Improving chronic diseases management using Learning from Excellence (LfE) model

Abstract

Abstract Background Learning from excellence (LfE) model demonstrated to be an effective method in the promotion of quality improvement in healthcare and in the reduction of patient’s harm. We applied LfE to identify the best models that could represent the excellence in the management of chronic heart failure (CHF) patients among the models adopted among 98 healthcare providers across 10 Italian Regions. Methods The research consisted of 2 phases: 1) the creation of a 9 indicators set to map CHF pathways and the analysis of these indicators through a quantitative approach using a modified positive deviance model which identified the best performers among our sample of hospitals and local health authorities (H/LHA) grouped in geographical Areas. We transformed 3 indicators (“tracking” indicators) into a 0-5 scale to assure direct comparison. 2) The H/LHA best performers were asked to share their organizational and clinical model during a workshop where every stakeholder involved could take part. Results Among the 10 investigated Italian Regions, 42 Areas were ranked and ranged 1,83-3,91. The three best performing areas that ranked above the 3rd quartile and were interested in taking part in this new approach were selected. The results arising from the qualitative analysis of these areas showed that communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing H/LHA. Indeed, the same role is played by all the policies and practices that enabled Interactions among healthcare workforce and patients, thus representing the ‘integration of care’. Conclusions The identification-celebration of best performers LfE implementation model holds the potential to promote quality improvement of processes among healthcare providers. This potential also unlocks in the chronic disease management field, making the sharing of best performers’ experience possible at a Regional and National level. Key messages Learning from excellence model demonstrated to be an effective method in the promotion of best models in the management of chronic diseases. Communication, trust and shared goals among healthcare professionals resulted to play a key role among the best performing hospital and local health authority.