1 The rigour of quality improvement work – why it matters, and what it looks like

• Published in: BMJ open quality Vol. 12; no. Suppl 1; p. A1
• Main Author: Shah, Amar
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023; BMJ Publishing Group
• Subjects: Quality improvement; Quality of care
• ISSN: 2399-6641
• DOI: 10.1136/bmjoq-2023-ISS.1

IntroductionQuality improvement has failed to live up to its promise. In theory, the application of a method to solve complex quality issues holds face validity. In practice however, much of what is termed quality improvement hasn’t demonstrated the results that we would expect to see.We propose the fundamental aspect of rigour as being critical to the efficacy of quality improvement. Rigour incorporates both design and evaluation – this session will describe the current landscape of QI, and outline how we can ensure effective design and evaluation in our own quality improvement work, to give it the best chance of success. As with any science, the reliability and validity of the knowledge and learning gained from the method of quality improvement are related to the rigour with which we apply it.We will discuss the main flaws in the design of quality improvement, and propose how we can rectify this through disciplined application of the core components of improvement: Aim, theory of change, execution theory, measurement and communication. We will also dive into the best approach to evaluation, to ensure that we maximise learning and adaptation during the quality improvement process.MethodsThis session will summarise the findings from the literature on the effectiveness of quality improvement, identifying the key factors that relate to success or failure of improvement work to achieve the proposed aim.We will return back to the fundamental concepts that underpin quality improvement, and draw out the essential element of rigour. We will describe what constitutes rigour in quality improvement, and how we can all strengthen the rigour of our own quality improvement work. We will utilise the five core components of improvement design in order to structure our thinking about rigour.We will also look at the topic of evaluation, and identify how we can best introduce simple and effective mechanisms to evaluate our quality improvement work in order to learn and adapt through the project, and continually improve our application of the method.We propose a simple framework to assess the rigour of our quality improvement work, and to ensure that future quality improvement work applies the core components of design, and a structured approach to evaluation, in order to improve the rigour of the scientific method.ResultsReferences