Quality improvement strategies for organizational change: a multiphase observational study to increase insight into nonparticipating organizations

Jeanny J. A. de Groot*, Maite Timmermans, Jose M. C. Maessen, Bjorn Winkens, Carmen D. Dirksen, Brigitte F. M. Slangen, Trudy van der Weijden

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BackgroundThe scope of implementation research is often restricted to the analysis of organizations that participate voluntarily in implementation interventions. The recruitment of participants for a quality improvement collaborative increases awareness of the specific innovation. The objective of this multiphase observational study was to identify differences between organizations that participated in a large-scale implementation project aiming to improve perioperative care, functional recovery, and length of hospital stay after gynecologic surgery and organizations that did not participate. A secondary objective was to explore how perioperative practice changed among nonparticipants.MethodsOf the seven gynecology departments of nonparticipating Dutch hospitals, five agreed to participate in a retrospective analysis. Baseline data of participating hospitals' (N=19) characteristics, time to functional recovery, and length of hospital stay were compared. Outcome measures for the subsequent pre-post awareness study in the five nonparticipating hospitals were: (1) overall adherence to predefined evidence-based perioperative elements; and (2) change in functional recovery and length of hospital stay. Multivariable regression models, adjusted for baseline characteristics, were used for analysis.ResultsIn retrospect, nonparticipating and participating hospitals did not differ in baseline characteristics, functional recovery, and length of hospital stay. In three of the five nonparticipating hospitals, adherence to the selected evidence-based perioperative elements increased significantly after awareness of the trial (overall mean difference 9.7%, 95% CI 6.9 to 12.5%, p

Original languageEnglish
Article number1011
Number of pages11
JournalBMC Health Services Research
Publication statusPublished - 29 Dec 2018


  • Implementation
  • Nonparticipant analysis
  • Awareness
  • Length of stay
  • Perioperative care
  • CARE

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