Marita Titler from the University of Iowa summarized the research group’s discussion, which focused primarily on the challenges to be addressed to strengthen quality improvement research.
Fundamental problems with quality improvement center on the fact that the research focuses on a wide range of evaluations, from reviews of individual interventions to entire systems. The heavily disease-oriented evaluations pose additional barriers to performing good research because positive findings cannot be generalized from one disease to another. Part of the inability to compare between interventions for different diseases is the lack of a standard language to share ideas and compare findings.
Other problems in quality improvement research are the methods used. As mentioned throughout the workshop, the contexts in which interventions take place are not well studied or documented. Additionally, there is little guidance on how to balance tradeoffs, such as internal and external validity. It was also noted that multiple methods would be necessary to evaluate cultural change and transformational change. This would require strengthening of research methods, especially qualitative methods. Limited progress has been made in qualitative methods in part because guidelines for how to do so have not been developed and because of their limited acceptance in peer-reviewed journals. Most major journals have word limitations for articles, and qualitative research and comprehensive summaries of methods often exceed those limitations. It was suggested that specific components be written for a major journal and lengthier sections be published in other more focused journals.
The current state of quality improvement research was compared to community-based partnership research a few years ago and clinical research 25 years ago. Sciences evolve and patience needs to be exercised as quality improvement researchers learn from the development of those fields.
Collaboration is needed with researchers in other disciplines, including researchers studying human factors, engineering, and social science. Researchers also need to learn from social and behavioral theorists to better understand the mechanisms of organizational cultural relationships.
The session ended with a note to consider both the costs of implementing interventions and the costs of not understanding the opportunities of quality improvement projects.