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Qual Manag Health Care. 2009 Oct-Dec;18(4):231-8. doi: 10.1097/QMH.0b013e3181c58e20.

Adapting to the context and learning from earlier experience: the implementation of a national breakthrough collaborative in the context of social services in Sweden.

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Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden.



Although often used in health care settings as a method for continuous quality improvement, experience with the breakthrough collaborative in nonclinical health care settings is limited. In this article, we report pilot data from a social services collaborative conducted in 2007 to 2009 in Sweden, with special attention given to features of the implementation context that appeared to facilitate or hinder its success.


We used a case study approach to describe the processes used in the pilot project as well as to characterize the context. Our analysis was guided by a framework consisting of earlier identified factors for success including "motivate and empower the teams" and "ensure teams have measurable and achievable targets."


We observed several context-specific factors. These included measuring challenges connected to large cooperating teams. Specifically, teams representing different organizations needed more time to carry out a breakthrough collaborative than those in clinical health care settings. As in breakthrough collaboratives conducted in health care settings, early measurement efforts enabled a clearer sense of direction, which may have served to reinforce motivation among team members. This study highlights features that may have universal importance in influencing the success of breakthrough collaboratives to improve the quality of social services.

[Indexed for MEDLINE]

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