linked study, Schouten and colleagues report a systematic review of the effectiveness of quality improvement collaboratives in improving the quality of care. They conclude that the evidence supporting these collaboratives is positive but limited and their effects are difficult to predict.1

Despite limited evidence, the quality improvement collaborative is one of the most popular methods for organising improvement efforts at hospitals and ambulatory practices worldwide. Quality improvement collaboratives in health care date back to the mid-1980s, and some of the earliest and most successful examples include the Northern New England Cardiovascular Disease Study Group, the US Veterans’ Affairs National Surgical Quality Improvement Program, and the Vermont Oxford Network. These ongoing initiatives have improved care and saved many lives at participating hospitals.2 3 4

In the 1990s, the Institute for Healthcare Improvement, the pre-eminent quality improvement organisation in the United States, popularised a quality improvement model they called the breakthrough series.5 Whereas earlier quality improvement collaboratives were limited to a single domain (such as cardiac surgery), the breakthrough series method has been applied to a wide range of topics, from improving access in primary care to reducing adverse drug events among patients in hospital.

Quality improvement collaboratives bring together quality improvement …

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