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The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary
2. How do you/does your organization approach qualityimprovement research/evaluation? What research designs/methodsare employed? What types of measures are needed for evaluation?Are the needed measures available? Is the infrastructure (e.g., information technology) able to support optimal research designs?
My take-home message is that QI research is currently under-theorized and would benefit from the application of a much wider literature—such as from mainstream organization and management research. There has been far too great a focus on “what works” and too little emphasis on “why might X work (or not work).”
3. What quality improvement strategies have you identified aseffective as a result of your research?
See response to previous question. If you asked instead, “What key theoretical approaches have you found that illuminate the process of quality improvement?” I would say there are many powerful theories out there in the literature, and there’s nothing as practical as a good theory. In my talk, and just as an example of the rich pickings available, I will briefly introduce the work of Martha Feldman on organizational routines, which I think would add huge value to current work in health care on “implementation.”
4. Do you think the type of evidence required for evaluatingquality improvement interventions is fundamentally different fromthat required for interventions in clinical medicine?
a. If you think the type of evidence required for quality improvement differs from that in the rest of medicine, is it because you thinkquality improvement interventions intrinsically require less testingor that the need for action trumps the need for evidence?
b. Does this answer depend on variations in context (e.g., acrosspatients, clinical microsystems, health plans, regions)? Other contextual factors? Which aspects of context, if any, do you measure aspart of quality improvement research?
I’m not sure I’d frame the question this way. There’s a fundamental difference (but also some commonalities) between research and evaluation. I recommend Michael Quinn Paton’s book on Utilization Focussed Evaluation. I think QI work has many parallels with evaluation work. Some ideas:
In general (but not universally), research is systematic inquiry directed at producing generalizable new knowledge. It is explicitly conclusion oriented (we look for the “findings” of research, and for its “bottom line”).