- • Quality improvement collaboratives strive to improve health care on certain topics. Improvements are often investigated in terms of outcomes defined before start of the project. However, in this paper we also explore other ways to conceptualize improvement.
- • We evaluated a ‘social participation’ improvement project that aimed to widen clients' social networks and to make them feel less lonely. Most of these clients were psychiatric or intellectually disabled clients.
- • Clients' social networks were not widened over the project, but clients reported to experience less loneliness. Furthermore, two different ways of improving clients' social lives were attempted. One was an individualizing approach, with improvement actions targeted at individual clients and their individual wishes, rather than at a client ward as a whole. Individual clients were encouraged to verbalize their wishes and to be enterprising in fulfilling these. The second approach was one of normalization. Clients ideally were to participate in ‘normal’ community, doing the same things and having the same social contacts as the general population.
- • The two ways of assessing the impact of the quality improvement collaborative sometimes pointed in the same direction. But our alternative way also brought to light aspects of the improvement project that would have gone unnoticed by using only the predefined outcomes. Therefore, we argue that it is valuable to explore (changes made during) quality improvement initiatives in various ways.