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Quality improvement into practice

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• Adam Backhouse , quality improvement programme lead 1 ,
• Fatai Ogunlayi , public health specialty registrar 2
• 1 North London Partners in Health and Care, Islington CCG, London N1 1TH, UK
• 2 Institute of Applied Health Research, Public Health, University of Birmingham, B15 2TT, UK
• Correspondence to: A Backhouse adam.backhouse{at}nhs.net

What you need to know

Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about ( a ) the contribution QI offers to staff and patients, ( b ) how to differentiate it from other approaches, ( c ) the benefits of using QI together with other change approaches

QI is not a silver bullet for all changes required in healthcare: it has great potential to be used together with other change approaches, either concurrently (using audit to inform iterative tests of change) or consecutively (using QI to adapt published research to local context)

As QI becomes established, opportunities for these collaborations will grow, to the benefit of patients.

The benefits to front line clinicians of participating in quality improvement (QI) activity are promoted in many health systems. QI can represent a valuable opportunity for individuals to be involved in leading and delivering change, from improving individual patient care to transforming services across complex health and care systems. 1

However, it is not clear that this promotion of QI has created greater understanding of QI or widespread adoption. QI largely remains an activity undertaken by experts and early adopters, often in isolation from their peers. 2 There is a danger of a widening gap between this group and the majority of healthcare professionals.

This article will make it easier for those new to QI to understand what it is, where it fits with other approaches to improving care (such as audit or research), when best to use a QI approach, making it easier to understand the relevance and usefulness of QI in delivering better outcomes for patients.

How this article was made

AB and FO are both specialist quality improvement practitioners and have developed their expertise working in QI roles for a variety of UK healthcare organisations. The analysis presented here arose from AB and FO’s observations of the challenges faced when introducing QI, with healthcare providers often unable to distinguish between QI and other change approaches, making it difficult to understand what QI can do for them.

How is quality improvement defined?

There are many definitions of QI ( box 1 ). The BMJ ’s Quality Improvement series uses the Academy of Medical Royal Colleges definition. 6 Rather than viewing QI as a single method or set of tools, it can be more helpful to think of QI as based on a set of principles common to many of these definitions: a systematic continuous approach that aims to solve problems in healthcare, improve service provision, and ultimately provide better outcomes for patients.

Definitions of quality improvement

Improvement in patient outcomes, system performance, and professional development that results from a combined, multidisciplinary approach in how change is delivered. 3

The delivery of healthcare with improved outcomes and lower cost through continuous redesigning of work processes and systems. 4

Using a systematic change method and strategies to improve patient experience and outcome. 5

To make a difference to patients by improving safety, effectiveness, and experience of care by using understanding of our complex healthcare environment, applying a systematic approach, and designing, testing, and implementing changes using real time measurement for improvement. 6

In this article we discuss QI as an approach to improving healthcare that follows the principles outlined in box 2 ; this may be a useful reference to consider how particular methods or tools could be used as part of a QI approach.

Principles of QI

Primary intent— To bring about measurable improvement to a specific aspect of healthcare delivery, often with evidence or theory of what might work but requiring local iterative testing to find the best solution. 7

Employing an iterative process of testing change ideas— Adopting a theory of change which emphasises a continuous process of planning and testing changes, studying and learning from comparing the results to a predicted outcome, and adapting hypotheses in response to results of previous tests. 8 9

Consistent use of an agreed methodology— Many different QI methodologies are available; commonly cited methodologies include the Model for Improvement, Lean, Six Sigma, and Experience-based Co-design. 4 Systematic review shows that the choice of tools or methodologies has little impact on the success of QI provided that the chosen methodology is followed consistently. 10 Though there is no formal agreement on what constitutes a QI tool, it would include activities such as process mapping that can be used within a range of QI methodological approaches. NHS Scotland’s Quality Improvement Hub has a glossary of commonly used tools in QI. 11

Empowerment of front line staff and service users— QI work should engage staff and patients by providing them with the opportunity and skills to contribute to improvement work. Recognition of this need often manifests in drives from senior leadership or management to build QI capability in healthcare organisations, but it also requires that frontline staff and service users feel able to make use of these skills and take ownership of improvement work. 12

Using data to drive improvement— To drive decision making by measuring the impact of tests of change over time and understanding variation in processes and outcomes. Measurement for improvement typically prioritises this narrative approach over concerns around exactness and completeness of data. 13 14

Scale-up and spread, with adaptation to context— As interventions tested using a QI approach are scaled up and the degree of belief in their efficacy increases, it is desirable that they spread outward and be adopted by others. Key to successful diffusion of improvement is the adaption of interventions to new environments, patient and staff groups, available resources, and even personal preferences of healthcare providers in surrounding areas, again using an iterative testing approach. 15 16

What other approaches to improving healthcare are there?

Taking considered action to change healthcare for the better is not new, but QI as a distinct approach to improving healthcare is a relatively recent development. There are many well established approaches to evaluating and making changes to healthcare services in use, and QI will only be adopted more widely if it offers a new perspective or an advantage over other approaches in certain situations.

A non-systematic literature scan identified the following other approaches for making change in healthcare: research, clinical audit, service evaluation, and clinical transformation. We also identified innovation as an important catalyst for change, but we did not consider it an approach to evaluating and changing healthcare services so much as a catch-all term for describing the development and introduction of new ideas into the system. A summary of the different approaches and their definition is shown in box 3 . Many have elements in common with QI, but there are important difference in both intent and application. To be useful to clinicians and managers, QI must find a role within healthcare that complements research, audit, service evaluation, and clinical transformation while retaining the core principles that differentiate it from these approaches.

Alternatives to QI

Research— The attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods. 17

Clinical audit— A way to find out if healthcare is being provided in line with standards and to let care providers and patients know where their service is doing well, and where there could be improvements. 18

Service evaluation— A process of investigating the effectiveness or efficiency of a service with the purpose of generating information for local decision making about the service. 19

Clinical transformation— An umbrella term for more radical approaches to change; a deliberate, planned process to make dramatic and irreversible changes to how care is delivered. 20

Innovation— To develop and deliver new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health. Health innovation responds to unmet needs by employing new ways of thinking and working. 21

Why do we need to make this distinction for QI to succeed?

Improvement in healthcare is 20% technical and 80% human. 22 Essential to that 80% is clear communication, clarity of approach, and a common language. Without this shared understanding of QI as a distinct approach to change, QI work risks straying from the core principles outlined above, making it less likely to succeed. If practitioners cannot communicate clearly with their colleagues about the key principles and differences of a QI approach, there will be mismatched expectations about what QI is and how it is used, lowering the chance that QI work will be effective in improving outcomes for patients. 23

There is also a risk that the language of QI is adopted to describe change efforts regardless of their fidelity to a QI approach, either due to a lack of understanding of QI or a lack of intention to carry it out consistently. 9 Poor fidelity to the core principles of QI reduces its effectiveness and makes its desired outcome less likely, leading to wasted effort by participants and decreasing its credibility. 2 8 24 This in turn further widens the gap between advocates of QI and those inclined to scepticism, and may lead to missed opportunities to use QI more widely, consequently leading to variation in the quality of patient care.

Without articulating the differences between QI and other approaches, there is a risk of not being able to identify where a QI approach can best add value. Conversely, we might be tempted to see QI as a “silver bullet” for every healthcare challenge when a different approach may be more effective. In reality it is not clear that QI will be fit for purpose in tackling all of the wicked problems of healthcare delivery and we must be able to identify the right tool for the job in each situation. 25 Finally, while different approaches will be better suited to different types of challenge, not having a clear understanding of how approaches differ and complement each other may mean missed opportunities for multi-pronged approaches to improving care.

What is the relationship between QI and other approaches such as audit?

Academic journals, healthcare providers, and “arms-length bodies” have made various attempts to distinguish between the different approaches to improving healthcare. 19 26 27 28 However, most comparisons do not include QI or compare QI to only one or two of the other approaches. 7 29 30 31 To make it easier for people to use QI approaches effectively and appropriately, we summarise the similarities, differences, and crossover between QI and other approaches to tackling healthcare challenges ( fig 1 ).

How quality improvement interacts with other approaches to improving healthcare

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QI and research

Research aims to generate new generalisable knowledge, while QI typically involves a combination of generating new knowledge or implementing existing knowledge within a specific setting. 32 Unlike research, including pragmatic research designed to test effectiveness of interventions in real life, QI does not aim to provide generalisable knowledge. In common with QI, research requires a consistent methodology. This method is typically used, however, to prove or disprove a fixed hypothesis rather than the adaptive hypotheses developed through the iterative testing of ideas typical of QI. Both research and QI are interested in the environment where work is conducted, though with different intentions: research aims to eliminate or at least reduce the impact of many variables to create generalisable knowledge, whereas QI seeks to understand what works best in a given context. The rigour of data collection and analysis required for research is much higher; in QI a criterion of “good enough” is often applied.

Relationship with QI

Though the goal of clinical research is to develop new knowledge that will lead to changes in practice, much has been written on the lag time between publication of research evidence and system-wide adoption, leading to delays in patients benefitting from new treatments or interventions. 33 QI offers a way to iteratively test the conditions required to adapt published research findings to the local context of individual healthcare providers, generating new knowledge in the process. Areas with little existing knowledge requiring further research may be identified during improvement activities, which in turn can form research questions for further study. QI and research also intersect in the field of improvement science, the academic study of QI methods which seeks to ensure QI is carried out as effectively as possible. 34

Scenario: QI for translational research

Newly published research shows that a particular physiotherapy intervention is more clinically effective when delivered in short, twice-daily bursts rather than longer, less frequent sessions. A team of hospital physiotherapists wish to implement the change but are unclear how they will manage the shift in workload and how they should introduce this potentially disruptive change to staff and to patients.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this article?

