Learning from large-scale quality improvement through comparisons.

OBJECTIVE To discover lessons from 10 national health and social care quality programmes in the Netherlands. DESIGN A mixed-methods comparison using a 'quantitative summarization of evidence for systematic comparison'. Each research team assessed whether there was evidence from their evaluation to support or refute 17 hypotheses about successful implementation of quality programmes. The programme managers carried out a similar assessment. Their assessments were represented as scores which made it possible to carry out a cross-case analysis to assess factors affecting the success of large-scale quality programmes. PARTICIPANTS The researchers who evaluated each of the programmes and the leaders who organized each programme. SETTING Health and social care service organizations and national organization, which led the quality improvement programmes. INTERVENTION(S) This study did not make an intervention but compared experiences and evaluations of interventions carried out by national organization to health and social care service organizations to help these organizations to improve their services. MAIN OUTCOME MEASURE(S) The success of the national programmes, and the learning achieved by the programme organizations and care service delivery organizations. RESULTS The method provided a way to summarize and compare complex information. Common factors which appeared to influence success in implementation included understanding of political processes, leader's influencing skills, as well as technical skills to manage projects and apply improvement and change methods. CONCLUSIONS Others could use a similar method to make a fast, broad level, but systematic comparison across reports of improvements or programmes. Descriptions, and then comparisons of the programmes, reveal common factors which appeared to influence success in implementation. There were groups of factors which appeared to be more important for the success of certain types of programmes. It is possible that these factors may also be important for the success of large-scale improvement programmes in other countries.