Improving Quality Improvement Collaboratives: Mixing Communication Media to Attain Multiple Measures of Success

Introduction

Despite the prevalence of electronic communication in the workplace researchers continue to debate the effectiveness of electronic media for getting work done in teams. Some have stated that electronic interaction is a poor replacement for face-to-face and can lead to misunderstandings and damaged personal relationships (Hinds & Bailey, 2003; Nardi & Whittaker, 2002). Others argue that despite the drawbacks, electronic communication is essential, particularly when work involves group members that are physically or temporally dispersed (Olson & Olson, 2000). Recently research has begun to suggest that the use a mix of communication modes enhances outcomes (Caughlin & Sharabis, 2013; Malhotra & Majchrzak, 2014). In health care settings using both electronic and face-to-face communication is commonplace. Shift work and multi-disciplinary patient care mean that caregivers are at times together at the same place at the same time, but also often work physically and temporally apart. In addition the increasing complexity of and drive to improve the quality of healthcare has given rise to one type of healthcare group, comprised of members from dispersed organizations, the quality improvement collaborative.

Members of quality improvement (QI) collaboratives share knowledge and act as resources for each other, with the goal of improving implementations of evidence-based practices (Newton, Davidson, Halcomb, Denniss, & Westgarth, 2006). A key purpose of a collaborative is to provide a formal structure that can be used by individuals to build networks of support and gain access to expertise in implementation areas. Many collaboratives hold scheduled conferences where members learn about problem-solving techniques and evidence-based practices, and individuals have the opportunity to meet in person. Members also share experiences during collaborative meetings. Other tools used in collaboratives can include site visits, written reports and sharing of data via electronic methods (Nembhard, 2009). Multiple studies have reported collaborative successes in improving processes, including studies in the areas of colorectal, perinatal, and diabetes care (Gould, 2010; Hicks et al., 2010; Jackson et al., 2010). Others, however, have suggested that collaboratives have only modest effects on outcomes and have concluded that little is known about the specific components that affect a collaborative’s effectiveness (Schouten, Hulscher, van Everdingen, Huijsman, & Grol, 2008). In addition few studies have assessed or found a positive effect on patient outcomes (Nadeem, Olin, Hill, Hoagwood, & Horwitz, 2013). Therefore there is a need for research on the behaviors of collaborative participants and the effect on outcomes (Lindenauer, 2008; Nadeem et al, 2013).

This chapter seeks to better understand how a mix of electronic and face-to-face communication employed by individual participants in a collaborative can affect measurable, objective outcomes in health care. To do so, the authors present a study of a fall prevention project carried out by Empira, a quality improvement collaborative of Minnesota nursing homes.