Adopting a QI approach, the team realise that, although the change they want to make is already determined, the way in which it is introduced and adapted to their wards is for them to decide. They take time to explain the benefits of the change to colleagues and their current patients, and ask patients how they would best like to receive their extra physiotherapy sessions.

The change is planned and tested for two weeks with one physiotherapist working with a small number of patients. Data are collected each day, including reasons why sessions were missed or refused. The team review the data each day and make iterative changes to the physiotherapist’s schedule, and to the times of day the sessions are offered to patients. Once an improvement is seen, this new way of working is scaled up to all of the patients on the ward.

The findings of the work are fed into a service evaluation of physiotherapy provision across the hospital, which uses the findings of the QI work to make recommendations about how physiotherapy provision should be structured in the future. People feel more positive about the change because they know colleagues who have already made it work in practice.

QI and clinical audit

Clinical audit is closely related to QI: it is often used with the intention of iteratively improving the standard of healthcare, albeit in relation to a pre-determined standard of best practice. 35 When used iteratively, interspersed with improvement action, the clinical audit cycle adheres to many of the principles of QI. However, in practice clinical audit is often used by healthcare organisations as an assurance function, making it less likely to be carried out with a focus on empowering staff and service users to make changes to practice. 36 Furthermore, academic reviews of audit programmes have shown audit to be an ineffective approach to improving quality due to a focus on data collection and analysis without a well developed approach to the action section of the audit cycle. 37 Clinical audits, such as the National Clinical Audit Programme in the UK (NCAPOP), often focus on the management of specific clinical conditions. QI can focus on any part of service delivery and can take a more cross-cutting view which may identify issues and solutions that benefit multiple patient groups and pathways. 30

Audit is often the first step in a QI process and is used to identify improvement opportunities, particularly where compliance with known standards for high quality patient care needs to be improved. Audit can be used to establish a baseline and to analyse the impact of tests of change against the baseline. Also, once an improvement project is under way, audit may form part of rapid cycle evaluation, during the iterative testing phase, to understand the impact of the idea being tested. Regular clinical audit may be a useful assurance tool to help track whether improvements have been sustained over time.

Scenario: Audit and QI

A foundation year 2 (FY2) doctor is asked to complete an audit of a pre-surgical pathway by looking retrospectively through patient documentation. She concludes that adherence to best practice is mixed and recommends: “Remind the team of the importance of being thorough in this respect and re-audit in 6 months.” The results are presented at an audit meeting, but a re-audit a year later by a new FY2 doctor shows similar results.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this paper?

Contrast the above with a team-led, rapid cycle audit in which everyone contributes to collecting and reviewing data from the previous week, discussed at a regular team meeting. Though surgical patients are often transient, their experience of care and ideas for improvement are captured during discharge conversations. The team identify and test several iterative changes to care processes. They document and test these changes between audits, leading to sustainable change. Some of the surgeons involved work across multiple hospitals, and spread some of the improvements, with the audit tool, as they go.

QI and service evaluation

In practice, service evaluation is not subject to the same rigorous definition or governance as research or clinical audit, meaning that there are inconsistencies in the methodology for carrying it out. While the primary intent for QI is to make change that will drive improvement, the primary intent for evaluation is to assess the performance of current patient care. 38 Service evaluation may be carried out proactively to assess a service against its stated aims or to review the quality of patient care, or may be commissioned in response to serious patient harm or red flags about service performance. The purpose of service evaluation is to help local decision makers determine whether a service is fit for purpose and, if necessary, identify areas for improvement.

Service evaluation may be used to initiate QI activity by identifying opportunities for change that would benefit from a QI approach. It may also evaluate the impact of changes made using QI, either during the work or after completion to assess sustainability of improvements made. Though likely planned as separate activities, service evaluation and QI may overlap and inform each other as they both develop. Service evaluation may also make a judgment about a service’s readiness for change and identify any barriers to, or prerequisites for, carrying out QI.

QI and clinical transformation

Clinical transformation involves radical, dramatic, and irreversible change—the sort of change that cannot be achieved through continuous improvement alone. As with service evaluation, there is no consensus on what clinical transformation entails, and it may be best thought of as an umbrella term for the large scale reform or redesign of clinical services and the non-clinical services that support them. 20 39 While it is possible to carry out transformation activity that uses elements of QI approach, such as effective engagement of the staff and patients involved, QI which rests on iterative test of change cannot have a transformational approach—that is, one-off, irreversible change.

There is opportunity to use QI to identify and test ideas before full scale clinical transformation is implemented. This has the benefit of engaging staff and patients in the clinical transformation process and increasing the degree of belief that clinical transformation will be effective or beneficial. Transformation activity, once completed, could be followed up with QI activity to drive continuous improvement of the new process or allow adaption of new ways of working. As interventions made using QI are scaled up and spread, the line between QI and transformation may seem to blur. The shift from QI to transformation occurs when the intention of the work shifts away from continuous testing and adaptation into the wholesale implementation of an agreed solution.

Scenario: QI and clinical transformation

An NHS trust’s human resources (HR) team is struggling to manage its junior doctor placements, rotas, and on-call duties, which is causing tension and has led to concern about medical cover and patient safety out of hours. A neighbouring trust has launched a smartphone app that supports clinicians and HR colleagues to manage these processes with the great success.

This problem feels ripe for a transformation approach—to launch the app across the trust, confident that it will solve the trust’s problems.

Before continuing reading think about your own organisation— What do you think will happen, and how would you use the QI principles described in this article for this situation?

Outcome without QI

Unfortunately, the HR team haven’t taken the time to understand the underlying problems with their current system, which revolve around poor communication and clarity from the HR team, based on not knowing who to contact and being unable to answer questions. HR assume that because the app has been a success elsewhere, it will work here as well.

People get excited about the new app and the benefits it will bring, but no consideration is given to the processes and relationships that need to be in place to make it work. The app is launched with a high profile campaign and adoption is high, but the same issues continue. The HR team are confused as to why things didn’t work.

Outcome with QI

Although the app has worked elsewhere, rolling it out without adapting it to local context is a risk – one which application of QI principles can mitigate.

HR pilot the app in a volunteer specialty after spending time speaking to clinicians to better understand their needs. They carry out several tests of change, ironing out issues with the process as they go, using issues logged and clinician feedback as a source of data. When they are confident the app works for them, they expand out to a directorate, a division, and finally the transformational step of an organisation-wide rollout can be taken.

Education into practice

Next time when faced with what looks like a quality improvement (QI) opportunity, consider asking:

How do you know that QI is the best approach to this situation? What else might be appropriate?

Have you considered how to ensure you implement QI according to the principles described above?

Is there opportunity to use other approaches in tandem with QI for a more effective result?

How patients were involved in the creation of this article

This article was conceived and developed in response to conversations with clinicians and patients working together on co-produced quality improvement and research projects in a large UK hospital. The first iteration of the article was reviewed by an expert patient, and, in response to their feedback, we have sought to make clearer the link between understanding the issues raised and better patient care.

Contributors: This work was initially conceived by AB. AB and FO were responsible for the research and drafting of the article. AB is the guarantor of the article.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: This article is part of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

• Olsson-Brown A
• Dixon-Woods M ,
• Batalden PB ,
• Berwick D ,
• Øvretveit J
• Academy of Medical Royal Colleges
• Nelson WA ,
• McNicholas C ,
• Woodcock T ,
• Alderwick H ,
• ↵ NHS Scotland Quality Improvement Hub. Quality improvement glossary of terms. http://www.qihub.scot.nhs.uk/qi-basics/quality-improvement-glossary-of-terms.aspx .
• McNicol S ,
• Solberg LI ,
• Massoud MR ,
• Albrecht Y ,
• Illingworth J ,
• Department of Health
• ↵ NHS England. Clinical audit. https://www.england.nhs.uk/clinaudit/ .
• Healthcare Quality Improvement Partnership
• McKinsey Hospital Institute
• ↵ World Health Organization. WHO Health Innovation Group. 2019. https://www.who.int/life-course/about/who-health-innovation-group/en/ .
• Sheffield Microsystem Coaching Academy
• Davidoff F ,
• Leviton L ,
• Taylor MJ ,
• Nicolay C ,
• Tarrant C ,
• Twycross A ,
• ↵ University Hospitals Bristol NHS Foundation Trust. Is your study research, audit or service evaluation. http://www.uhbristol.nhs.uk/research-innovation/for-researchers/is-it-research,-audit-or-service-evaluation/ .
• ↵ University of Sheffield. Differentiating audit, service evaluation and research. 2006. https://www.sheffield.ac.uk/polopoly_fs/1.158539!/file/AuditorResearch.pdf .
• ↵ Royal College of Radiologists. Audit and quality improvement. https://www.rcr.ac.uk/clinical-radiology/audit-and-quality-improvement .
• Gundogan B ,
• Finkelstein JA ,
• Brickman AL ,
• Health Foundation
• Johnston G ,
• Crombie IK ,
• Davies HT ,
• Hillman T ,
• ↵ NHS Health Research Authority. Defining research. 2013. https://www.clahrc-eoe.nihr.ac.uk/wp-content/uploads/2014/04/defining-research.pdf .

Research and Quality Improvement: How Can They Work Together?

Affiliations.

