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Continuous innovation. This is the key to the Collaborative's success and it's become the take home message for Phyllis Weber, chief executive officer of California Transplant Donor Network (CTDN), in Oakland, California.

One of the most important "take home" lessons CTDN learned was to share the responsibility in developing best practices by involving hospital staff. "In the OPO world, we assumed the ultimate responsibility rested on the OPO staff. Through the Collaborative, there's a willing partnership on both sides," explains Weber. Weber also concludes that since CTDN has joined the Organ Donation Collaborative, they found that donor hospitals were willing to take on some of the educational responsibilities. And peer to peer education was widely accepted as a result. CTDN's hospital education also included observing the donation process and educating hospital staff in "real-time." "We've found this very effective. Sitting down for formal educational programs just doesn't happen anymore. You have to grab everyone on the run when they're in the midst of the donation. And it's the most effective education that can take place," says Weber.

Consequently CTDN's involvement in the Collaborative has improved its conversion rates. "We've been close to 70 percent over the last ten months  with approximately twelve hospitals sustaining a 75 percent rate or greater for at least one year. This is a significant improvement," says Weber. CTDN went from achieving a 50 percent conversion rate goal in 2001 to a 70 percent in a four-year time period.

"Using the Collaborative method and using the models of improvement is something that we have really embraced within our organization and it's  making the small changes and testing them over and over again until you get it right. It's a powerful tool within our organization," explains Weber.

Through testing small ideas, CTDN changed its mindset in improving their thoracic organ recovery and as a result were one of the national leaders in the number of organs transplanted per donor. Therefore, its staff was chosen to be part of the faculty for the Organ Transplant Collaborative.

One of CTDN's very own brought innovation to the Collaborative and ultimately paved the way for the creation of an advance donation specialist position. "Wayne Babcock brought the idea of the advance donation specialist position to CTDN as he conducted a retrospective study with local doctors of patients on demonstrating that a younger donor's heart had the ability to recover from severe stress through extensive donor management," says Weber. The number of organs per donor went from 3.5 to 4 organs per donor.

"I think he demonstrated with specialized training this advance practice role really can help improve the number of organs transplanted. We created this position in 2003 and currently have six of these specialists, two of which were just hired," says Weber. "We've seen the results already. Having the advance practice coordinator working alongside the transplant coordinator really improves the skills of your entry level transplant coordinator and exposes them to aggressive donor management early on in the process."

As the Organ Transplant Collaborative gets off the ground running, the transplant field anxiously awaits the early results. CTDN has already noted how the involvement of transplant programs and the participation of transplant surgeons and physicians has improved the process. "In our OPO, we haven't been successful in transplanting DCD donors, so that's a major improvement area and we've had offers from transplant surgeons to sit down with us to create a better evaluation tool."

For Phyllis Weber and the CTDN , the Collaborative's message is simple; continue to create solutions along the way. And that's a message we should all adhere to.