Evaluation of four learning collaboratives for improving diagnostic excellence in radiology.

Introduction: Learning collaboratives are frequently used within healthcare to facilitate practice improvement through collaboration among clinical teams across multiple organizations. The aim of this study was to use the Agency for Healthcare Research and Quality (AHRQ) collaborative taxonomy to identify collaborative elements that influence successful implementation of clinical practices and sustain improvements in four radiology learning collaboratives. Methods: We used an ethnographic approach to evaluate a learning collaborative network using the AHRQ collaborative taxonomy. Data collection included observations, interviews, and review of site performance metrics. Results: We identified four themes that spanned the four AHRQ taxonomy primary elements (innovation, time, communication, social system) that explained the influence of the collaborative structure on site improvements and sustained success: (1) structured education in quality improvement and access to quality improvement tools provides a framework for quality improvement; (2) an expert-guided, structured improvement process sets the pace of improvement; (3) intentional participant interaction and contribution in meetings reinforces accountability; and (4) credible leadership and facilitation sustains participation. Conclusions: While we identified all four primary elements of the AHRQ framework as important for a successful learning collaborative, social system elements were particularly dominant in their influence on sites' success. In particular, expert, credible leaders who provided the right tools, at the right time and pace, with constructive guidance were critical for maintaining site engagement and driving problem-solving.