Evaluating a quality improvement learning collaborative: qualitative evaluation of Using Labs Wisely.

Abstract

Overuse of low-value laboratory tests can harm patients, waste healthcare resources and contribute to environmental damage. To address this, Choosing Wisely Canada launched <i>Using Labs Wisely</i> (ULW), a national learning collaborative designed to reduce unnecessary testing through shared data, training and quality improvement initiatives. ULW brought together hospitals of all sizes to implement stewardship projects, foster collaboration and monitor progress through a centralised data repository. This study evaluated ULW to identify successes, challenges and opportunities for improvement. We conducted a qualitative study using a theory-informed interview guide based on the Theoretical Framework of Acceptability (TFA). Fifteen hospitals in the first ULW cohort were invited to participate. Interviews with clinicians and managers explored experiences with ULW, including what worked, what did not and recommendations for improvement. Transcripts were analysed inductively using thematic analysis, with themes reviewed collaboratively and mapped to TFA constructs. Thirteen hospitals participated, reflecting strong interest in reducing low-value testing and valuing ULW's structured, collaborative approach. Participants highlighted the programme's national credibility, resources and peer learning opportunities which facilitated institutional buy-in and elevated the laboratory's role in quality improvement. While generally manageable, common challenges included difficulties with data extraction, lack of standardisation across systems and limited human resources, particularly during pandemic-related strain. Participants called for expanded quality improvement training, clinical outcome tracking and cross-site collaboration to address increasingly complex and costly tests. ULW successfully supported hospitals to reduce low-value laboratory testing through structured improvement, benchmarking and peer learning. Challenges remain, particularly around data and resources, but the evaluation highlights key enablers and lessons that can inform the programme's evolution and guide future collaboratives in other healthcare settings.