• 1 Director, Data Science, Quality Insights, Williamsburg, VA.
• 2 Chair, ANNA Research Committee.
• 3 President, ANNA's Old Dominion Chapter.
• 4 Instructor, Case Western Reserve University, Cleveland, OH.
• 5 Associate Degree Nursing Instructor, Northeast Wisconsin Technical College, Green Bay, WI.
• PMID: 35503694

Research and quality improvement provide a mechanism to support the advancement of knowledge, and to evaluate and learn from experience. The focus of research is to contribute to developing knowledge or gather evidence for theories in a field of study, whereas the focus of quality improvement is to standardize processes and reduce variation to improve outcomes for patients and health care organizations. Both methods of inquiry broaden our knowledge through the generation of new information and the application of findings to practice. This article in the "Exploring the Evidence: Focusing on the Fundamentals" series provides nephrology nurses with basic information related to the role of research and quality improvement projects, as well as some examples of ways in which they have been used together to advance clinical knowledge and improve patient outcomes.

Keywords: kidney disease; nephrology; quality improvement; research.

Copyright© by the American Nephrology Nurses Association.

• Nephrology*
• Quality Improvement*

Grants and funding

• K23 NR019744/NR/NINR NIH HHS/United States

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• Quality Improvement Article
• Published: 04 January 2021

A practical guide to publishing a quality improvement paper

• Stephen A. Pearlman   ORCID: orcid.org/0000-0003-3027-8794 1 , 2 &
• Jonathan R. Swanson 3  

Journal of Perinatology volume  41 ,  pages 1454–1458 ( 2021 ) Cite this article

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Quality improvement (QI) is a relatively new and evolving field as it applies to healthcare. Hence, publishing a QI paper may present certain challenges as QI differs from standard types of scientific research. Some considerations in writing are inherent to all types of manuscripts submitted for publication, whereas others are unique to QI papers. This paper, the final in a series of eight papers related to QI in the neonatal setting, describes the best practices for writing and publishing QI manuscripts. Common pitfalls to avoid are also highlighted.

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Swanson JR, Pearlman SA. Roadmap to a successful quality improvement project. J Perinatol. 2017;37:112–5.

Article   CAS   Google Scholar  

Katakam L, Suresh GK. Identifying a quality improvement project. J Perinatol. 2017;37:1161–5.

Article   Google Scholar  

Picarillo AP. Introduction to quality improvement tools for the clinician. J Perinatol. 2018;38:929–35.

Coughlin K, Posencheg MA. Quality improvement methods—part II. J Perinatol. 2019;39:1000–7.

Gupta M, Kaplan HC. Measurement for quality improvement: using data to drive change. J Perinatol. 2020;40:962–71.

Fischer HR, Duncan SD. The business case for quality improvement. J Perinatol. 2020;40:972–9.

Ravi D, Tawfik D, Sexton JB, Profit J. Changing safety culture. J Perinatol. 2020. https://doi.org/10.1038/s41372-020-00839-0 .

Franklin B. Poor Richard’s Almanack 1732–1758 Philadelphia New Printing Office near the Market. https://pdfs.semanticscholar.org/0ec9/52af9ec79a1e2ad794f60d448b7c3c7e3b96.pdf . Accessed 10 Sep 2020.

Mackay AL. Dictionary of scientific quotations. Norfolk: Galliard Ltd; 2001.

Stevenson DK. William A Silverman lecture. J Perinatol. 2014;34:1–5.

Harmon JE, Gross AG. From Galileo’s New Science to the Human Genome. 2002. http://fathom.lib.uchicago.edu/2/21701730/ . Accessed 10 Sep 2020.

Institute for Healthcare Improvement. Topics. www.ihi.org/topics/pages/default.aspx . Accessed 27 Oct 2020.

McQuillan RF, Wong BM. The SQUIRE guidelines: a scholarly approach to quality improvement. J Grad Med Educ. 2016;8:771–2.

Wong BM, Sullivan GM. How to write up your quality improvement initiative for publication. J Grad Med Educ. 2016;8:128–33.

Mudrak B. Verb tense in scientific manuscripts. Am J Experts. https://www.aje.com/dist/docs/AJE-Choosing-the-Right-Verb-Tense-for-Your-Scientific-Manuscript-2015.pdf . Accessed 27 Oct 2020.

On paragraphs. https://owl.purdue.edu/owl/general_writing/academic_writing/paragraphs_and_paragraphing/index.html . Accessed 28 Oct 2020.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. J Surg. Res. 2016;200:676–82.

Smith S, Carlton E. Introducing quality improvement to the Emergency Medicine Journal. Emerg Med J. 2019;36:258–63.

Oermann MH, Ingles TM. Writing manuscripts about quality improvement: SQUIRE 2.0 and beyond. https://wkauthorservices.editage.com/resources/author-resource-review/2017/May-2017.html . Accessed 27 Oct 2020.

Journal of Perinatology. Guide to authors. https://www.nature.com/jp/authors-and-referees/guide-to-authors . Accessed 27 Oct 2020.

Schondelmeyer AC, Brower LH, Statile AM, White CM, Brady PW. Quality improvement feature series article: writing and reviewing quality improvement manuscripts. J Ped Inf Dis Soc. 2018;7:188–90.

Grady D, Redberg RF, O’Malley PG. Quality improvement for quality improvement studies. JAMA Int Med. 2018;178:187.

Perla RJ, Provost LP, Murray SK. The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf. 2011;20:46–51.

Gupta M, Kaplan HC. Using statistical process control to drive improvement in neonatal care: a practical introduction to control charts. In: Gupta M, Kaplan HC, editors. Clinics in perinatology. Philadelphia: Elsevier; 2017. Vol. 44. p. 627–45.

Provost LP, Murray SK. The healthcare data guide. San Francisco: Jossey-Bass; 2008.

Brady PW, Tchou MJ, Ambroggio L, Schondelmeyer AC, Shaughnessy EE. Quality improvement feature series article 2: displaying and analyzing quality improvement data. J Ped Inf Dis Soc. 2018;7:100–3.

Kanter M, Courneya PT. Perspective on publishing quality improvement efforts. Perm J. 2017;21:17–140.

Article   PubMed   PubMed Central   Google Scholar  

Hempel S, Shekelle PG, Liu JL, Sherwood Danz M, Foy R, Lim YW, et al. Development of the quality improvement minimum quality criteria set (QI_MQCS): a tool for critical appraisal of quality improvement intervention publications. BMJ Qual Saf. 2015;24:796–804.

Holzmueller CG, Pronovost PJ. Organising a manuscript reporting quality improvement or patient safety research. BMJ Qual Saf. 2013;22:777–85.

Bain BJ, Littlewood TJ, Szydlo RM. The finer points of writing and refereeing scientific articles. Br J Haematol. 2016;172:350–9.

Sutherland LR. How to get your paper published: confessions of an editor. Can J Gastroenterol. 2003;17:279.

Thayer WS Osler. The teacher Sir William Osler. Baltimore: Johns Hopkins Press; 1920. p. 51–52.

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Pearlman, S.A., Swanson, J.R. A practical guide to publishing a quality improvement paper. J Perinatol 41 , 1454–1458 (2021). https://doi.org/10.1038/s41372-020-00902-w

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DOI : https://doi.org/10.1038/s41372-020-00902-w

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Evidence-Based Quality Improvement: a Scoping Review of the Literature

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• Published: 29 September 2022
• Volume 37 , pages 4257–4267, ( 2022 )

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• Susanne Hempel PhD 1 , 2 , 6 ,
• Maria Bolshakova BS 1 ,
• Barbara J. Turner MD 2 ,
• Jennifer Dinalo PhD 5 ,
• Danielle Rose PhD 3 ,
• Aneesa Motala BA 1 , 2 , 6 ,
• Ning Fu PhD 1 , 4 ,
• Chase G. Clemesha MD 5 ,
• Lisa Rubenstein MD 6 &
• Susan Stockdale PhD 3  

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Quality improvement (QI) initiatives often reflect approaches based on anecdotal evidence, but it is unclear how initiatives can best incorporate scientific literature and methods into the QI process. Review of studies of QI initiatives that aim to systematically incorporate evidence review (termed evidence-based quality improvement (EBQI)) may provide a basis for further methodological development.

In this scoping review (registration: https://osf.io/hr5bj ) of EBQI, we searched the databases PubMed, CINAHL, and SCOPUS. The review addressed three central questions: How is EBQI defined? How is evidence used to inform evidence-informed QI initiatives? What is the effectiveness of EBQI?

We identified 211 publications meeting inclusion criteria. In total, 170 publications explicitly used the term “EBQI.” Published definitions emphasized relying on evidence throughout the QI process. We reviewed a subset of 67 evaluations of QI initiatives in primary care, including both studies that used the term “EBQI” with those that described an evidence-based initiative without using EBQI terminology. The most frequently reported EBQI components included use of evidence to identify previously tested effective QI interventions; engaging stakeholders; iterative intervention development; partnering with frontline clinicians; and data-driven evaluation of the QI intervention. Effectiveness estimates were positive but varied in size in ten studies that provided data on patient health outcomes.

Conclusions

EBQI is a promising strategy for integrating relevant prior scientific findings and methods systematically in the QI process, from the initial developmental phase of the IQ initiative through to its evaluation. Future QI researchers and practitioners can use these findings as the basis for further development of QI initiatives.

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Evidence-based quality improvement (EBQI) is one of a growing number of strategies used to enhance quality improvement (QI) initiative impacts in clinical practice. EBQI aims to integrate scientific evidence and methods into the QI process while maintaining focus on team-based innovation and problem-solving within real-world settings. Standard healthcare QI approaches focus powerfully on the need for measurement to determine innovation effects, and teams are advised to consult subject matter experts to strengthen their work. 1 , 2 , 3 , 4 , 5 There currently is no standard approach, however, for integrating evidence from relevant pre-existing scientific literature into QI innovation and evaluation. Comprehensive review and critical appraisal of relevant research, for example, is not typically emphasized or conducted. 6 In practice, QI teams often use anecdotal evidence alone to shape innovations, and low-validity methods to evaluate them. 7 EBQI initiatives, as a subset of all QI initiatives, aim to systematically incorporate pre-existing scientific evidence and methods into the QI process as a core focus.

