Quality improvement in long-term mental health: results from four collaboratives

Authors


  • Competing interest statement: All authors declare that all answers to the questions on your competing interest form are ‘no’.

  • Ethics approval: Since the quality improvement initiatives were part of daily practice and were initiated and implemented by health care organizations and not by the evaluation research team no ethics approval was required.

  • Funding of the study: The Care for Better programme and the evaluation study are funded by the Netherlands Organization for Health Research and Development (ZonMw 60-60900-96-005). The researchers of the evaluation study are independent from this funding organization.

  • Authors' contributions: A. N., T. B. and M. S. formulated the research question of this paper and developed the questionnaire. M. S. and T. B. carried out the study, performed the statistical analyses and drafted the manuscript. A. N. advised on the analyses. A. N., T. B. and R. B. formulated the overall research questions and overall study design of the evaluation. S. R. was involved in formulating the indicators for each collaborative. All authors critically revised the manuscript and have read and approved the final manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

M. M. H. Strating, Institute of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands, E-mail: strating@bmg.eur.nl

Abstract

Accessible summary

  • • Overall, the four collaboratives lead to significant improvement in most objective outcomes, such as health, loneliness, and clients' problem areas.
  • • With respect to perceived effectiveness significant differences between the four collaboratives were found. Team members participating in the Social Psychiatric Care collaborative scored significantly lower than team members in the other three collaboratives. The Recovery-Oriented Care collaborative scored weakly higher.
  • • Multilevel regression analyses indicated that innovation attributes, appropriate measures, usable data collection tools, and an innovative team culture could explain variation in perceived effectiveness.
  • • The results supported the notion that a layered approach is necessary to achieve improvements in quality of care.

Abstract

This multiple case study evaluates four quality improvement collaboratives (QICs) in long-term mental health care focusing on social psychiatric care, recovery oriented care, social participation and somatic co-morbidity of psychiatric patients. The aim is to explore (1) effectiveness in terms of objective outcome indicators and impact of changes as perceived by team members; and (2) associations between collaborative-, organizational- and team-level factors and perceived effectiveness. Most objective outcomes, such as health, loneliness and clients' problem areas, showed significant improvement. Because of the diversity in content no single measure for objective effectiveness could be computed across the four collaboratives. Perceived effectiveness of team members was used as an indicator of the overall impact. In all, 55 of the 94 participating team leaders and 117 remaining team members completed a written survey at the end of each quality improvement collaborative. Multilevel regression analyses indicated that innovation attributes, appropriate measures, usable data collection tools and an innovative team culture could explain variation in perceived effectiveness. In conclusion, overall positive changes for clients were realized as demonstrated by objective outcomes and team members' perceptions of improvements in care processes. The results supported the notion that a layered approach is necessary to achieve improvements in quality of care.

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