The effectiveness of clinical networks in improving quality of care and patient outcomes: A systematic review of quantitative and qualitative studies

Journal article


Brown, Bernadette B., Patel, Cyra, McInnes, Elizabeth C., Mays, Nicholas, Young, Jane and Haines, Mary. (2016) The effectiveness of clinical networks in improving quality of care and patient outcomes: A systematic review of quantitative and qualitative studies. BMC Health Services Research. 16(360), pp. 1 - 16. https://doi.org/10.1186/s12913-016-1615-z
AuthorsBrown, Bernadette B., Patel, Cyra, McInnes, Elizabeth C., Mays, Nicholas, Young, Jane and Haines, Mary
Abstract

Background: Reorganisation of healthcare services into networks of clinical experts is increasing as a strategy to promote the uptake of evidence based practice and to improve patient care. This is reflected in significant financial investment in clinical networks. However, there is still some question as to whether clinical networks are effective vehicles for quality improvement. The aim of this systematic review was to ascertain the effectiveness of clinical networks and identify how successful networks improve quality of care and patient outcomes. Methods: A systematic search was undertaken in accordance with the PRISMA approach in Medline, Embase, CINAHL and PubMed for relevant papers between 1 January 1996 and 30 September 2014. Established protocols were used separately to examine and assess the evidence from quantitative and qualitative primary studies and then integrate findings. Results: A total of 22 eligible studies (9 quantitative; 13 qualitative) were included. Of the quantitative studies, seven focused on improving quality of care and two focused on improving patient outcomes. Quantitative studies were limited by a lack of rigorous experimental design. The evidence indicates that clinical networks can be effective vehicles for quality improvement in service delivery and patient outcomes across a range of clinical disciplines. However, there was variability in the networks’ ability to make meaningful network- or system-wide change in more complex processes such as those requiring intensive professional education or more comprehensive redesign of care pathways. Findings from qualitative studies indicated networks that had a positive impact on quality of care and patients outcomes were those that had adequate resources, credible leadership and efficient management coupled with effective communication strategies and collaborative trusting relationships. Conclusions: There is evidence that clinical networks can improve the delivery of healthcare though there are few high quality quantitative studies of their effectiveness. Our findings can provide policymakers with some insight into how to successfully plan and implement clinical networks by ensuring strong clinical leadership, an inclusive organisational culture, adequate resourcing and localised decision-making authority.

Keywordsclinical networks; delivery of healthcare; health system planning; organisation of healthcare; health services; implementation science; quality improvement
Year2016
JournalBMC Health Services Research
Journal citation16 (360), pp. 1 - 16
PublisherBiomed Central Ltd
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-016-1615-z
Scopus EID2-s2.0-84992195156
Open accessOpen access
Page range1 - 16
Research GroupNursing Research Institute
Publisher's version
Additional information

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Place of publicationUnited Kingdom
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Flemmings, Kate and McInnes, Elizabeth. (2012) The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis. In In K. Haines and C. Lockwood (Ed.). Synthesizing qualitative research: Choosing the right approach pp. 59 - 82 John Wiley & Sons. https://doi.org/10.1002/9781119959847.ch4
Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks
McInnes, Elizabeth, Middleton, Sandy, Gardner, Glenn, Haines, Mary, Haertsch, Maggie, Paul, Christine L. and Castaldi, Peter. (2012) A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks. BMC Health Services Research. 12(1), pp. 1 - 12. https://doi.org/10.1186/1472-6963-12-49
Determinants of successful clinical networks: the conceptual framework and study protocol
Haines, Mary, Brown, Bernadette, Craig, Jonathan, D'Este, Catherine, Elliott, Elizabeth, Klineberg, Emily, McInnes, Elizabeth, Middleton, Sandy, Paul, Christine and Redman, Sally. (2012) Determinants of successful clinical networks: the conceptual framework and study protocol. Implementation Science. 7(16), pp. 1 - 10. https://doi.org/10.1186/1748-5908-7-16
Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study
Sutherland-Fraser, Sally, McInnes, Elizabeth, Maher, Elisabeth and Middleton, Sandy. (2012) Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nursing. 11(25), pp. 1 - 10. https://doi.org/10.1186/1472-6955-11-25
Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis
Flemmings, Kate and McInnes, Elizabeth. (2012) The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis. In In K. Haines and C. Lockwood (Ed.). Choosing the right approach pp. 59 - 82 John Wiley & Sons. https://doi.org/10.1002/9781119959847.ch4
Repositioning for pressure ulcer prevention in adults (Protocol)
Gillespie, Brigid, Chaboyer, Wendy, McInnes, Elizabeth, Kent, Bridie and Whitty, Jennifer. (2012) Repositioning for pressure ulcer prevention in adults (Protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009958
Revelations on the teaching of reading in the early years of schooling
Young, Janelle, Walsh, Maureen Patricia and McDonald, Lorraine. (2012) Revelations on the teaching of reading in the early years of schooling. Journal of Catholic School Studies. 84(1), pp. 44 - 54.
