The role of quality improvement collaboratives in general practice: a qualitative systematic review.

BACKGROUND: This systematic review used qualitative methodologies to examine the role of quality improvement collaboratives (QICs) in general practice. The aim was to inform implementers and participants about the utility of using or participating in QICs in general practice. METHODS: Included studies were published in English, used a QIC intervention, reported primary research, used qualitative or mixed methods, and were conducted in general practice.A Medline search between January 1995 and February 2020 was developed and extended to include Embase, CINAHL and PsycInfo databases. Articles were sought through chaining of references and grey literature searches.Qualitative outcome data were extracted using a framework analysis. Data were analysed using thematic synthesis. Articles were assessed for quality using a threshold approach based on the criteria described by Dixon-Woods. RESULTS: 15 qualitative and 18 mixed-methods studies of QICs in general practice were included. Data were grouped into four analytical themes which describe the role of a collaborative in general practice: improving the target topic, developing practices and providers, developing the health system and building quality improvement capacity. DISCUSSION: General practice collaboratives are reported to be useful for improving target topics. They can also develop knowledge and motivation in providers, build systems and team work in local practice organisations, and improve support at a system level. Collaboratives can build quality improvement capacity in the primary care system. These roles suggest that QICs are well matched to the improvement needs of general practice.General practice participants in collaboratives reported positive effects from effective peer interaction, high-quality local support, real engagement with data and well-designed training in quality improvement.Strengths of this study were an inclusive search and explicit qualitative methodology. It is possible some studies were missed. Qualitative studies of collaboratives may be affected by selection bias and confirmation bias. PROSPERO REGISTRATION NUMBER: CRD4202017512.

A quality improvement collaborative to build improvement capacity in regional primary care support organisations.

Strong primary care is foundational for effective, efficient health systems but remains variable in health systems around the world. Increasing quality improvement capacity in primary care support organisations has potential to improve primary care and health systems. This project worked with staff from primary healthcare support organisations with the aim of improving by 20% the confidence and competence scores of participants seeking to implement a quality improvement activity. The Breakthrough Collaborative approach was used to design a programme of learning workshops, action periods, data feedback and local support. Improvement measures included confidence in quality improvement (self-rated) and competence in quality improvement (using the validated Quality Improvement Knowledge Assessment Tool). Participants were required to submit quality improvement plans and run local quality improvement projects. The programme was run three times with improvements made between each cycle. Overall, 50 teams consisting of 173 regional staff took part. They engaged a total of 341 front-line primary care services such as general practices, Aboriginal medical services and pharmacies. In the first cycle, there was no improvement in measured regional staff knowledge and skills. In response, the learning workshops were changed to increase didactic teaching and supported practice of fundamental quality improvement skills. Regional organisational leaders were consulted to decrease the turnover in participants during each collaborative cycle. In the final cohort, a 38% improvement in knowledge and skills was recorded. All teams submitted quality improvement plans and ran local workshops indicating good engagement. This programme addresses a key need for health systems that is shared around the world: the improvement of primary care. It demonstrates using the Breakthrough Collaborative methodology to increase quality improvement capacity in the sector. After initial challenges, repeated cycles recorded greater than 30% improvement in the measured competence of participants in quality improvement activities.