Effects of Surprises During Quality Improvement Projects: A Longitudinal Study on Method-Driven Learning in Behavioral Healthcare

Abstract

Quality improvement teams engage in multiple learning opportunities during an improvement project. These learning opportunities consist of both induced opportunities, such as formal training efforts, and incidental opportunities due to surprises (i.e., events that violate expectations) encountered during problem solving activities. In this paper, we propose that these two types of team learning opportunities can result in method-driven learning (MDL) at the team level. Our data are collected using a unique longitudinal survey design spanning 31 weeks that involved 33 participants in five design for Six Sigma projects conducted in different behavioral healthcare organizations, yielding a total of 562 weekly survey responses. We examine two modes of surprises. Those occurring spontaneously (measured based on self-rated and coder-rated variables) and reflective surprises (measured as externally-induced treatments). Our results show that: 1) the proportion of surprises occurring spontaneously during problem solving activities is positively correlated with team learning (i.e., MDL); and 2) collective reflections on surprises also facilitate team learning. Furthermore, we find evidence that surprises occurring spontaneously can negatively moderate the effect of induced learning opportunities (measured as efforts expended on training) on team learning. However, we find no evidence of such a negative moderation effect for surprises from reflection. Overall, our paper develops a nuanced understanding about the direct and moderating effects of surprises on team learning in the behavioral healthcare context, thereby contributing not only to the quality management literature but also quality improvement practices in behavioral healthcare.