The study found that improvement collaboratives were able to achieve large increases in compliance with health care standards and in some cases, in health outcomes, across all care areas addressed, regardless of the baseline level of quality. Of the 135 analyzed time-series charts, 88% attained performance levels of at least 80%, and 76% reached at least 90%, even though more than half had baseline levels at 50% or below. The data provide compelling evidence that collaborative improvement can achieve large increases in performance, regardless of baseline level, and that results can be achieved relatively rapidly.  Across collaboratives, time series charts showed average increases of 52%.  Teams reached performance levels of 80% in about 13 months on average when baselines levels were below 50% and in about 6 months when baselines were above 50%. 

The analysis also suggests that moving beyond 80% performance requires different efforts (system redesign) to make high quality the routine and that deliberate spread reduces time required to raise performance of new sites.

The strength of a health system is measured in its ability to deliver good health outcomes. By achieving significant, sustained improvements in compliance with standards and outcomes, collaborative improvement is a viable tool for health systems strengthening in developing countries.