End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families
Coventry, Alysia, McInnes, Elizabeth and Rosenberg, John. (2012) End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families. JBI Database of Systematic Reviews and Implementation Reports. 10, pp. 95 - 106. https://doi.org/10.11124/jbisrir-2012-177
Facing the challenge of retaining new teachers in rural and remote settings: A report of two case studies using a community-based mentoring model in Queensland, Australia
Young, Janelle and Kennedy, Joy. (2011) Facing the challenge of retaining new teachers in rural and remote settings: A report of two case studies using a community-based mentoring model in Queensland, Australia. In J. Wright (Ed.). AARE 2011 Conference Proceedings. Australia: Australian Association for Research in Education. pp. 1 - 11
Older people's views in relation to risk of falling and need for intervention: A meta-ethnography
McInnes, Elizabeth, Seers, Kate and Tutton, Liz. (2011) Older people's views in relation to risk of falling and need for intervention: A meta-ethnography. Journal of Advanced Nursing. 67(12), pp. 2525 - 2536. https://doi.org/10.1111/j.1365-2648.2011.05707.x
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally E. M., Dumville, Jo C. and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub4
A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit
Jammali-Blasi, Asmara, McInnes, Elizabeth, Markus, Romesh, Faux, Steven, O'Loughlin, Grainne, Dale, Simeon and Middleton, Sandy. (2011) A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit. Journal of Vascular Nursing. 29(1), pp. 3 - 10. https://doi.org/10.1016/j.jvn.2010.11.004
Support surfaces for treating pressure ulcers (Review)
McInnes, Elizabeth, Dumville, Jo C., Jammali-Blasi, Asmara and Bell-Syer, Sally E. M.. (2011) Support surfaces for treating pressure ulcers (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009490
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. 21(21-22), pp. 3195 - 3198. https://doi.org/10.1002/14651858.CD001735.pub4
Who to turn to? Knowing the 'ropes' in an underbounded health care system
Chiarella, Mary and McInnes, Elizabeth. (2010) Who to turn to? Knowing the 'ropes' in an underbounded health care system. Contemporary Nurse. 36(February), pp. 10 - 20. https://doi.org/10.5172/conu.2010.36.1-2.010
Cross-age mentoring :exploring the effects of Indigenous Australian students reading together
Young, Janelle and Patmore, Madonna. (2010) Cross-age mentoring :exploring the effects of Indigenous Australian students reading together. Proceedings of the national conference for teachers of english and literacy: away with words: exploring the ambiguities in literacy and English education. Australia: Australian Association for the Teaching of English. pp. 1 - 14
Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention
Li, Francesca, Walker, Kim, McInnes, Elizabeth and Duff, Jed. (2010) Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention. Journal of Vascular Nursing. 28(3), pp. 92 - 96. https://doi.org/10.1016/j.jvn.2010.06.002
Taking full advantage and engaging teacher aides with literacy in the prep year
Young, Janelle. (2010) Taking full advantage and engaging teacher aides with literacy in the prep year. Journal of Catholic School Studies. 82(1), pp. 81 - 89.
Celebrating connecting with communities: Coproduction in global primary health care
Chiarella, Mary, Savage, Jane and McInnes, Elizabeth. (2010) Celebrating connecting with communities: Coproduction in global primary health care. Primary Health Care Research and Development. 11(2), pp. 108 - 122.
In their own words: Support surfaces to prevent pressure ulcers
McInnes, Elizabeth. (2010) In their own words: Support surfaces to prevent pressure ulcers. Journal of Evidence-Based Medicine. 3(2), pp. 132 - 132. https://doi.org/10.1111/j.1756-5391.2010.01081.x
Developing literacy understandings :Examining the effects of engaging teacher aides in professional development
Young, Janelle Patricia and Warren, Elizabeth Anne. (2009) Developing literacy understandings :Examining the effects of engaging teacher aides in professional development. Standing Conference on University Teaching and Research in the Education of Adults (SCUTREA) 2009. Cambridge, UK: Standing Conference on University Teaching and Res.... pp. 1 - 9
Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2)
Bell-Syer, Sally, Brady, Marian, Bruce, Julie, Cullum, Nicky A., Foxlee, Ruth, Jull, Andrew, Margolis, David, McInnes, Elizabeth, Nelson, Andre, O'Meara, Susan and Ubbink, Dirk. (2009) Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2). International Wound Journal. 6(4), pp. 306 - 309. https://doi.org/10.1111/j.1742-481X.2009.00620_1.x
Enhancing emergent literacy potential for young children
Young, Janelle. (2009) Enhancing emergent literacy potential for young children. Australian Journal of Language and Literacy. 32(2), pp. 163 - 180.
