Collaborative Improvement

Collaborative improvement occurs when an organized network of a large number of sites (districts, facilities or communities) work together for a specified period of time to achieve significant improvements in a focused topic through shared learning. Since several sites participate in collaborative improvement, the results achieved by an individual site are shared with learning community. The participating sites reorganize their service delivery systems to implement proven interventions to strengthen outcomes. Teams at different facilities rapidly test means of operationalizing the interventions and share results to develop the best strategy for achieving the goal. During collaboration, teams from different health facilities or sites gather in learning sessions to share ideas for improvement and results they have achieved. The intervals between learning sessions are known as action periods--periods of intense activity during which each team implements changes and measures results.

The Model for Improvement is the driving force that guides the development of the improvement project with three fundamental questions:  

  • What are we trying to accomplish? Specify the aim, or objective, of the improvement effort.
  • How will we know that a change results in an improvement? Choose the outcome and process indicators that will be used to measure progress.
  • What changes can we make that will result in an improvement? Identify the specific actions that will be taken to improve the system or the quality of services.

Figure 8. Implementation phases

Collaborative improvement is usually implemented in three phases (Figure 8):

1. Preparation phase: Establish aim, indicators, innovation to be tested, improvement collaborative structure, steering committee or technical advisory group, coaches, sites and quality improvement (QI) teams. Define roles and responsibilities.

2. Implementation phase:  Conduct learning sessions and action periods to test the innovation.

3. Synthesis and initiating spread phase: Summarize results, document lessons learned and prepare and plan for scale-up.

Management Structure

A few key people manage the collaborative improvement process: a director, a coordinator, a quality improvement (QI) advisor and a technical expert. Coaches are selected and then trained to support and enhance the performance of QI teams. These teams lead the QI process in their respective sites.

A Steering Committee (SC) or Technical Advisory Group (TAG) often supports the collaborative improvement effort. In programs that address maternal, newborn and child health (MNCH), for example, the SC or TAG reviews the practices or standards that guide the aim and indicators of the process to ensure compliance with national health policies and guidelines. Involving SC or a TAG from the beginning assures that the results of the collaborative will be endorsed by stakeholders at the national level and enhances the chances of obtaining approvals for spread.

Documenting results

A QI team that includes representatives of both service providers and clients manages the improvement process in each site. Each QI team usually assigns a team member the task of collecting data to measure the selected indicators. The QI team will examine and discuss these indicators to interpret the effect of the adopted changes and determine whether they resulted in the desired improvement. The data are checked for accuracy by the QI coach, who provides overall technical support to the QI team. 

The coaches facilitate the aggregation of data for participating sites to assess collective progress. The aggregated data for all participating health sites provide an average, which, if plotted on a chart with results from individual sites, allows each site to compare its performance to the other sites. This motivates continual improvement and creates opportunities for discussion and experience-sharing among  teams. It also helps coaches determine when to intervene if a team is not showing progress.

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