The Breakthrough Series Collaborative: A Scoping Review of a Systems Level Intervention for Social Services

Background/Purpose: The Breakthrough Series Collaborative (BSC) methodology is a continuous learning approach originally designed for use in healthcare (IHI, 2003) to address entrenched, multifaceted problems within the complexities of healthcare system such as hospital infection rates (Tuma et al., 2023). It has recently been applied to other complex service systems outside of healthcare. BSCs hold a great deal of promise as a system level intervention to address the complex, system-entrenched problems that social workers often seek to address. BSCs can be used on their own, or alongside more static, often individually or family-focused, evidence-supported interventions. Given the relatively recent application of BSCs outside of healthcare, and the lack of any systematic description of the use of BSCs and its promise for broad social work application, a scoping review using systematic review methods was conducted to map the scholarship on BSCs outside of healthcare and make recommendations to advance the use and study of the BSC methodology.

Methods: The protocol for this scoping review was registered using a protocol published with the Open Science Framework (OSF) and developed in consultation with a research librarian. Inclusion criteria included studies conducted after 1995 (the date BSCs were developed), written in English, implementation in a system other than healthcare, and reported methods, and reported data. Covidence was used by the research team to manage the search process, import articles for screening, and screen articles for eligibility. Study methods and findings were extracted from articles meeting eligibility criteria using multiple coders.

Results: The initial database search produced a total of 1532 studies. Of these, 524 unique studies were identified after removing duplicates. A total of 48 studies were screened in based on title and abstract review. After full text review, a total of 11 studies met inclusion criteria. A review of the studies indicates that most studies were carried out in child welfare (n=5) and early childhood settings (n=4) in the United States. Studies generally relied on descriptive and qualitative approaches. Few standardized measurement approaches were identified to assess either the processes or outcomes of BSCs.

Conclusions and Implications: Although the BSC methodology has been used primarily in medicine, the studies conducted on BSCs outside of healthcare indicate the potential of the intervention to address complex problems embedded in many social service systems. There is a need for continued research to build on existing findings with more rigorous methods, including standardized measurement and fidelity approaches. Possible studies in social work-relevant systems beyond healthcare, child welfare and early childhood include K-12 education, criminal justice, housing, and other complex service systems grappling with multi-factor entrenched problems.