Prospects for Further Success and Next Steps

There is a great need in Switzerland and worldwide for the implementation of evidence-based practice. Too often, there is a gap between best practice as described in the literature and what is reliably implemented at the bedside and within organizations. The Breakthrough Collaborative model has much to offer in closing this gap. The challenge is to overcome the classical barriers to implementing evidence-based practice, such as lack of knowledge, skepticism toward the evidence, belief that one's patients are different, want of user-friendly guidelines, lack of tools, and insufficient time for implementation. The collaborative model, as illustrated in our case studies, can help to reduce almost all of these barriers. The most important challenge is the active engagement of executive boards and the integration of patient safety improvement goals into the strategy of healthcare organizations. Additional research and project evaluation is needed to assess the applicability and the effectiveness of the model in primary care, long-term care, and for large- scale change versus local use.

To develop the collaborative model further and to boost the transferability of improvements, it is important to keep track of the implementation of improvement interventions within participating institutions, and to assess the relative contribution of all interventions. Mixed methods research should be systematically coupled to collaboratives, to understand the quantitative elements, but also the importance of the context, culture, and organizational readiness: all are important aspects of implementation science.

Conclusion

Many Swiss citizens, healthcare professionals, and politicians believe that they have the best healthcare system in the world. There is, however, no evidence that Swiss healthcare is superior to that of other high-income countries. In such an environment, improvement of care is a challenge and has lagged behind other countries.

Breakthrough Collaboratives have supplied a model that integrates awareness-raising, knowledge-sharing, fostering of cultural change, and the development of champions who have become organizational change agents. The model has had convincing results in Switzerland and is gaining momentum. However, further research is needed to measure results and to assess specific as well as system-wide contributing factors.

 
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