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International Journal for Quality in Health Care Advance Access originally published online on October 18, 2007
International Journal for Quality in Health Care 2007 19(6):334-340; doi:10.1093/intqhc/mzm049
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Designing national quality reforms: a framework for action

Sheila Leatherman1,2 and Kim Sutherland3

1 School of Public Health, University of North Carolina, NC, USA
2 London School of Economics, University of Cambridge, UK
3 Judge Business School, University of Cambridge, UK

Healthcare systems worldwide strive to improve the quality of care they provide. Securing predictable systemic improvement is, however, a complex task. The imperative to be evidence-based is often constrained by the literature, which is of uneven scientific rigour and neither well-synthesized nor contextualised. This article provides a conceptual framework to guide the translation of the available evidence into policy and managerial decisions for improving quality. The framework has three aspects: a taxonomy to organize the available evidence of potential quality-enhancing interventions; a multi-tier approach to selecting and implementing interventions in a healthcare system; and a model to guide the adoption of professional, governmental and market levers for change.

Address reprint requests to: Sheila Leatherman, School of Public Health, University of North Carolina, NC, USA Tel: +1 612 922 0220; E-mail: sheilaleatherman{at}aol.com

Accepted for publication September 4, 2007.


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