Given its foundation in applying best evidence and distinct focus on collaboration with the practice, EBQI is increasingly recognized as a valuable approach to structure implementation of advances in healthcare delivery. 7 Among other factors, the rapid evolution of partnership improvement initiatives between healthcare organizations and researchers, and the increasing availability of embedded healthcare researchers within healthcare organizations have made EBQI more accessible and attractive to healthcare organizations. 3 , 4 , 5

To date, core elements of EBQI have not been well documented, leaving a critical knowledge gap about components of EBQI and how it differs from other QI approaches. In addition, evidence of the effects of employing EBQI has yet to be synthesized. We found no prior systematic reviews of EBQI, and while individual studies have shown promising results 8 to our knowledge, EBQI has not been evaluated in an evidence synthesis across studies.

This scoping review explores the EBQI literature. We document how EBQI is defined in publications and aimed to identify key components that characterize this methodology across studies. The review catalogues definitions and characteristics of EBQI as currently used in practice. Particular emphasis was on the definition, scope, and use of evidence, i.e., the core aspect of EBQI. We also examined evidence of effectiveness of EBQI. The scoping review was guided by these review questions 10 :

Review question 1: How is EBQI defined?

Review question 2: How is evidence used to inform evidence-informed quality improvement initiatives?

Review question 2a: How is evidence defined in these initiatives?

Review question 2b: What are the components of EBQI?

Review question 3: What is the effectiveness of EBQI to promote uptake of evidence-based practices?

Our objective was to conduct a systematic search to identify the available knowledge, provide a clear description of the methodology, and inform further development of methods for incorporating research evidence into QI initiatives.

The scoping review followed a detailed review protocol. We followed the steps outlined by Arksey and Malloy: (1) determining the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. 9 In addition, we conducted a consultation exercise to inform and validate findings. The project was deemed exempt by our institutional Human Subject Committee. The protocol was registered in the Open Science Framework and is publicly available. 10 The reporting follows PRISMA-ScR, a PRISMA adaptation for scoping reviews. 11 , 12

Search Strategy

The literature searches are documented in the supplemental digital content ( SDC ). First, a search using the exact terms (“evidence based quality improvement,” “evidence-based quality improvement,” or “EBQI”) was employed to identify publications published to March 2020 that explicitly refer to EBQI in the title, abstract, or keyword of the publication (i.e., the elements that are searchable in research databases). All retrieved publications that used the terminology were included.

Second, we used a broader search strategy aimed at identifying QI initiative evaluations that were not explicitly labeled as EBQI. We assumed that some authors may not use the term “EBQI” even when they have used an evidence-based QI strategy and describe a similar approach in the full-text publication. We applied a string of exclusion criteria to arrive at a manageable sample (see eligibility section), and given the large literature on QI interventions, 19 we searched only for studies published between 2017 and 2020.

We searched PubMed (biomedical literature), CINAHL (nursing and allied health profession literature), and SCOPUS (social sciences). We searched for EBQI publications without date restriction, other QI studies were limited to three years of QI publications as described below in more detail.

Eligibility Criteria

Eligibility criteria were organized in a SPIOS (study design, participants, intervention, outcome, setting) framework; full details are shown in the SDC. Briefly, we applied the following:

EBQI–labeled publications: All publications using EBQI terminology were included in the data abstraction.

Primary care effectiveness subsample: Among EBQI publications, we identified studies reporting effectiveness results for the evaluation of an EBQI initiative. Studies had to report on patient health, and we restricted to primary care to identify a more homogenous sample of research studies.

EBQI–compatible studies: Empirical studies involving U.S. healthcare professionals, reporting on an evaluation of a QI initiative in primary care, and documenting evidence review as part of their methodology to select, design, or implement a QI intervention. Evidence review was defined as a literature review undertaken at the beginning of the project, documentation of locally generated data to determine the need for the intervention (practice-based evidence), and/or utilizing of authoritative sources such as evidence-based clinical practice guidelines. Two independent literature reviewers screened citations and full-text publications; discrepancies were resolved through discussion in the team. Reviewers first excluded all citations that did not indicate an empirical evaluation of a QI initiative. The remaining citations were screened as full-text publication, applying all eligibility criteria described in the SDC (e.g., U.S.-based).

Data Abstraction and Synthesis

Data abstraction was tailored to the review questions. We used ten features in total to characterize the included studies (described in more detail in the SDC ):

Evidence to identify target : using evidence (data) to identify the target of the QI initiative

Iterative : conducting an interactive process for selecting the QI intervention

Engagement of stakeholders : reaching out within the organization to ensure a collaborative process

Evidence to identify intervention : reviewing evidence (research literature or local data) to select effective QI interventions

QI facilitation : use of facilitation of the QI process

Leadership involvement : involving clinical operations leadership in the QI initiative

Priority setting with leadership : setting priorities for the QI initiative together with clinical operations leadership

Frontline engagement : engaging frontline personnel early in the QI initiative

Evidence to determine success : using data to determine the success of the QI initiative

Analytic support : using analytic support to help QI teams

The abstraction domains had been developed by the QI content expert team members drawing on practical and research expertise (SH, ST, BT). The information was collated in evidence tables and component tables allow a concise overview. Effectiveness outcomes were summarized in a random-effects meta-analysis.

Expert Consultation

The preliminary scoping review results were presented to Dr. Lisa Rubenstein, a proponent and conceptual originator of EBQI. The formal consultation step aimed to ensure that the review addresses the right questions, identified all relevant literature, and synthesized the included material appropriately. Dr. Rubenstein was not involved in the planning of the review and assessed methods and results de novo. The consultation exercise resulted in one additional domain (priority setting with leadership) that was added to the data abstraction (see SDC ).

The literature searches identified 2001 citations. Of these, we obtained 496 for full-text inclusion screening. Figure 1 shows the flow diagram.

Flow diagram.

We included 211 publications, detailed in the evidence tables in the SDC. In total, we identified 170 diverse publications that used the term EBQI. SDC Figure 1 plots the number of EBQI publications over time and shows the rapid increase in frequency and popularity of EBQI. Two peaks emerged, one around 2006–2008, the other after 2016. The 170 identified publications are described in detail in an evidence table in the appendix (see SDC Table 1 ) and were used to address review question 1.

Review Question 1 Synthesis: How Is EBQI Defined?

The majority of EBQI–labeled publications did not define EBQI; only 23 of the 170 studies provided a definition or detailed description of the EBQI process. Studies highlighted different aspects of EBQI such as stakeholder engagement 13 or described EBQI broadly as a continuous quality improvement method. 14 Rubenstein et al. 15 defined EBQI as “a continuous quality improvement approach whose goal is translation of research on care delivery models into routine practice.” Figure 2 shows the terms used in the identified publications.

EBQI semantic definition overview.

Review Question 2 Synthesis: How Is Evidence Used to Inform Evidence-Informed Quality Improvement Initiatives?

The second evidence table (SDC Table 2 ) shows all 25 EBQI–labeled studies that reported on an evaluation of a QI initiative (listed first), followed by the 42 EBQI–compatible primary care evaluations, for a total of 67 EBQI–labeled or EBQI–compatible studies. The table shows the wide range of clinical topic areas and interventions addressed and describes their implementation strategy in detail. Across studies, most used published research literature to select interventions to be implemented in the QI initiative.

Review Question 2a Synthesis: How Is Evidence Defined?

In the 25 EBQI–labeled evaluations, 17 studies that provided information on the utilized evidence referred to published literature identified in a literature review. Ten EBQI studies referred to the use of local data. Six studies used expert panels and consensus meetings. Six studies referred to clinical practice guidelines that were reviewed to identify the QI intervention. Studies used these sources either alone or in combination.

Review Question 2b Synthesis: What Are the Components of EBQI?

Table 1 shows the 10 potential EBQI features that we abstracted for each study, the number of features characterizing each study, and the overall frequency of features across studies. EBQI–labeled studies (top half of Table 1 ) are followed by EBQI–compatible studies (bottom half of Table 1 ). Table 2 provides a summary of features across all 67 studies. Across studies, two thirds of studies reported having used evidence to identify an effective intervention, engaging stakeholders, using an iterative development, and involving frontline clinicians. In addition, all 67 identified studies used data to determine the success of the QI initiative.

When we compared features across the subsets, evidence to identify the target of the quality improvement intervention was more frequently reported in EBQI–labeled studies than in EBQI–compatible studies (72% vs 43%). Across EBQI–labeled and EBQI–compatible studies, involvement of leadership in priority setting for the quality improvement target (44% vs 21%) and the provision of analytic support (36% vs 26%) were least frequently reported. EBQI studies consistently reported more EBQI features: the median number of components used within study was 7 for the EBQI–labeled sample (maximum of 10) and 5.5 for the EBQI–compatible sample. The distributions in the two sets differed statistically significantly ( p = 0.037; Mann-Whitney U test).

Review Question 3 Synthesis: EBQI Effectiveness

We abstracted data from all 14 evaluations of primary care QI initiatives that used the term EBQI and that reported on a patient health outcome (SDC Table 3 ). Not all studies provided sufficient detail to allow effect size calculation. None of the studies compared two quality improvement strategies in a head-to-head comparison; hence, the documented effectiveness represents the effectiveness of the combined EBQI and implemented intervention. The forest plot in Figure 3 shows effect estimates for four studies reporting categorical outcomes, expressed as relative risk (RR), that could be combined in a meta-analysis. Studies assessed the implementation of a breast-feeding protocol in primary care, 16 an intervention targeting primary care referrals to smoking cessation clinics, 13 the implementation of collaborative care for depression, 14 and a program to increase adherence to immunization guidelines for adults with diabetes. 17 The effectiveness estimates varied widely by quality improvement target and study, only one of the studies reported a statistically significant effect, but all suggested more improvements in the EBQI group.

EBQI effectiveness.

The scoping review shows that the evidence base for EBQI is growing, and to our knowledge, this is the first study that provides an overview of the available EBQI literature.

We identified EBQI components and their relative frequency, both across EBQI–labeled studies and in comparison to studies that were similar in approach to EBQI without using EBQI terminology. The focus on evidence at multiple stages of the QI initiative and the strong emphasis on engaging stakeholders were key features.

However, “evidence” was often not systematically described in the identified studies. Not all studies reported a review of the evidence to identify a target for the QI initiative (54% across EBQI–labeled and EBQI–compatible studies). This gap calls into question the focus of these studies on using evidence to identify and define QI aims, a critical entry point for introducing evidence into the QI process. Most, but not all (88%) of the studies reviewed evidence to select and shape the QI intervention design, another critical entry point for applying published research, local data, and implementation science knowledge. More complete reporting on evidence use across studies would promote assessment of fidelity to the EBQI process, which is critical to evaluation of the success of the QI initiative and our ability to learn from initiatives across settings. 18

Our review also shows that overall, there is still insufficient information regarding the effectiveness of EBQI. We only found a small number of studies using EBQI that reported on key and patient-centered outcomes, i.e., patient health, and studies addressed substantially different intervention targets, ranging from breast-feeding to depression treatment. We did not find studies that compared EBQI with other quality improvement strategies in head-to-head comparisons; hence, the effect of EBQI in the included studies was invariably confounded with the QI content. It is not known yet how EBQI compares to other quality improvement strategies, in particular quality improvement interventions that are based on anecdotal evidence. Future research should evaluate the comparative effectiveness of EBQI to provide more information on this critical aspect.

Our review has several limitations. While we systematically identified all known EBQI publications, we sampled the literature for EBQI–compatible studies and restricted to those published in recent years and limited to primary care given the large QI literature. 19 The sampling strategy was chosen to obtain a systematic and pragmatic sample that would serve as an exemplar of EBQI–compatible studies. However, it should be noted that earlier approaches were not included, which undoubtedly left out important approaches, and EBQI–compatible approaches in other fields, such as improvements in hospitals in international settings, could have provided additional important information.

We show that EBQI is a promising and growing strategy that aims to integrate prior scientific findings and methods into QI initiatives. Commonly used EBQI features integrate evidence throughout the improvement process, from the initial developmental phase of the QI initiative through to its evaluation. Future research should clearly document EBQI processes to enable better characterization of core initiative features and should assess the comparative effectiveness and success in addressing patient-centered goals.

Institute for Healthcare Improvement Website http://www.ihi.org/ihi . Accessed 5/2/2022.

Deming WE . Quality, Productivity and Competitive Position. Cambridge, MA: MIT Center for Advanced Engineering Studies; 1982.

Google Scholar  

Meyers D, Miller T, Genevro J, Zhan C, De La Mare J, Fournier A, et al. EvidenceNOW: balancing primary care implementation and implementation research. Ann Fam Med. 2018;16(Suppl 1):S5-s11. https://doi.org/10.1370/afm.2196

Article   PubMed   PubMed Central   Google Scholar  

Nelson K, Reddy A, Stockdale SE, Rose D, Fihn S, Rosland A-M, et al. , editors. The Primary Care Analytics Team: Integrating Research and Clinical Care Within the Veterans Health Administration Office of Primary Care. Healthcare; 2021: Elsevier.

Ovretveit J, Hempel S, Magnabosco JL, Mittman BS, Rubenstein LV, Ganz DA . Guidance for research-practice partnerships (R-PPs) and collaborative research. J Health Manag. 2014;28(1):115-26. https://doi.org/10.1108/JHOM-08-2013-0164

Melnyk BM, Buck J, Gallagher-Ford L . Transforming quality improvement into evidence-based quality improvement: a key solution to improve healthcare outcomes. Worldviews Evid.-Based Nurs. 2015;12(5):251-2. https://doi.org/10.1111/wvn.12112

Article   PubMed   Google Scholar  

Shojania KG, Grimshaw JM . Evidence-based quality improvement: the state of the science. Health Aff (Millwood). 2005;24(1):138-50. https://doi.org/10.1377/hlthaff.24.1.138

Stockdale SE, Zuchowski J, Rubenstein LV, Sapir N, Yano EM, Altman L, et al. Fostering evidence-based quality improvement for patient-centered medical homes: initiating local quality councils to transform primary care. Health Care Manag Rev. 2018;43(2):168-80. https://doi.org/10.1097/hmr.0000000000000138

Article   Google Scholar  

Arksey H, O'Malley L . Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19-32.

Hempel S, Bolshakova M, Turner B, Rose D, Dinalo J, Motala A, et al. Scoping Review Protocol: Evidence-Based Quality Improvement as an Implementation Strategy for Evidence-Based Practices. 2020. https://osf.io/hr5bj/ . Accessed 5/2/2022.

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850

Ottawa Hospital Research Institute, University of Oxford. PRISMA for Scoping Reviews. 2015. http://www.prisma-statement.org/Extensions/ScopingReviews . Accessed 27 July 2020.

Yano EM, Rubenstein LV, Farmer MM, Chernof BA, Mittman BS, Lanto AB, et al. Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice. Health Serv Res. 2008;43(5 Pt 1):1637-61. https://doi.org/10.1111/j.1475-6773.2008.00865.x

Chaney EF, Rubenstein LV, Liu CF, Yano EM, Bolkan C, Lee M, et al. Implementing collaborative care for depression treatment in primary care: a cluster randomized evaluation of a quality improvement practice redesign. Implement Sci. 2011;6:121. https://doi.org/10.1186/1748-5908-6-121

Rubenstein LV, Chaney EF, Ober S, Felker B, Sherman SE, Lanto A, et al. Using evidence-based quality improvement methods for translating depression collaborative care research into practice. Fam Syst Health. 2010;28(2):91-113. https://doi.org/10.1037/a0020302

Dumphy D, Thompson J, Clark M . A breastfeeding quality improvement project in rural primary care. J Hum Lac. 2016;32(4):633-41. https://doi.org/10.1177/0890334416662240

Gottlieb RP, Dols JD . Improving vaccination rates in adults with type 2 diabetes in a family practice setting through the use of evidence-based interventions. J Doctoral Nurs Pract. 2018;11(2):151-9. https://doi.org/10.1891/2380-9418.11.2.151

Stockdale SE, Hamilton AB, Bergman AA, Rose DE, Giannitrapani KF, Dresselhaus TR, et al. Assessing fidelity to evidence-based quality improvement as an implementation strategy for patient-centered medical home transformation in the Veterans Health Administration. Implement Sci. 2020;15(1):18. https://doi.org/10.1186/s13012-020-0979-y

Hempel S, Rubenstein LV, Shanman RM, Foy R, Golder S, Danz M, et al. Identifying quality improvement intervention publications--a comparison of electronic search strategies. Implement Sci. 2011;6:85. https://doi.org/10.1186/1748-5908-6-85

Badru M. A Clinical Practice Guideline to Reduce Behavioral Outbursts in Veterans with Posttraumatic Stress Disorder. Clinical Practice Guideline to Reduce Behavioral Outbursts in Veterans with Posttraumatic Stress Disorder. 2017:1-.

Bennett JG . Implementing Lipid Screening Guidelines for Children in a Rural Health Clinic. Implementing Lipid Screening Guidelines for Children in a Rural Health Clinic. 2016:1-.

Cohen AN, Chinman MJ, Hamilton AB, Whelan F, Young AS . Using patient-facing kiosks to support quality improvement at mental health clinics. Med Care. 2013;51(3 Suppl 1):S13-20. https://doi.org/10.1097/MLR.0b013e31827da859

Fortney J, Enderle M, McDougall S, Clothier J, Otero J, Altman L, et al. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics. Implement Sci. 2012;7:30. https://doi.org/10.1186/1748-5908-7-30

Fortney JC, Enderle MA, Clothier JL, Otero JM, Williams JS, Pyne JM . Population level effectiveness of implementing collaborative care management for depression. Gen Hosp Psychiatry. 2013;35(5):455-60. https://doi.org/10.1016/j.genhosppsych.2013.04.010

Fox AB, Hamilton AB, Frayne SM, Wiltsey-Stirman S, Bean-Mayberry B, Carney D, et al. Effectiveness of an evidence-based quality improvement approach to cultural competence training: the Veterans Affairs’ “Caring for Women Veterans” Program. J Contin Educ Health Prof. 2016;36(2):96-103. https://doi.org/10.1097/ceh.0000000000000073

Gadbois C, Chin ED, Dalphonse L . Health promotion in an opioid treatment program an evidence-based nursing quality improvement project. J Addict Nurs. 2016;27(2):127-42. https://doi.org/10.1097/JAN.0000000000000124

Klause KT, Dodds VA, Selleck C, Deupree JP . Addressing intimate partner violence at a safety-net clinic for adults. J Nurs Pract. 2020;16(2):154-7. https://doi.org/10.1016/j.nurpra.2019.08.019

Le Flore G. Applying Clinical Guidelines to Curtail Opioid Overprescribing in Primary Care. Applying Clinical Guidelines to Curtail Opioid Overprescribing in Primary Care. 2017:1-.

Meredith LS, Batorsky B, Cefalu M, Darling JE, Stockdale SE, Yano EM, et al. Long-term impact of evidence-based quality improvement for facilitating medical home implementation on primary care health professional morale. BMC Fam Pract. 2018;19(1):149. https://doi.org/10.1186/s12875-018-0824-4

Ong A. Ripple effect: shared governance and nurse engagement. Nurs Manag. 2017;48(10):28-34. https://doi.org/10.1097/01.NUMA.0000524811.11040.05

Rizzo KA . Effectiveness of Continuous Subcutaneous Insulin Infusion Therapy Education in a Clinic Setting. Effectiveness Of Continuous Subcutaneous Insulin Infusion Therapy Education In A Clinic Setting. 2018:1-.

Rubenstein LV, Meredith LS, Parker LE, Gordon NP, Hickey SC, Oken C, et al. Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment. J Gen Intern Med. 2006;21(10):1027-35. https://doi.org/10.1111/j.1525-1497.2006.00549.x

Sherman SE, Chapman A, Garcia D, Braslow JT . Improving recognition of depression in primary care: a study of evidence-based quality improvement. Jt Comm J Qual Saf. 2004;30(2):80-8.

PubMed   Google Scholar  

Starkey M, Wiest D, Qaseem A . Improving depression care through an online learning collaborative. Am J Med Qual. 2016;31(2):111-7. https://doi.org/10.1177/1062860614555883

Walker CT, Gullotti DM, Prendergast V, Radosevich J, Grimm D, Cole TS, et al. Implementation of a standardized multimodal postoperative analgesia protocol improves pain control, reduces opioid consumption, and shortens length of hospital stay after posterior lumbar spinal fusion. Neurosurgery. 2019. https://doi.org/10.1093/neuros/nyz312

Walker-Smith TL . A Prospective Quality improvement project using a mammography risk assessment tool to increase screening mammogram use with low-income Hispanic Women: a doctor of nursing practice project report. Corpus Christi, Texas: Texas A&M University-Corpus Christi 2018.

Whitten SK, Stanik-Hutt J . Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project. J Am Assoc Nurs Pract. 2013;25(7):368-76. https://doi.org/10.1111/j.1745-7599.2012.00800.x

Yoon J, Chow A, Rubenstein LV . Impact of medical home implementation through evidence-based quality improvement on utilization and costs. Med Care. 2016;54(2):118-25. https://doi.org/10.1097/mlr.0000000000000478

Young LS, Crausman RS, Fulton JP . Suboptimal opioid prescribing: a practice change project. R I Med J (2013). 2018;101(2):41-4.

Barclay C, Viswanathan M, Ratner S, Tompkins J, Jonas DE . Implementing evidence-based screening and counseling for unhealthy alcohol use with epic-based electronic health record tools. Jt Comm J Qual Patient Saf. 2019;45(8):566-74. https://doi.org/10.1016/j.jcjq.2019.05.009

Bowen DJ, Powers DM, Russo J, Arao R, LePoire E, Sutherland E, et al. Implementing collaborative care to reduce depression for rural native American/Alaska native people. BMC Health Serv Res. 2020;20(1):34. https://doi.org/10.1186/s12913-019-4875-6

Breaux-Shropshire TL, Huie R, Shropshire TS, Wyatt A, Shropshire AT, Estrada CA, et al. First steps in improving blood pressure control among primary care hypertensive veterans utilizing quality improvement tools. Ala Nurs. 2017;44(3):19-22.

Brodie N, McPeak KE . Improving human papilloma virus vaccination rates at an urban pediatric primary care center. Pediatr Qual Saf. 2018;3(5):e098. https://doi.org/10.1097/pq9.0000000000000098

Burge SA, Powell W, Mazour L . A quality improvement endeavor improving depression screening for rural older adults. O J Rural Nurs Health Care. 2019;19(2):44-64. https://doi.org/10.14574/ojrnhc.v19i2.563

Murphy Buschkoetter KL, Powell W, Mazour L . Implementation of a comprehensive diabetic foot exam protocol in rural primary care. Online J Rural Nurs Health Care. 2019;19(1):43-63. https://doi.org/10.14574/ojrnhc.v19i1.560

Camp NL, Robert RC, Nash JE, Lichtenstein CB, Dawes CS, Kelly KP . Modifying provider practice to improve assessment of unhealthy weight and lifestyle in young children: translating evidence in a quality improvement initiative for at-risk children. Child Obes. 2017;13(3):173-81. https://doi.org/10.1089/chi.2016.0124

Campbell K, Carpenter KLH, Espinosa S, Hashemi J, Qiu Q, Tepper M, et al. Use of a Digital Modified Checklist for Autism in Toddlers - revised with follow-up to improve quality of screening for autism. J Pediatr. 2017;183:133-9.e1. https://doi.org/10.1016/j.jpeds.2017.01.021

Colborn KL, Helmkamp L, Bender BG, Kwan BM, Schilling LM, Sills MR . Colorado Asthma toolkit implementation improves some process measures of asthma care. J Am Board Fam Med. 2019;32(1):37-49. https://doi.org/10.3122/jabfm.2019.01.180155

Daaleman TP, Brock D, Gwynne M, Weir S, Dickinson I, Willis B, et al. Implementing lean in academic primary care. Qual Manag Health Care. 2018;27(3):111-6. https://doi.org/10.1097/qmh.0000000000000173

Fabre JC, Andresen PA, Wiltz GM . Closing the loop on electronic referrals: a quality improvement initiative using the care coordination model. J Ambul Care Manag. 2020;43(1):71-80. https://doi.org/10.1097/jac.0000000000000315

Fisher-Borne M, Preiss AJ, Black M, Roberts K, Saslow D . Early outcomes of a multilevel human papillomavirus vaccination pilot intervention in federally qualified health centers. Acad Pediatrics. 2018;18(2):S79-S84. https://doi.org/10.1016/j.acap.2017.11.001

Fortney JC, Pyne JM, Ward-Jones S, Bennett IM, Diehl J, Farris K, et al. Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics. Fam Syst Health. 2018;36(3):267-80. https://doi.org/10.1037/fsh0000357

Garza L, Dols J, Gillespie M . An initiative to improve primary prevention of cardiovascular disease in adults with type II diabetes based on the ACC/AHA (2013) and ADA (2016) guidelines. J Am Assoc Nurs Pract. 2017;29(10):606-11. https://doi.org/10.1002/2327-6924.12492

Gold R, Bunce A, Cowburn S, Davis JV, Hollombe C, Nelson CA, et al. Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges. BMC Health Serv Res. 2017;17(1):253. https://doi.org/10.1186/s12913-017-2194-3

Green BB, Fuller S, Anderson ML, Mahoney C, Mendy P, Powell SL . A quality improvement initiative to increase colorectal cancer (CRC) screening: collaboration between a Primary Care Clinic and Research Team. J Fam Med. 2017;4(3). https://doi.org/10.26420/jfammed.2017.1115

Hanlin RB, Asif IM, Wozniak G, Sutherland SE, Shah B, Yang J, et al. Measure accurately, act rapidly, and partner with patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results. J Clin Hypertens (Greenwich). 2018;20(1):79-87. https://doi.org/10.1111/jch.13141

Article   CAS   PubMed   PubMed Central   Google Scholar  

Hawk M, Nowalk MP, Moehling KK, Pavlik V, Raviotta JM, Brown AE, et al. Using a mixed methods approach to examine practice characteristics associated with implementation of an adult immunization intervention using the 4 Pillars Practice Transformation Program. J Healthc Qual. 2017;39(3):153-67. https://doi.org/10.1097/jhq.0000000000000071

Jonas DE, Miller T, Ratner S, McGuirt B, Golin CE, Grodensky C, et al. Implementation and quality improvement of a screening and counseling program for unhealthy alcohol use in an academic general internal medicine practice. J Healthc Qual. 2017;39(1):15-27. https://doi.org/10.1097/jhq.0000000000000069

Knierim KE, Hall TL, Dickinson LM, Nease DE, Jr., de la Cerda DR, Fernald D, et al. Primary care practices' ability to report electronic clinical quality measures in the EvidenceNOW southwest initiative to Improve Heart Health. JAMA Netw Open. 2019;2(8):e198569. https://doi.org/10.1001/jamanetworkopen.2019.8569

Implementation of psychiatric e-consultation in family medicine community health centers. Int J Psychiatry Med. 2019;54(4/5):296-306. https://doi.org/10.1177/0091217419869081

Makelarski JA, DePumpo M, Boyd K, Brown T, Kho A, Navalkha C, et al. Implementation of systematic community resource referrals at small primary care practices to promote cardiovascular disease self-management. J Healthc Qual. 2019. https://doi.org/10.1097/jhq.0000000000000234

Minsky N, Tamler R , editors. Endocrine eConsults improve access to care for the underserved. ACM International Conference Proceeding Series; 2017. March 13_KQ2_CINAH, PubMed, SCOPUS.

Modica C, Lewis JH, Bay C . Colorectal cancer: applying the value transformation framework to increase the percent of patients receiving screening in federally qualified health centers. Prev Med Rep. 2019;15:100894. https://doi.org/10.1016/j.pmedr.2019.100894

Nagykaldi ZJ, Scheid D, Zhao D, Mishra B, Greever-Rice T . An innovative community-based model for improving preventive care in rural counties. J Am Board Fam Med. 2017;30(5):583-91. https://doi.org/10.3122/jabfm.2017.05.170035

Nowalk MP, Moehling KK, Zhang S, Raviotta JM, Zimmerman RK, Lin CJ . Using the 4 pillars to increase vaccination among high-risk adults: who benefits? Am J Manage Care. 2017;23(11):651-5.

Ober AJ, Watkins KE, Hunter SB, Ewing B, Lamp K, Lind M, et al. Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study. BMC Fam Pract. 2017;18(1):107. https://doi.org/10.1186/s12875-017-0673-6

Quanbeck A, Brown RT, Zgierska AE, Jacobson N, Robinson JM, Johnson RA, et al. A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for opioid prescribing in primary care. Implement Sci. 2018;13(1):21. https://doi.org/10.1186/s13012-018-0713-1

Regan ME . Implementing an evidence-based clinical decision support tool to improve the detection, evaluation, and referral patterns of adult chronic kidney disease patients in primary care. J Am Assoc Nurs Pract. 2017;29(12):741-53. https://doi.org/10.1002/2327-6924.12505

Richards JE, Bobb JF, Lee AK, Lapham GT, Williams EC, Glass JE, et al. Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: an evaluation in three pilot sites. Drug Alcohol Depend. 2019;201:134-41. https://doi.org/10.1016/j.drugalcdep.2019.04.015

Roderick SS, Burdette N, Hurwitz D, Yeracaris P . Integrated behavioral health practice facilitation in patient centered medical homes: a promising application. Fam Syst Health. 2017;35(2):227-37. https://doi.org/10.1037/fsh0000273

Savas A, Smith E, Hay B . EHR quality indicator tracking: a process improvement pilot project to meet MACRA requirements. Nurs Pract. 2019;44(4):30-9. https://doi.org/10.1097/01.NPR.0000554084.05450.0e

Schaeffer AM, Jolles D . Not missing the opportunity: improving depression screening and follow-up in a multicultural community. Jt Comm J Qual Patient Saf. 2019;45(1):31-9. https://doi.org/10.1016/j.jcjq.2018.06.002

Schiff GD, Reyes Nieva H, Griswold P, Leydon N, Ling J, Federico F, et al. Randomized trial of reducing ambulatory malpractice and safety risk: results of the Massachusetts PROMISES Project. Med Care. 2017;55(8):797-805. https://doi.org/10.1097/mlr.0000000000000759

Schurman JV, Deacy AD, Johnson RJ, Parker J, Williams K, Wallace D, et al. Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination. World J Clin Pediatr. 2017;6(1):81-8. https://doi.org/10.5409/wjcp.v6.i1.81

Senger JJ . A Concussion Toolkit Educational Session: promoting evidence-based management of youth concussion in a rural primary care setting. Concussion Toolkit Educational Session: Promoting Evidence-Based Management Of Youth Concussion In A Rural Primary Care Setting. 2018:1-.

Shah T, Patel-Teague S, Kroupa L, Meyer AND, Singh H . Impact of a national QI programme on reducing electronic health record notifications to clinicians. BMJ Qual Saf. 2019;28(1):10-4. https://doi.org/10.1136/bmjqs-2017-007447

Sloand E, Vangraafeiland B, Holm A, MacQueen A, Polk S . Text message quality improvement project for influenza vaccine in a low-resource largely Latino pediatric population. J Healthc Qual. 2019;41(6):362-8. https://doi.org/10.1097/JHQ.0000000000000190

van Eeghen C, Kennedy AG, Pasanen ME, MacLean CD . A new quality improvement toolkit to improve opioid prescribing in primary care. J Am Board Fam Med. 2020;33(1):17-26. https://doi.org/10.3122/jabfm.2019.01.190238

Weiner BJ, Rohweder CL, Scott JE, Teal R, Slade A, Deal AM, et al. Using practice facilitation to increase rates of colorectal cancer screening in community health centers, North Carolina, 2012-2013: Feasibility, Facilitators, and Barriers. Prev Chronic Dis. 2017;14:E66. https://doi.org/10.5888/pcd14.160454

Williams MD, Sawchuk CN, Shippee ND, Somers KJ, Berg SL, Mitchell JD, et al. A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety. BMJ Open Qual. 2018;7(1):e000066. https://doi.org/10.1136/bmjoq-2017-000066

Yusupov E, Krishnamachari B, Rand S, Abdalla M, Zwibel H . Quality of hypertension care: an improvement initiative in two outpatient health care centers. J Eval Clin Pract. 2019;25(3):463-8. https://doi.org/10.1111/jep.13067

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Hempel, S., Bolshakova, M., Turner, B.J. et al. Evidence-Based Quality Improvement: a Scoping Review of the Literature. J GEN INTERN MED 37 , 4257–4267 (2022). https://doi.org/10.1007/s11606-022-07602-5

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A quality improvement project abstract submission should share your ‘innovative quality improvement project or quality measures/analyses that you implemented in your own practice.’ This usually has a short word count.

• You should aim for completeness; Use full names and formal credentials; department and institution worked. The author information usually does NOT count against the total word count but be sure you check the instructions.
• There may be a limit on how many authors can be on the submission.
• The first author is the one who conceived the study and did most of the work; will be the person who presents. Sometimes you have to be a member of an association to submit an abstract, so check for those rules as well.
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• Check how your abstract is being reviewed. Is it blind? You may see instructions like, To ensure blinded peer-review, no direct references to the author(s) or institution(s) of origin should be made anywhere in the title, body, tables or figures.

Your best strategy in writing a title: Write the abstract first.  Then pull out 6-10 key words or key phrases found in the abstract, and string them together into various titles. Brainstorm lots of keywords to help find the best mix.

• Ideally 10-12 words long
• Title should highlight the case​
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• ​Did you review supporting evidence? What does the literature say about this topic?​
• ​You probably have a research question, or perhaps a PICO question or EBP question, if you are in healthcare. This may also be in the form of a statement of purpose
• 5-8 sentences long
• This will be the longest part of the abstract. Describe your study design or intervention
• ​Describe the population involved with your project
• ​What target measures did you set to show improved performance? ​
• ​Describe the procedures in your project, basically the process, each step taken, and the tools/techniques/strategies used
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Research versus practice in quality improvement? Understanding how we can bridge the gap

Lisa r hirschhorn.

1 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

Rohit Ramaswamy

2 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 4107 McGavran-Greenberg Hall, CB #7469, Chapel Hill, NC 27599, USA

Mahesh Devnani

3 Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, OPD Block Sector 12, Chandigarh 160012, India

Abraham Wandersman

4 Department of Psychology, University of South Carolina, 1512 pendleton st, Columbia, SC 29208, USA

Lisa A Simpson

5 AcademyHealth, 1666 K Street, Suite 1100, Washington, DC 20006, USA

Ezequiel Garcia-Elorrio

6 Department of Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina

The gap between implementers and researchers of quality improvement (QI) has hampered the degree and speed of change needed to reduce avoidable suffering and harm in health care. Underlying causes of this gap include differences in goals and incentives, preferred methodologies, level and types of evidence prioritized and targeted audiences. The Salzburg Global Seminar on ‘Better Health Care: How do we learn about improvement?’ brought together researchers, policy makers, funders, implementers, evaluators from low-, middle- and high-income countries to explore how to increase the impact of QI. In this paper, we describe some of the reasons for this gap and offer suggestions to better bridge the chasm between researchers and implementers. Effectively bridging this gap can increase the generalizability of QI interventions, accelerate the spread of effective approaches while also strengthening the local work of implementers. Increasing the effectiveness of research and work in the field will support the knowledge translation needed to achieve quality Universal Health Coverage and the Sustainable Development Goals.

Introduction

After mixed results from the Millennium Development Goals (MDGs) strategy, the global agenda recognized the critical role of ensuring not just access but quality of health care delivery. As a result, quality and improvement have become a core focus within the Universal Health Coverage movement to achieve the goal of better population health and Sustainable Development Goals (SDGs)[ 1 – 3 ]. In low- and middle-income countries, quality improvement (QI) is used to identify performance gaps and implement improvement interventions to address these problems at the local, sub national and national levels. Methods used by these improvement interventions range from process improvements using incremental, cyclically implemented changes appropriate to the local context, to system-level interventions and policies to improve and sustain quality. Regardless of the scope of improvement efforts and methods employed, the impact and spread of QI has often fallen short. Causes of these lost opportunities include how decisions about improvement interventions are made, the methodology for measuring the effectiveness of the intervention, what data are collected and used and how the information on both the implementation and the intervention is communicated to drive spread and knowledge translation [ 4 , 5 ]. Practitioners engaged in improvement in their organizations are frustrated by research reviews which often show a lack of conclusiveness about the effectiveness of QI when many of them see the local benefits from their work. Researchers complain about the lack of rigor in the application of QI methods in practice sittings and about poor documentation of the implementation process [ 6 ].

There is a growing realization of the need for common ground between implementers and researchers that promotes use of more systematic and rigorous methods to assess the improvement intervention effectiveness when appropriate but does not demand that all QI implementations be subject to the experimental methods commonly considered to be the gold standard of evidence. To explore the causes of this gap and address how to bridge the gap and better engage the targeted consumers of generated knowledge, including communities, governments and funders, a session ‘Better Health Care: How do we learn about improvement?’ was organized by Salzburg Global Seminar (SGS) [ 7 ]. The session brought together experts from a range of fields and organizations, including researchers, improvement implementers from the field, policy makers, and representatives from countries and international organizations.

For a partnership between researchers and implementers to become more consistent in improvement projects and studies, the incentives and priorities of each of these groups need to be better aligned in QI work and its evaluation. In this paper, we build on the Salzburg discussions, existing literature, and our own experience to explore the barriers to collaboration and offer suggestions on how to start to address these barriers. In the spirit of quality improvement, we hope that these recommendations are adopted and tried by groups interested in advancing the research and the practice of QI.

Why the gap exists

Both groups use data to evaluate whether improvements have taken place and are interested in the question of ‘did it work’. However, these gaps have occurred in part because of differences in goals, evidence needs and methods used and incentives for results and dissemination.

As we consider the major differences between researchers and implementers, we should recognize that there is not a clearly defined dichotomy between these two groups. Rather, those who are focused on in improvement are part of a continuum and are driven by a range of goals from driving and demonstrating local improvements to a focus on attributing these improvements to QI methods that can be generalized and spread, as illustrated in Table ​ Table1, 1 , which also describes differences in incentives, discussed further below. Organization-based implementers focus on quality improvement projects, where the primary goal is driving change to a local problem to improve care. Policy and decision makers' goals are broader improvement, needing evidence for current and future decision on what methods and implementation strategies to use. Researchers have a goal of developing new and generalizable knowledge about the effectiveness of QI methods.

