A systematic narrative review of quality improvement models in
health care
In 2008, NHS Quality Improvement Scotland (NHS QIS) commissioned
a systematic narrative review on quality improvement from Dr Alison
Powell, Dr Rosemary Rushmer and Professor Huw Davies at the Social
Dimensions of Health Institute at the Universities of Dundee and St
Andrews. Three questions were addressed in the review:
- What models exist for quality improvement in healthcare at
organisational level?
- What evidence is available on their usefulness, effectiveness
and potential application in a system such as NHSScotland?
- How can NHSScotland learn from this literature and what are the
implications for NHS QIS in the development, dissemination and
implementation of its conceptual framework?
The report presents the five major categories of model first
used in industry. It shows that there is almost no traditional
experimentation associated with the models and there is absence of
evidence on costs, but lots of rich data. The models show both a
number of differences (in terms of pace and scope of change, focus
of change activities and enabling or mandating improvement), but
also similarities (in terms of objectives, tools and implementation
approach). This means that a clear cut taxonomy is neither feasible
nor useful and it is impossible to identify a single ¿right¿
model.
A number of necessary but not sufficient conditions for
successful implementation of quality improvement initiatives are
presented, including:
- active engagement of health professionals
- tailored, multi-faceted approach
- sustained action at multiple levels
- Board level support and follow through
- active participation of managers - align with corporate
objectives, provide local tools, address local system consequences
and embed new practices.
Published Date: 24 February 2009
