Enhancing Collaborative Learning for Quality Improvement: Evidence from the Improving Clinical Flow project, a Breakthrough Series Collaborative with Project ECHO

2020 
ABSTRACT Background: This project engaged teams from Federally Qualified Health Centers (FQHCs) in a QI collaborative to improve clinical flow (i.e., increase quality and efficiency of operations), using a novel combination of Breakthrough Series Collaborative tools with Project ECHO's telementoring model. This mixed-methods study describes the collaborative and evaluates its success in generating improvement and developing QI capacity at participating FQHCs. Methods: The 18-month collaborative utilized three in-person/virtual learning session workshops and weekly telementoring sessions with brief lectures and case-based learning. Participants engaged in QI work (e.g., PDSAs) and tracked data for ten care system measures to evaluate progress. These data were averaged across consistently reporting sites for standard run chart analysis. Semi-structured interviews assessed the effectiveness and value of the approach for participants. Results: Fifteen sites across the US participated for one year (Cohort 1); ten sites continued to 18 months (Cohort 2). Cohort 2 evidenced improvement for six measures: Patient Experience, Patient Time Valued, Empanelment, Cycle Time, CRC Screening, and Third Next Available Appointment. Progress varied across sites and measures. Participant interviews indicated value from both in-person and virtual activities, increased QI knowledge, and professional growth, as well as challenges when participants lacked time, engagement, leadership support, and consistent and committed staff. Conclusions: This novel collaborative structure is promising. Evidence indicates progress in building QI capacity and improving processes and patient experience across participating FQHCs. Future iterations should address barriers to improvement identified here. Additional work is needed to compare the efficacy of this approach to other collaborative modes.
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