Posted by: ayrshirehealth | June 22, 2012

Collaborative Learning: Influencing clinical improvement. By @suzi_hannah

Collaborative Learning: Bringing Together Will, Ideas and Execution to Improve Patient Safety.  

From a napkin to a global movement

I was intrigued to read that, in 1994, Paul Batalden MD, co-founder of the Institute of Healthcare Improvement (IHI) came up with an idea to accelerate quality improvement initiatives in healthcare systems.

He sketched out the concept for a model on a napkin while in a meeting and passed it to his colleague, IHI CEO Don Berwick, MD.

This began the development of the Breakthrough Series Collaborative model which has provided the structure that engages teams in successful quality improvement initiatives in healthcare systems worldwide.

The tartan effect

I recently attended the second national Scottish Patient Safety Programme (SPSP) Learning Session of the joint collaborative for Sepsis and Venous Thromboembolism (VTE). This event was an excellent example of a national Breakthrough Series Collaborative. The room was buzzing with the breadth of clinical knowledge combined with application experts;  that is to say, professionals with advanced knowledge in the science of improvement.  Representing NHS health boards from across Scotland, teams joined together with a shared vision to improve patient care and outcomes. The enthusiasm in the room and willingness to share experiences and ideas for change was tangible.

  • Key to this success is an all share all learn attitude, a philosophy that has been instilled in me throughout my journey to become an Improvement Advisor:  share openly, steal shamelessly, and develop relationships with other clinical teams and improvement experts with a common goal.

It’s all about building a community which reassures you that you are not alone in your improvement journey. This enabling of shared learning on a national scale provides the opportunity for clinical teams to return to their practice, eager to apply their new knowledge and theories with an emphasis on testing, testing and more testing.

Avoiding ‘spray and pray’  

The IHI have taught us the value in adopting the science of improvement and the importance of building capacity and capability within teams to deliver reliable improvements.

  • Key learning for me as a graduate of the IA Professional Development Programme was the importance of understanding the complexity of our healthcare systems and the requirement for three vital ingredients to support successful quality improvement; the combination of will, ideas and execution.

We are never short of willing clinicians with good ideas and enthusiasm to improve the system, but often the challenge for clinical teams lies in the application of theories and ideas that deliver reliable process and sustainable improved outcomes.  The crucial component for the success of improvement initiatives is the ability to execute change ideas robustly and developing these skills within healthcare teams has become an important aspect of quality improvement in NHS Scotland.

Until recently it may have been difficult to see how the desirable model of combining subject matter knowledge and profound knowledge could be achieved on a national scale, however Healthcare Improvement Scotland and the Scottish Patient Safety Programme have invested in developing Improvement Advisors and SPSP Fellows across NHS Scotland and a growing community of healthcare professionals with advanced skills in improvement science is becoming a reality.

Building a movement

Tom Nolan, IHI Senior Fellow, once suggested that

“you should never be more than two steps away from an improvement expert.”

He proposed this as a gauge of an organisation’s capacity for supporting and spreading the science of improvement and I have heard this repeated a number of times in recent months at various improvement meetings and events.

NHS Scotland

At the recent SPSP Collaborative involving some 280 delegates, close to 50 people were identified as having been educated in advanced knowledge of improvement science.

This is surely a sign that quality improvement knowledge is gaining momentum in NHS Scotland and what could have been described as a minority group in the not too distant past is beginning to feel like a movement.


Further Reading

The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on

Langley, G.J. Moen,R. Nolan, K.M. Nolan,T.W. Norman, C.L. Provost,L.P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd Edition . Jossey Bass.

Next weeks blog :

by @markfleming1 – eHealth: a revolution or best considered as evolution



  1. The breakthrough collaborative model could become one that was used within local teams to support their improvement work – local team meetings become the learning sessions ?

  2. Thanks for the comment, I agree. This is something I would be keen
    to develop. There is an oportunity with a small group of CNs I met
    with last week from diferent hopsital sites who are taking forward
    improvement work. The basis is there with PDSA testing agreed
    however would be good to introduce them to the wider learning of
    improvement science….another way of supporting capacity and
    capability building.

    • .. and would be fabulous if the participants and changes could involve nursing, medicine, pharmacy, AHPs and people using service. Starting one PDSA that had nursing and A.N. other discipline would be a start ?

  3. Great blog Susan. We used a collaborative approach with the Improving Nutritional Care Programme at HIS. This approach provided a powerful platform for testing, learning and sharing.

    • Thanks for your feedback Michelle, much appreciated. I like that it is possible to adopt the same model locally on a smaller scale, however the large scale collaboratives are impressive and improvement teams benefit so much from the experience of being part of it.

      • We heard today that Grampian and Tayside are using the collaborative approach in the work around Older People in Acute Care. Lots of way the improvement methodology can be applied in real practical ways to deliver change.

  4. […] boards in Scotland with the common aim to achieve improved patient experience and outcome.   Workstream change packages to support improvement activity across hospital systems have been taken forward by committed […]

  5. […] first real introduction to improvement methodology and the model from improvement , as discussed by Susan Hannah and other within recent blogs, was  during the introduction of an Emergency Response Team within […]

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