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Aims Improvement collaboratives consisting of various components are used throughout health care to improve quality, but no study has identified which components work best. This study tested the effectiveness of different components in addiction treatment services, hypothesizing that a combination of all components would be most effective. Design An unblinded cluster-randomized trial assigned clinics to one of four groups: interest circle calls (group teleconferences), clinic-level coaching, learning sessions (large face-to-face meetings) and a combination of all three. Interest circle calls functioned as a minimal intervention comparison group. Setting Out-patient addiction treatment clinics in the United States. Participants Two hundred and one clinics in five states. Measurements Clinic data managers submitted data on three primary outcomes: waiting-time (mean days between first contact and first treatment), retention (percentage of patients retained from first to fourth treatment session) and annual number of new patients. State and group costs were collected for a cost-effectiveness analysis. Findings Waiting-time declined significantly for three groups: coaching (an average of 4.6 days/clinic, P = 0.001), learning sessions (3.5 days/clinic, P = 0.012) and the combination (4.7 days/clinic, P = 0.001). The coaching and combination groups increased significantly the number of new patients (19.5%, P = 0.028; 8.9%, P = 0.029; respectively). Interest circle calls showed no significant effect on outcomes. None of the groups improved retention significantly. The estimated cost per clinic was $2878 for coaching versus $7930 for the combination. Coaching and the combination of collaborative components were about equally effective in achieving study aims, but coaching was substantially more cost-effective. Conclusions When trying to improve the effectiveness of addiction treatment services, clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives (interest circles calls and learning sessions) do not seem to add further value. [ABSTRACT FROM AUTHOR]

Purpose Our purpose is to describe how coaches who are clinical faculty help in the developmental process of residents to become better physicians and to lead the improvement of quality and safety in the Dartmouth-Hitchcock Leadership Preventive Medicine Residency Program (DHLPMR). Methods Using a semi-structured interview guide, eight coaches were interviewed and two focus groups were held with a total of nine residents. The qualitative data were content analysed to understand how both the coaches and residents perceive coaches' work and their role. Results The interviews with the coaches suggest that they take great pride in their work: they find it to be challenging and meaningful. The coaches use various skills and techniques - asking questions, listening deeply, observing the resident in action, offering encouragement and challenging the resident to think or act differently. The residents also perceive the work of the coach to help them progress on their learning journey. The role of the coach tends to go beyond coaching residents relative to improving an aspect of health care performance to creating the conditions for transformation and growth for the residents and the coaches. Conclusion The DHLPMR program is a unique residency program that has the intention to foster the development of future physician leaders who have the ability to both practise medicine and improve the clinical practices in which they work. The coaches are a vital ingredient in this program as they convey the residents/fellows on their leadership learning journey. [ABSTRACT FROM AUTHOR]