Indigenous students' early engagement with numeracy :The case of Widgy and Caddy
Vries, Eva de, Young, Janelle Patricia and Warren, Elizabeth Anne. (2008) Indigenous students' early engagement with numeracy :The case of Widgy and Caddy. In Merrilyn Goos, Ray Brown and Katie Makar (Ed.). Proceedings of the 31st Annual Conference of the Mathematics Education Research Group of Australasia. Brisbane, Australia: Mathematics Education Research Group of Australasia. pp. 547 - 554
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky A., Bell-Syer, Sally, Dumville, Jo C. and Jammali-Blasi, Asmara. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub3
The impact of early numeracy engagement on four-year-old indigenous students
Warren, Elizabeth, Young, Janelle and De Vries, Eva. (2008) The impact of early numeracy engagement on four-year-old indigenous students. Australasian Journal of Early Childhood. 33(4), pp. 2 - 8.
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky, Bell-Syer, Sally and Legood, Rosa. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub2
The role of oral language in assisting young Australian Indigenous students' numeracy outcomes
Warren, Elizabeth Anne, Young, Janelle Patricia and de Vries, Eva. (2008) The role of oral language in assisting young Australian Indigenous students' numeracy outcomes. Changing Climates: Education for Sustainable Futures. Brisbane, Australia: Australian Association for Research in Education.
Young Indigenous Students' Numeracy learning :The Role of Oral Language
Young, Janelle Patricia, DeVries, Eva and Warren, E.. (2008) Young Indigenous Students' Numeracy learning :The Role of Oral Language. Conference of the International Group for the Psychology of Mathematics Education (PME). Morelia Michoacan Mexico: International Group for the Psychology of Mathemati.... pp. 1 - 1
An overview of the competency movement in nursing and midwifery
Tho, Debra, Chiarella, Mary, McInnes, Elizabeth and Lau, Cecilia. (2008) An overview of the competency movement in nursing and midwifery. Collegian. 15(2), pp. 45 - 53. https://doi.org/10.1016/j.colegn.2008.02.001
Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention
McInnes, Elizabeth and Wimpenny, Peter. (2008) Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention. International Journal of Evidence-Based Healthcare. 6(3), pp. 337 - 344.
Legality, morality and reality - the role of the nurse in maintaining standards of care
Chiarella, Mary and McInnes, Elizabeth. (2008) Legality, morality and reality - the role of the nurse in maintaining standards of care. Australian Journal of Advanced Nursing. 26(1), pp. 77 - 83.
Oral language, representations and mathematical understanding: Indigenous Australian students
Warren, Elizabeth and Young, Janelle. (2008) Oral language, representations and mathematical understanding: Indigenous Australian students. The Australian Journal of Indigenous Education. 37(1), pp. 130 - 137. https://doi.org/10.1017/S1326011100016173
A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions
Bunn, Frances, Dickinson, Angela, Barnett-Page, Elaine, McInnes, Elizabeth and Horton, Khim. (2008) A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing and Society. 28(4), pp. 449 - 472. https://doi.org/10.1017/S0144686X07006861
Design-based research of Emergent Literacy :Enhancing potential for young children
Young, Janelle Patricia. (2007) Design-based research of Emergent Literacy :Enhancing potential for young children. In A. McNamara, J. Rickwood and F. Van Haren (Ed.). Critical Capital Teaching and Learning, CD Conference proceedings. AATE ALEA. Canberra, Australia: AATE/ALEA Professional Organisations. pp. 1 - 21
Parent and Teacher Perception of Emergent Literacy in the early weeks of school: An Australian Study
Young, Janelle. (2007) Parent and Teacher Perception of Emergent Literacy in the early weeks of school: An Australian Study Toronto,Ontario: International Reading Association.
