TY - JOUR
T1 - Improving the quality of healthcare
T2 - a cross-sectional study of the features of successful clinical networks
AU - Haines, Mary M.
AU - Brown, Bernadette
AU - D'Este, Catherine A.
AU - Yano, Elizabeth M.
AU - Craig, Jonathan C.
AU - Middleton, Sandy
AU - Castaldi, Peter A.
AU - Pollock, Carol A.
AU - Needham, Kate
AU - Watt, William H.
AU - Elliott, Elizabeth J.
AU - Scott, Anthony
AU - Dominello, Amanda
AU - Klineberg, Emily
AU - Atkinson, Jo An
AU - Paul, Christine
AU - Redman, Sally
AU - on behalf of the Clinical Networks Research Group
N1 - Funding Information:
The authors acknowledge the valuable contribution of the clinical network managers and co-chairs, and the Agency executive, for participating in this research. In addition, the authors thank Robert Sanson-Fisher, Daniel Barker and Mario D'Souza from the University of Newcastle for their valuable input into the study design, data management and data analysis stages, respectively. We acknowledge the support of Cyra Patel and Frances Gilham in assisting with preparing this manuscript. As well as the named authors, the other members of the Clinical Networks Research Group are: Deanna Kalucy (Sax Institute), Rob Sanson-Fisher (University of Newcastle), Elizabeth McInnes (St Vincent's Health and Australian Catholic University) and Cyra Patel (The Children's Hospital at Westmead).
Funding Information:
PC, WW, KN and Nigel Lyons, who are part of the Clinical Networks Research Group, were previously employed by the NSW Agency for Clinical Innovation. SM is and CAP was a member of the Agency for Clinical Innovation Board. SM and MH are members of the Agency for Clinical Innovation Board Research Sub-Committee. The Agency has provided funds to support this research as part of the National Health and Medical Research Council (NHMRC) partnership project grant scheme. These funds have been awarded on the basis of an NHMRC deed of agreement detailing the governance and conduct of research in Australia. The inclusion of current and past executives and a board member on the investigator team raises perceived and actual conflicts of interest that were considered by the University of Sydney Human Research Ethics Committee, at that time: • The current executive member (Nigel Lyons) and board member (CAP) have a competing interest in the study that is focused on the Agency’s performance Past executives (PC, KN and WW) may be perceived as having a conflict of interest in the outcomes of this study.
Publisher Copyright:
© 2018 Haines et al. This article is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms. See: www.creativecommons.org/licenses/by-nc-sa/4.0/
PY - 2018/12
Y1 - 2018/12
N2 - Objectives: Networks of clinical experts are being established internationally to help embed evidence based care in health systems. There is emerging evidence that these clinical networks can drive quality improvement programs, but the features that distinguish successful networks are largely unknown. We examined the factors that make clinical networks effective at improving quality of care and facilitating system-wide changes. Methods: We conducted a retrospective cross-sectional study of 19 statewide clinical networks that reflected a range of medical and surgical specialty care and were in operation from 2006 to 2008 in New South Wales, Australia. We conducted qualitative interviews with network leaders to characterise potential impacts, and conducted internet surveys of network members to evaluate external support and the organisational and program characteristics of their respective networks. The main outcome measures were median ratings of individual network impacts on quality of care and system-wide changes, determined through independent assessment of documented evidence by an expert panel. Results: We interviewed 19 network managers and 32 network co-chairs; 592 network members completed internet surveys. Three networks were rated as having had high impact on quality of care, and seven as having had high impact on system-wide change. Better-perceived strategic and operational network management was significantly associated with higher ratings of impact on quality of care (coefficient estimate 0.86; 95% confidence interval [CI] 0.02, 1.69). Better-perceived leadership of the network manager (coefficient estimate 0.47; 95% CI 0.10, 0.85) and strategic and operational network management (coefficient estimate 0.23; 95% CI 0.06, 0.41) were associated with higher ratings of impact on system-wide change. Conclusions: This study represents the largest study of clinical networks undertaken to date. The results suggest that clinical networks that span the health system can improve quality of care and facilitate system-wide change. Network management and leadership, encompassing both strategic and operational elements at the organisational level, appear to be the primary influences on network success. These findings can guide future organisational and system-wide change programs and the development or strengthening of clinical networks to help implement evidence based care to improve service delivery and outcomes.
AB - Objectives: Networks of clinical experts are being established internationally to help embed evidence based care in health systems. There is emerging evidence that these clinical networks can drive quality improvement programs, but the features that distinguish successful networks are largely unknown. We examined the factors that make clinical networks effective at improving quality of care and facilitating system-wide changes. Methods: We conducted a retrospective cross-sectional study of 19 statewide clinical networks that reflected a range of medical and surgical specialty care and were in operation from 2006 to 2008 in New South Wales, Australia. We conducted qualitative interviews with network leaders to characterise potential impacts, and conducted internet surveys of network members to evaluate external support and the organisational and program characteristics of their respective networks. The main outcome measures were median ratings of individual network impacts on quality of care and system-wide changes, determined through independent assessment of documented evidence by an expert panel. Results: We interviewed 19 network managers and 32 network co-chairs; 592 network members completed internet surveys. Three networks were rated as having had high impact on quality of care, and seven as having had high impact on system-wide change. Better-perceived strategic and operational network management was significantly associated with higher ratings of impact on quality of care (coefficient estimate 0.86; 95% confidence interval [CI] 0.02, 1.69). Better-perceived leadership of the network manager (coefficient estimate 0.47; 95% CI 0.10, 0.85) and strategic and operational network management (coefficient estimate 0.23; 95% CI 0.06, 0.41) were associated with higher ratings of impact on system-wide change. Conclusions: This study represents the largest study of clinical networks undertaken to date. The results suggest that clinical networks that span the health system can improve quality of care and facilitate system-wide change. Network management and leadership, encompassing both strategic and operational elements at the organisational level, appear to be the primary influences on network success. These findings can guide future organisational and system-wide change programs and the development or strengthening of clinical networks to help implement evidence based care to improve service delivery and outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85060145521&partnerID=8YFLogxK
U2 - 10.17061/phrp28011803
DO - 10.17061/phrp28011803
M3 - Article
C2 - 30652189
AN - SCOPUS:85060145521
SN - 2204-2091
VL - 28
JO - Public Health Research & Practice
JF - Public Health Research & Practice
IS - 4
M1 - e28011803
ER -
