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All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaboratives

Nembhard, Ingrid M.

doi: 10.1097/HMR.0b013e31822af831

Background: Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired.

Purpose: This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants’ performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices.

Methodology: We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources.

Findings: The more collaborative teams used inter-OLAs, the more their organizations’ performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams’ use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization’s use of Q-HR practices multiplied the performance benefit of inter-OLA use.

Practice Implications: Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile.

Ingrid M. Nembhard, PhD, MS, is Assistant Professor, School of Public Health, School of Management, Yale University, New Haven, Connecticut. E-mail:

This research was funded by the Harvard Business School Division of Research. The author was supported by a grant (1K01HS01898701) from the Agency for Healthcare Research and Quality. This study was approved by the Harvard University Committee on the Use of Human Subjects.

This paper was presented at the 2011 Academy of Management conference in San Antonio, Texas. An earlier version of this work was awarded the Alfred Sloan Dissertation Award, first prize.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2012 Lippincott Williams & Wilkins, Inc.