Australian Indigenous Students :The role of oral language and representations in the negotiation of mathematical understanding
Vries, Eva de, Young, Janelle Patricia and Warren, Elizabeth Anne. (2007) Australian Indigenous Students :The role of oral language and representations in the negotiation of mathematical understanding. In Jane Watson and Kim Beswick (Ed.). Mathematics: Essential Research, Essential Practice. Proceedings of the 30th Annual conference of the Mathematics Education Research Group of Australasia.. Adelaide, Australia: Mathematics Education Research Group of Australasia. pp. 775 - 784
Focusing on Literacy :A Whole School Approach Preschool to Year 12
Branson, Christopher Michael, Young, Janelle Patricia, Parkinson, John and Johnson, Ruth. (2005) Focusing on Literacy :A Whole School Approach Preschool to Year 12. In Janelle Young (Ed.). Pleasure; Passion; Provocation: Proceedings of the AATE/ALEA National Conference. , Australia: AATE/ALEA Professional Organisations. pp. 1 - 14
Growing into Literacy :Emergent literacy understandings prior to school
Young, Janelle Patricia. (2005) Growing into Literacy :Emergent literacy understandings prior to school. In Peter L Jeffery (Ed.). Australian Association for Research in Education 2004 Conference Papers Collection. Melbourne, Australia: Australian Association for Research in Education. pp. 1 - 17
Attitudes to Reading :In Investigation across the Primary Years
Young, Janelle Patricia and Black, Anne-Marie. (2005) Attitudes to Reading :In Investigation across the Primary Years. In Janelle Young (Ed.). Pleasure Passion Provocation: Conference Proceedings of the AATE/ALEA National Conference 2005. Gold Coast, Australia: AATE/ALEA Professional Organisations. pp. 1 - 20
Prevention rather than intervention: Translating research into educational practice in the early years
Young, Janelle. (2005) Prevention rather than intervention: Translating research into educational practice in the early years. The International Journal of Learning. 11, pp. 1679 - 1688.
Clinical practice guidelines for the assessment and prevention of falls in older people
McInnes, Elizabeth, Gibbons, Elizabeth and Chandler-Oatts, Jacqueline. (2005) Clinical practice guidelines for the assessment and prevention of falls in older people. Worldviews on Evidence-Based Nursing. 2(1), pp. 33 - 36. https://doi.org/10.1111/j.1524-475X.2005.04094.x
Developing a guideline on the use of pressure-relieving
Legood, Rosa and McInnes, Elizabeth. (2005) Developing a guideline on the use of pressure-relieving. Journal of Advanced Nursing. 50(3), pp. 307 - 314. https://doi.org/10.1111/j.1365-2648.2005.03394.x
Growing in Literacy: Emergent Literacy Understandings Prior to School
Young, Janelle. (2004) Growing in Literacy: Emergent Literacy Understandings Prior to School. AARE 2004 International Education Research Conference. Melbourne, Australia: Australian Association for Research in Education. pp. 1 - 17
The prevention of pressure ulcers
Rycroft-Malone, Jo and McInnes, Elizabeth. (2004) The prevention of pressure ulcers. Worldviews on Evidence-Based Nursing. 1(2), pp. 146 - 149. https://doi.org/10.1111/j.1741-6787.2004.04032.x
Evidence review on older people's views and experiences of falls prevention strategies
McInnes, Elizabeth and Askie, Lisa. (2004) Evidence review on older people's views and experiences of falls prevention strategies. Worldviews on Evidence-Based Nursing. 1(1), pp. 20 - 37. https://doi.org/10.1111/j.1741-6787.2004.04013.x
Developing national clinical practice guidelines :the NICE experience
McInnes, Elizabeth. (2004) Developing national clinical practice guidelines :the NICE experience. Implementing evidence based practice in nursing and midwifery. Adelaide, Australia: The Joanna Briggs Institute. pp. 73 - 76
The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care
McInnes, Elizabeth. (2004) The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. Journal of Tissue Viability. 14(1), pp. 4 - 23.
Parent partnerships within Catholic school communities: Values underpins success
Warren, Elizabeth, Young, Janelle and Hanifin, Pam. (2003) Parent partnerships within Catholic school communities: Values underpins success. Journal of Empirical Theology. 4(1), pp. 63 - 80.
Evidence-based practice
Richens, Yana, Loftus-Hills, Alison and McInnes, Elizabeth Catherine. (2003) Evidence-based practice. In In S. Hinchliff, S. Norman and J. Schober (Ed.). Nursing practice and health care pp. 149 - 176 Hodder Arnold.
Predicting patterns of early literacy achievement: A longitudinal study
Young, Janelle Patricia. (2003) Predicting patterns of early literacy achievement: A longitudinal study. In P. Jeffrey (recorded as compiler) (Ed.). Proceedings of the Joint AARE-NZARE Conference (distributed CD). Croydon Victoria, Australia: Professional Resource Services Pty Ltd for AARE Office.
Literacy and numeracy in the home: Parents supporting children's learning
Young, Janelle Patricia and Warren, Elizabeth Anne. (2002) Literacy and numeracy in the home: Parents supporting children's learning. In Bill Cope and Mary Kalantzis (Ed.). Learning for the Future: Proceedings of the Learning Conference 2001. Melbourne, Australia: Common Ground Publishing. pp. 369 - 376
Parent and school partnerships in supporting literacy and numeracy
Warren, Elizabeth and Young, Janelle. (2002) Parent and school partnerships in supporting literacy and numeracy. Asia-Pacific Journal of Teacher Education. 30(3), pp. 217 - 228.