Abstract:

One of the most widely used approaches to systematic healthcare improvement is the Breakthrough Series Collaborative. The methodology was developed 1995 by the Institute for Healthcare Improvement (IHI) in Boston, United states. A lot of healthcare organizations, not least in Sweden, are using the methodology. Despite the fact that the method has been practiced for a while and that it seem to be applied all around the world, critical examinations of its use and application are very rare. In order to bridging the gap between theory and use of the Breakthrough Series Collaborative methodology and contribute to the knowledge this study tries to survey teams using the methodology over time, illuminating the disadvantages and benefits. The purpose with this paper is to empirically evaluate the use of the Breakthrough Series Collaborative improvement methodology in a Swedish healthcare context.

A survey was translated and adopted in several steps and then used to longitudinally follow improvement projects within a Breakthrough Series Collaborative program within a county council in Sweden. Measurements where made at the beginning of the improvement project and through the whole life cycle. In this paper data from the first measurement and a second measurement six month later are used. Descriptive statistics are presented as percentages, range, mean and standard deviation (SD). Differences are analyzed using Wilcoxon Match Pairs test and correlations.

The response rate was 44% in the first measurement and 29% in the second measurement. Drop out analyzes using Mann-Witney U test found no significant differences. In both measurements the item if the methodology supporting the work mostly answered “Moderate”, and there were no significances between the measurements in this item, as well as most differences were not significant. Correlations were calculated and only three significant item correlations were found; those were about satisfaction, competition/time to work and awareness of responsibility.

The participators stated that the work with the improvement idea contributes to an increase of the overall improvement at the unit and were satisfied with what they had accomplished. But at the same times they demand more time and support to work with the improvement ideas. Contrary to the aim of the improvement program, the respondents stated that the county council only partly prioritizes improvement work; ordinary work often intrudes on time dedicated to work with the improvement idea. The most striking result is that almost half of the respondents (46% in both measurements) stated that the Breakthrough Series Collaborative methodology only support the improvement work at a moderate level.

Keywords:

Breakthrough Series Collaborative methodology, Quality Improvement, Healthcare settings, survey evaluation.