全球智库信息集成服务系统

We identified and reviewed 38 academic and 16 grey literature publications covering diverse improvement approaches. Some examples include Six Sigma, Lean, Business Process Reengineering, Plan-Do-Study-Act, clinical audits and feedback, quality improvement collaboratives and peer-learning communities, training and education interventions, and patient engagement and feedback-related interventions.

Key influences on improvement processes in healthcare

Based on the reviewed literature, six key factors influence the implementation of improvement efforts:

• Leadership
• Relationships and interactions that support an improvement culture
• Skills and competencies
• Use of data
• Patient and public involvement, engagement and participation
• Working as an interconnected system of individuals and organisations, influenced by internal and external contexts

This review also attempted to go beyond identifying these high-level influences by explaining what specific aspects of the influencing factors are important for quality improvement. The report provides a detailed analysis of influencing factors across the six categories outlined above, as well as summary tables for each.

Poor-quality healthcare has significant health-related and economic consequences for patients and the wider health system. Although many healthcare organisations are now engaging with improvement activity, the challenges associated with improving care quality remain considerable.

The field of improvement research has significant potential to contribute to a better understanding of how improvements in patient care can be achieved and sustained. It is an interdisciplinary academic field, and although the literature on quality improvement is broad and diverse, it is also fragmented. Many studies look at individual improvement models, approaches and interventions, and focus on understanding what works in relation to specific improvement aims. There is less consolidated and curated evidence on learning about the process of doing improvement. A better understanding of the nature of improvement processes and influences on them could inform both ongoing and future practice, by drawing out practical insights such as those related to the challenges faced by improvers and the strategies used to overcome them.

Against this context, The Healthcare Improvement Studies (THIS) Institute commissioned RAND Europe to conduct a rapid evidence review of the academic and grey literature, to draw out initial learning about what influences quality improvement processes in healthcare, and to inform potential themes to explore in future research.

• Chapter One

  Background and context

• Chapter Two

  Methodology

• Chapter Three

  Profile of the reviewed literature

• Chapter Four

  Learning about the influences on improvement processes

• Chapter Five

  Reflections and implications for future research