International Journal for Quality in Health Care Advance Access originally published online on April 21, 2009
International Journal for Quality in Health Care 2009 21(3):153-159; doi:10.1093/intqhc/mzp012
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Pseudoinnovation: the development and spread of healthcare quality improvement methodologies
Health Policy and Management Group, Herbert Simon Institute, Manchester Business School, Booth Street West, Manchester M15 6PB, UK
Background. Over the last two decades, we have seen the successive rise and fall of a number of concepts, ideas or methods in healthcare quality improvement (QI). Paradoxically, the content of many of these QI methodologies is very similar, though their presentation often seeks to differentiate or distinguish them.
Methods. This paper sets out to explore the processes by which new QI methodologies are developed and disseminated and the impact this has on the effectiveness of QI programmes in healthcare organizations. It draws on both a bibliometric analysis of the QI literature over the period from 1988 to 2007 and a review of the literature on the effectiveness of QI programmes and their evaluation.
Results. The repeated presentation of an essentially similar set of QI ideas and methods under different names and terminologies is a process of ‘pseudoinnovation’, which may be driven by both the incentives for QI methodology developers and the demands and expectations of those responsible for QI in healthcare organizations. We argue that this process has important disbenefits because QI programmes need sustained and long-term investment and support in order to bring about significant improvements. The repeated redesign of QI programmes may have damaged or limited their effectiveness in many healthcare organizations.
Conclusions. A more sceptical and scientifically rigorous approach to the development, evaluation and dissemination of QI methodologies is needed, in which a combination of theoretical, empirical and experiential evidence is used to guide and plan their uptake. Our expectations of the evidence base for QI methodologies should be on a par with our expectations in relation to other forms of healthcare interventions.
Keywords: quality management, measurement of quality, general methodology, healthcare system
Address reprint requests to: Kieran Walshe, Health Policy and Management Group, Herbert Simon Institute, Manchester Business School, Booth Street West, Manchester M15 6PB, UK. Tel: +44-161-275-3852; E-mail: kieran.walshe{at}manchester.ac.uk; kieran.walshe{at}mbs.ac.uk
Accepted for publication March 2, 2009.
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