What influences improvement processes in healthcare?

A rapid review of literature exploring the influences on improvement processes in healthcare identified a number of themes and issues relevant to future research in this space, including the key influences affecting the implementation of improvement processes in healthcare.

What is the issue?

Although many healthcare organisations are engaging in activities to improve the quality of healthcare, there are still considerable challenges in doing so. Research on quality improvement could help inform a better understanding of how improvements in patient care can be achieved and sustained.

The literature on the subject is however fragmented. While many studies focus on understanding what works in relation to specific improvement aims, there is less evidence on learning about the process of carrying out improvement, and on the experiences of those involved.

How did we help?

RAND Europe was commissioned by The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge to conduct a rapid review of literature exploring the influences on improvement processes in healthcare. The aim of the study was to identify themes and issues relevant to future research in this space.

What did we find?

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

• Patient and public involvement, engagement and participation

• Using data for improvement purposes

• 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.

What do we recommend?

Further research is needed to understand how challenges to implementing improvement can be addressed in practice, taking into consideration the interactions and interdependencies between different influences on improvement. Further research on the unintended consequences of improvement efforts is also needed, to ensure that any new improvement efforts can manage such risks.

The above insights should help improvement practitioners to recognise the issues that they need to consider in the design and implementation of improvement initiatives. They also highlight priority areas for the wider research community.