Finding order in heterogeneity: types of quality-improvement intervention publications

Abstract

Background: Stakeholders in quality improvement agree on the need for augmenting and synthesising the scientific literature supporting it. The diversity of perspectives, approaches, and contexts critical to advancing quality improvement science, however, creates challenges. The paper explores the heterogeneity in clinical quality improvement intervention (QII) publications. Methods: A preliminary classification framework was developed for QII articles, aiming for categories homogeneous enough to support coherent scientific discussion on QII reporting standards and facilitate systematic review. QII experts were asked to identify articles important to QII science. The framework was tested and revised by applying it to the article set. The final framework screened articles into (1) empirical literature on development and testing of QIIs; (2) QII stories, theories, and frameworks; (3) QII literature syntheses and meta-analyses; or (4) development and testing of QIIrelated tools. To achieve homogeneity, category (1) required division into (1a) development of QIIs; 1(b) history, documentation, or description of QIIs; or (1c) success, effectiveness or impact of QIIs. Results: By discussing unique issues and established standards relevant to each category, QII stakeholders can advance QII practice and science, including the scope and conduct of systematic literature reviews.

Squire 2.0 (Standards for Quality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process

“…Leaders in the field were working to consolidate the evidence for a science of improvement 2,3 and without guidance on how to write their findings, authors struggled to report their improvement work in a reliable and consistent way. 4,5 These factors influenced the initial publication in 2008 of the Standards for Quality Improvement Reporting Excellence (SQUIRE), 6 which we will refer to as SQUIRE 1.0. The guidelines were developeyd in an effort to reduce uncertainty about the information deemed to be important in scholarly reports of health care improvement, and to increase the completeness, precision, and transparency of those reports.…”

The Role for Clinician Educators in Implementing Healthcare Improvement

“…30 Adoption of SQUIRE by a growing number of journals-including the Journal of General Internal Medicine and Annals of Internal Medicinemay provide a useful opportunity for scholars who seek to publish outcomes of original quality improvement research. [30][31][32] Finally, publication of reports that describe innovative residency curricula in quality improvement 33 offers an additional opportunity for Clinician Educators. [34][35][36] Moreover, the growing number of online sites that disseminate examples of such education innovation offer clinician educators additional opportunities for publication.…”

Improvement Science: conceptual and theoretical foundations for its application to healthcare quality improvement

“…The scope of Healthcare Improvement Science includes quality improvement projects, predominantly developed at the local level, which value the conception and implementation of incremental changes and the learning acquired through such experience 32,45 . These projects, characterized by their pragmatic perspective, derive from quality management andmost probably are at the root of the name "Science of Improvement" in a broader context, in combination with the dynamic process of testing and adjusting changes.…”