Karen Zamboni|Ulrika Baker|Mukta Tyagi|Joanna Schellenberg|Zelee Hill|Claudia Hanson
How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review
University of London|London School of Hygiene & Tropical Medicine|Karolinska Institutet|Public Health Foundation of India|University of London|London School of Hygiene & Tropical Medicine|University College London|Karolinska Institutet
quality improvement collaboratives widely used improve health care highincome low middleincome settings teams multiple health facilities share learning given topic apply structured cycle change testing previous systematic reviews reported positive effects target outcomes role context mechanism change underexplored realistinspired systematic review aims analyse contextual factors influencing intended outcomes identify quality improvement collaboratives may result improved adherence evidencebased practiceswe built initial conceptual framework drive enquiry focusing three context domains health facility setting projectspecific factors wider organisational external factors two domains pertaining mechanisms intraorganisational interorganisational changes systematically searched five databases grey literature publications relating quality improvement collaboratives healthcare setting containing data context mechanisms analysed reported findings thematically refined programme theorywe screened 962 abstracts 88 met inclusion criteria retained 32 analysis adequacy appropriateness external support functionality quality improvement teams leadership characteristics alignment national systems priorities may influence outcomes quality improvement collaboratives strength quality evidence weak participation quality improvement collaborative activities may improve health professionals knowledge problemsolving skills attitude teamwork shared leadership habits improvement interaction across quality improvement teams may generate normative pressure opportunities capacity building peer recognitionour review offers novel programme theory unpack complexity quality improvement collaboratives exploring relationship context mechanisms outcomes remains need greater use behaviour change organisational psychology theory improve design adaptation evaluation collaborative quality improvement approach test effectiveness research needed determine whether certain contextual factors related capacity precondition quality improvement collaborative approach test emerging programme theory using rigorous research designs