Health care improvement models

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, and
  • active participation of managers - align with corporate objectives, provide local tools, address local system consequences and embed new practices.

Published Date: 24 February 2009