collaborative methodology, evidence-based practice, quality improvement



  1. Newton, Phillip J. RN, BN(Hons)
  2. Davidson, Patricia M. RN, BA, MEd, PhD
  3. Halcomb, Elizabeth J. RN, BN(Hons), Grad Cert ICNurse
  4. Denniss, A. Robert PhD, MBBS, FRACP
  5. Westgarth, Fidye BSc, MPH, Grad Dip QI


Background: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap.


Aim: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF.


Methods: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review.


Results: On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process.


Conclusion: The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease.