where quality improvement has not been guided by evidence-based learning. Quality improvement has been based largely on experiential learning, but this knowledge has yet to be adequately captured in the literature. The spread of ideas from experiential learning has thus been poor.

This session of the workshop was devoted to discussing the barriers to quality improvement and, in particular, to developing an evidence base for use in quality improvement and in quality improvement research.


Many workshop speakers emphasized the need to concentrate on the particular purpose of quality improvement projects and research. Davidoff noted that quality improvement efforts can have many divergent purposes. Some believe the purpose is improving performance, a process that occurs mainly through experiential learning and which differs significantly from scientific research, whose purpose, Davidoff noted, is to discover generalizable truths through hypothesis testing.

The emphasis on experiential learning that has evolved may lead to the conclusion that many of those doing quality improvements are uninterested in studying and writing about their experiences, Davidoff said. For them, discovering the generalizable truths about the efficacy and effectiveness of quality improvement interventions may be largely a secondary consideration.


Understanding specific contexts and what is generalizable across settings is extremely valuable in the implementation of interventions, Grimshaw said. He also stated that work in the field attempts to generate evidence while considering context and its effect on processes.

If local contexts are not considered, then the lessons learned from interventions will not be generalizable and will fail to improve the health care system, Batalden cautioned. For example, the practice of health care policy is local, while the policy of health care is not, Batalden added. The local uptake of health care policies, thus, must be considered when working to improve care. Active research and knowledge development are needed, both locally and across local settings.

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