International Journal for Quality in Health Care Advance Access published online on March 2, 2007
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzm004
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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
Understanding what works—and why—in quality improvement: the need for theory-driven evaluation
Centre for Public Policy and Management, Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
Address reprint request to Kieran Walshe, Manchester centre for Healthcare Management, University of Manchester, Manchester, UK; Tel: (0161) 275 3852. Fax: (0161) 273 5245. E-mail: kieran.walshe@man.ac.uk
Accepted for publication January 15, 2007.
| The first 10% of the full text of this article appears below. |
Clinicians who are asked to participate in quality improvement programmes in healthcare organizations are often heard to ask for the evidence that they ‘work’. By that, they often mean they want randomized controlled trials, which show that accreditation, or credentialing, or criterion-based audit, or adverse event monitoring, or continuous quality improvement programmes, or whatever approach is being used cause meaningful and worthwhile improvements in the quality of care[1]. When they learn that there are relatively few experimental studies of quality improvement interventions[2], and those which do exist often show weak or moderate effects at best, this state of affairs is sometimes used to argue that it is not worthwhile investing time
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