Selected participants and stakeholders in quality improvement work and research and their incentives and goals

Incentives for results and dissemination

The differences in goals and evidence are related to often competing incentives. Implementers are incentivized to improve quality and meet the demands of stakeholders, whether local communities, government or funders. Researchers are rewarded through dissemination of evidence in high-impact peer-reviewed journals, research grants and academic promotions. Policy makers are rewarded by timely response to gaps with broad visible changes in their populations. Timeframes of these incentives are also often different, with the most rigorous studies taking years to measure impact, followed by careful analysis and dissemination. Implementers and policy makers, however, are often under pressure to show short-term change and respond to new and emerging issues even as they continue with existing improvement work.

The goals of documentation and dissemination of projects can also differ between researchers and implementers and their stakeholders. There is a strong recognition that the evidence generated by even the best QI efforts is not effectively translated into further spread and adoption [ 8 ]. This is because implementers working on QI interventions in their organizations are incentivized by improvement and do not usually have a demand to document their work beyond communication with organizational leaders. While there are growing venues for sharing of case reports through learning collaboratives and local meetings designed to facilitate peer learning, this documentation typically involves a description of the process of implementation, but not at a level of detail or rigor of value to researchers and the broader community. There are a number of disincentives for implementers to increase the rigor and detail of their local work including competing demands to deliver services and ongoing improvement, and the paucity of journals interested in publishing even well- documented local results because they prioritize rigorous results of evaluations with strong designs involving carefully constructed QI research studies. Researchers are incentivized by more academic dissemination through these peer-reviewed journals and presentation at conferences. This nonalignment results in practitioners being deprived of access to broader venues to disseminate their work and researchers losing rich contextual data that is critically important to evaluate the effectiveness of QI.

Evidence needed and methods prioritized

The differences in the goals and incentives of different stakeholders lead to differences in the amount of evidence that is considered adequate and the methods used to generate this evidence. Implementers are interested in the evidence of change in their local projects, with less emphasis on transferring or generalizing what they did for use in other settings. They may rely on a combination of pre-and-post intervention data, QI statistical methods such as run charts and tacit organizational knowledge to assess the evidence of change in their projects. Policy makers have an interest in evidence which is robust enough from the QI to inform resource allocation, but may still have a focus on a specific geography rather than generalizability at scale. They are interested in generalizable knowledge about successful QI methods, but are sensitive to the burden and costs and time of requiring rigorous research methods on implementing groups.

Researchers aim for evidence which is robust enough to provide globally relevant conclusions with limited threats to internal validity. This group is most supportive of the use of rigorous experimental research designs to generate the highest possible standards of evidence. Traditionally, this had been limited to a small set of rigid experimental designs with appropriate controls or comparison groups driven in part by research funders and academic standards to be able to attribute change to the improvement interventions. This set of designs has been expanding in the past few years as better understanding of the value of quasi-experimental methods has emerged. [ 9 , 10 ]

Why better alignment is needed

QI interventions differ from many fixed clinical or public health interventions [ 11 ]. In this supplement, Ramaswamy and others describe QI interventions as complex (multi-pronged and context-specific) interventions in complex systems (non-linear pathways and emergent behaviors). For better learning from QI, implementers, policy makers and researchers both need to know not just effectiveness (the focus of local measurement, outcomes research and impact evaluation) but also 'how and why' the change happened (implementation), cost and sustainability ensuring that the evidence produced will be more relevant to the stakeholders at the local and broader level. Therefore, finding a common ground through ‘development of a culture of partnership’ [ 12 ] to co-identify appropriate methods and data collection to understand and disseminate implementation strategies is critical to inform how to how to create the different knowledge products: generalizable evidence for dissemination (researchers), insights into how to scale (policy makers) and how to sustain the improvements (implementers) [ 13 ]. A well-known and commonly cited example is the Surgical Safety Checklist, which was found to improve adherence to evidence-based practices and save lives across a range of settings [ 14 ]. However, attempts to replicate these successes were not always effective since capturing generalizable knowledge on how to introduce and support the implementation of this intervention with fidelity was not part of the original research dissemination, [ 15 ] a lesson understood by the original researchers and addressed through accompanying toolkits [ 16 ].

Another important area where collaboration between implementers and researchers is needed to improve learning from QI in understanding the impact of different contextual factors to identify which aspects of an improvement intervention are generalizable, which are context-specific and which are critical to address when planning replication. During the seminar, a study of antenatal corticosteroids (ANCS), an intervention found in higher income settings to reduce death among premature infants, was discussed to identify how contextual factors can be better addressed through local knowledge to inform implementation [ 17 ]. The randomized controlled trial showed that implementation of ANCS in low-resource settings resulted in increased mortality among some of the infants who were given steroids; the published conclusion was that ANCS was not a recommended improvement intervention in these settings. The group identified the gap in the translation of ANCS use from resource richer settings did not consider the different contextual factors which required adaption such as the lack of capacity to accurately determine prematurity needed to determine eligibility for the steroids.

Starting the work to bridge the gap

Based on the reasons for the gaps identified above, we recommend a number of initial steps to better bridge the gap between researchers and implementers:

• Aligning project goals and joint planning : Before QI projects get launched, the initial work must start with implementers and researchers discussing and agreeing on the goals and objectives of the work including and beyond local improvement. In addition to alignment of improvement goals, all stakeholders must be engaged at the start of the QI project to agree on the purposes and uses of the results, local learning or broader dissemination or both. This work needs to happen at the design phase and continue with ongoing planned communication throughout the work. This will ensure that all stakeholders are jointly engaged in identifying the most appropriate research questions and the most appropriate methods to answer them.

The need to understand both process and context in the evaluation and study of QI interventions also cannot be accomplished without engaging both researchers and practitioners in the process [ 13 ]. The knowledge about how the project was implemented, and what was relevant to the context often resides with those responsible for implementation. However, as mentioned previously, the implementers often have neither the incentives nor the support to systematically document and disseminate this knowledge in a way that makes it available for general use. Researchers can play a key role in influencing the QI research integration by supporting systematic documentation of the implementation process in addition to an evaluation of outcomes and by partnering with implementers to make this happen. Introduction of adaptive designs such as SMART trials into improvement research may also offer a common ground where improvement implementers and researchers can collaborate introducing use of data to make mid-course changes to the implementation design.

• Building implementer research capacity. Building capacity of implementers as potential producers of and better consumers of research and evaluation results in another important approach to bridge the gap. For example, empowerment evaluation is designed to increase the likelihood that programs will achieve results by increasing the capacity of program stakeholders to plan, implement and evaluate their own program [ 19 ]. Building capacity within implementing organizations through technical support provided by researchers for interested implementers can establish a viable infrastructure for practitioners and researchers to work together more effectively. For example, multi-year research practice partnerships in facilities in Kenya has led to sustainable QI programs with dissemination of methods and results through co-authored peer-reviewed journals and conference presentations [ 20 ] Similar results were seen for research capacity building targeting implementers in the Africa Health Initiative in five countries in Africa [ 21 ]. Support for practice-based researchers to build their capacity in QI and in process evaluation using implementation science methods can also increase the potential of improvement projects to produce the knowledge needed about the implementation to spread learning within and beyond their organization.
• Aligning incentives to drive collaboration : Creating areas of shared incentives will require initiatives from funders and universities to appreciate the higher value of co-produced research, reward capacity building of researchers in the field and fund innovative models of embedded research where researchers are part of or embedded into the implementing organization [ 22 ]. In addition, offering opportunities for meaningful participation in research and building capacity for this work among implementers has also been associated with better improvement and dissemination [ 23 ].
• Simplifying documentation for dissemination of learning : As mentioned earlier, it is useful for both implementers and researchers if documenting the implementation of QI programs becomes part of routine practice. However, this will not happen without simplifying documentation standards. SQUIRE and TiDieR guidelines are very helpful for academic publications. However, they are not always a good fit for projects whose primary purpose is not research but who have the potential to add to the knowledge needed to improve QI [ 24 , 25 ]. Researchers could partner with implementers to develop simpler, practice-based research guidelines and to create other venues such as through existing organizations focused on quality and improvement where methods and results could be posted using these guidelines without a formal peer-review process. Templates and examples could be provided to improve the quality of documentation as well as editorial staff to assist with structure and formatting. The incentive for implementers is to get their stories told, and at the same time provide an opportunity for researchers to get data on where to focus further research. In addition, there are growing options to share knowledge and research findings such as the WHO Global Learning Lab for Quality UHC which provides a forum for implementers to disseminate work available to broader community [ 26 ].

To improve learning from and effectiveness of QI work requires involvement and collaboration between both researchers and practitioners. Researchers can advance the field by creating generalizable knowledge on the effectiveness of interventions and on implementation strategies and practitioners improve outcomes on the ground by implementing QI interventions. By increasing the collaboration, more systematic evaluations of interventions in local contexts and better design of research will result in production of the generalizable knowledge needed to increase the impact of QI. In order for this to take place, there needs to be an intentional effort to address the gaps that challenge researchers and practitioners working together. This can occur by aligning incentives, increasing the value and utility of produced research to implementers, and as a shared community developing new guidance to bring these different groups to more effective collaboration. The growing experience in QI and improvement science offers many opportunities for better collaboration between researchers and implementers to increase the value of this partnership to accelerating progress toward quality Universal Health Coverage and the Sustainable Development Goals.

M.D. received financial support from SGS to attend this seminar.