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Logo of qualsafetyQuality and Safety in Health CareCurrent TOCInstructions for authors
Qual Saf Health Care. Sep 2002; 11(3): 270–275.
PMCID: PMC1743631

Evaluation of quality improvement programmes


In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement.

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Selected References

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  • West E. Management matters: the link between hospital organisation and quality of patient care. Qual Health Care. 2001 Mar;10(1):40–48. [PMC free article] [PubMed]
  • Bigelow B, Arndt M. Total quality management: field of dreams? Health Care Manage Rev. 1995 Fall;20(4):15–33. [PubMed]
  • Motwani J, Sower VE, Brashier LW. Implementing TQM in the health care sector. Health Care Manage Rev. 1996 Winter;21(1):73–82. [PubMed]
  • Shortell SM, Bennett CL, Byck GR. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q. 1998;76(4):593–510. [PMC free article] [PubMed]
  • Blumenthal D, Kilo CM. A report card on continuous quality improvement. Milbank Q. 1998;76(4):625–511. [PMC free article] [PubMed]
  • Ovretveit J. The Norwegian approach to integrated quality development. J Manag Med. 2001;15(2):125–141. [PubMed]
  • Shortell SM, O'Brien JL, Hughes EF, Carman JM, Foster RW, Boerstler H, O'Connor EJ. Assessing the progress of TQM in US hospitals: findings from two studies. Qual Lett Healthc Lead. 1994 Apr;6(3):14–17. [PubMed]
  • Shortell SM, O'Brien JL, Carman JM, Foster RW, Hughes EF, Boerstler H, O'Connor EJ. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res. 1995 Jun;30(2):377–401. [PMC free article] [PubMed]
  • Carman JM, Shortell SM, Foster RW, Hughes EF, Boerstler H, O'Brien JL, O'Conner EJ. Keys for successful implementation of total quality management in hospitals. Health Care Manage Rev. 1996 Winter;21(1):48–60. [PubMed]
  • Boerstler H, Foster RW, O'Connor EJ, O'Brien JL, Shortell SM, Carman JM, Hughes EF. Implementation of total quality management: conventional wisdom versus reality. Hosp Health Serv Adm. 1996 Summer;41(2):143–159. [PubMed]
  • Gustafson DH, Hundt AS. Findings of innovation research applied to quality management principles for health care. Health Care Manage Rev. 1995 Spring;20(2):16–33. [PubMed]
  • Shaw C. External assessment of health care. BMJ. 2001 Apr 7;322(7290):851–854. [PMC free article] [PubMed]
  • Thomson RG, McElroy H, Kazandjian VA. Maryland Hospital Quality Indicator Project in the United Kingdom: an approach for promoting continuous quality improvement. Qual Health Care. 1997 Mar;6(1):49–55. [PMC free article] [PubMed]
  • Rosenthal GE, Harper DL. Cleveland health quality choice: a model for collaborative community-based outcomes assessment. Jt Comm J Qual Improv. 1994 Aug;20(8):425–442. [PubMed]
  • Hertz HS, Reimann CW, Bostwick MC. The Malcolm Baldrige National Quality Award concept: could it help stimulate or accelerate health care quality improvement? Qual Manag Health Care. 1994 Summer;2(4):63–72. [PubMed]
  • Sweeney J, Heaton C. Interpretations and variations of ISO 9000 in acute health care. International Organization for Standardization. Int J Qual Health Care. 2000 Jun;12(3):203–209. [PubMed]
  • Shaw CD. External quality mechanisms for health care: summary of the ExPeRT project on visitatie, accreditation, EFQM and ISO assessment in European Union countries. External Peer Review Techniques. European Foundation for Quality Management. International Organization for Standardization. Int J Qual Health Care. 2000 Jun;12(3):169–175. [PubMed]
  • Øvretveit J. Quality evaluation and indicator comparison in health care. Int J Health Plann Manage. 2001 Jul-Sep;16(3):229–241. [PubMed]
  • Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. Int J Qual Health Care. 1994 Jun;6(2):115–132. [PubMed]
  • Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001 Sep 29;323(7315):746–749. [PMC free article] [PubMed]
  • Walshe K, Wallace L, Freeman T, Latham L, Spurgeon P. The external review of quality improvement in health care organizations: a qualitative study. Int J Qual Health Care. 2001 Oct;13(5):367–374. [PubMed]
  • Øvretveit J. The economics of quality--a practical approach. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2000;13(4-5):200–207. [PubMed]

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