How teams use indicators for quality improvement – A multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams

• Published in: Social science & medicine (1982) 2013-11, Vol.96, p.69-77
• Main Authors: Gort, Marjan, Broekhuis, Manda, Regts, Gerdien
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Breast Cancer; Breast Neoplasms - therapy; Cancer; Female; Group Processes; Gynecology. Andrology. Obstetrics; Health care; Health care delivery; Health Care Services; Health services; Humans; Indicators; Interprofessional Relations; Mammary gland diseases; Medical personnel; Medical sciences; Miscellaneous; Multidisciplinary teams; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Netherlands; Organizational Case Studies; Patient Care Team - organization & administration; Performance management; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Quality improvement; Quality Improvement - organization & administration; Quality Indicators, Health Care; Quality of care; Quality of Health Care; Task Performance; Teams; The Netherlands; Tumors; Women's health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2013.06.001

A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their ‘new’ managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results. •Recent studies find that the underlying mechanism of how indicator use relates to quality improvement is unclear.•The study unravels the process of indicator use, and investigates the role of team factors in this process and its results.•An in-depth, multiple-case study was conducted in the Netherlands in 2008, involving four breast cancer teams.•Teams that processed the stages of the process in a more intensive, active and interactive way achieved better results.•Controllability and actionability of the indicators seem to affect perceived results.