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Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Michel LA Dückers12*, Cordula Wagner13, Leti Vos14 and Peter P Groenewegen15

Author Affiliations

1 NIVEL-Netherlands Institute for Health Services Research, Utrecht, the Netherlands

2 Impact, Dutch Knowledge & Advice Centre for Post-disaster Psychosocial Care, Amsterdam, the Netherlands

3 EMGO Institute for Health and Care Research, Free University Medical Centre, Amsterdam, the Netherlands

4 Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands

5 Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, the Netherlands

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Implementation Science 2011, 6:18  doi:10.1186/1748-5908-6-18

Published: 9 March 2011



Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used.


The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators.


MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports.


It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.