Skip to main content
Intended for healthcare professionals
Restricted access
Review article
First published online January 28, 2009

Review: What Can We Learn From Quality Improvement Research?: A Critical Review of Research Methods

Abstract

This article presents a systematic review of the research methods used to study quality improvement (QI) effectiveness in health care organizations. The review relied on existing literature as well as emergent themes to identify types of QI programs (e.g., data/feedback, information technology, staff education) and quality outcomes (e.g., mortality, morbidity, unnecessary variation). Studies were separated into four categories according to the type of organization in which the QI program was introduced: (a) hospital, (b) nursing home, (c) physician group, and (d) other health care organization. Results of the review indicate that most QI effectiveness research is conducted in hospital settings, is focused on multiple QI interventions, and utilizes process measures as outcomes. The review also yielded substantial variation with respect to the study designs used to examine QI effectiveness. The article concludes with a critique of these designs and suggestions for ways future research could address these shortcomings.

Get full access to this article

View all access and purchase options for this article.

References

Barnes, R.V., Lawton, L., & Briggs, D. (1994). Clinical benchmarking improves clinical paths: Experience with coronary artery bypass grafting. Joint Commission Journal on Quality Improvement, 20(5), 267-276.
Brook, R.H., Kamberg, C.J., Mayer-Oakes, A., Beers, M.H., Raube, K., & Steiner, A. (1990). Appropriateness of acute medicine care for the elderly: An analysis of the literature. Health Policy, 14(3), 225-242.
Brothers, T.E., Robison, J.G., & Elliott, B.M. (1997). Relevance of quality improvement methods to surgical practice: Prospective assessment of carotid endarterectomy. American Surgeon, 63(3), 213-219.
Carey, R.G., & Teeters, J.L. (1995). CQI case study: Reducing medication errors. Joint Commission Journal on Quality Improvement, 21(5), 232-237.
Chu, L.A., Bratzler, D.W., Lewis, R.J., Murray, C., Moore, L., Shook, C., et al. (2003). Improving the quality of care for patients with pneumonia in very small hospitals. Archives of Internal Medicine, 163(3), 326-332.
Civetta, A.C., Keller, R.B., & Wennberg, D.E. (1996). Decreasing catheter-related infection and hospital costs by continuous quality improvement. Critical Care Medicine, 24(9), 1660-1665.
Daucourt, V., Saillour-Glenisson, F., Michel, P., Jutand, M.A., & Abouelfath, A. (2003). A multicenter cluster randomized controlled trial of strategies to improve thyroid function testing. Medical Care, 41(3), 432-441.
Dellefield, M.E. (2006). Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent survey deficiency citation in California nursing homes. Research in Nursing and Health, 29, 345-358.
Deming, W.E. (1986). Out of the crisis. Cambridge : Massachusetts Institute of Technology Center for Advanced Engineering Study.
Dubois, R.W., & Brook, R.H. (1988). Preventable deaths: Who, how often, and why? Annals of Internal Medicine, 109(7), 582-589.
Eccles, M., Grimshaw, J., Campbell, M., & Ramsay, C. (2003). Research designs for studies evaluating the effectiveness of change and improvement strategies. Quality and Safety in Health Care, 12(1), 47-53.
Eccles, M., Steen, N., Grimshaw, J., Thomas, L., McNamee, P., Soutter, J., et al. (2001). Effect of audit and feedback, and reminder messages on primary-care radiology referrals: A randomised trial. Lancet, 357(9266), 1406-1409.
Ellrodt, A.G., Conner, L., Rieidinger, M., & Weingarten, S.R. (1995). Measuring and improving physician compliance with clinical practice guidelines: A controlled intervention trial. Annals of Internal Medicine, 122(4), 277-282.
Ferguson, T.B., Jr. , Peterson, E.D., Coombs, L.P., Eiken, M.C., Carey, M.L., Grover, F.L., et al. (2003). Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial. Journal of the American Medical Association, 290(1), 49-56.
Gregor, C., Pope, S., Werry, D., & Dodek, P. (1996). Reduced length of stay and improved appropriateness of care with a clinical path for total knee or hip arthroplasty. Joint Commission Journal on Quality Improvement, 22(9), 617-627.
Grimshaw, J.M., Thomas, R.E., MacLennan, G., Fraser, C., Ramsay, C.R., Vale, L., et al. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), 1-94.
Grol, R., Baker, R., & Moss, F. (2002). Quality improvement research: Understanding the science of change in health care: Essential for all who want to improve health care. Quality and Safety in Health Care, 11(2), 110-112.
Harris, R.H., MacKenzie, T.D., Leeman-Castillo, B., Corbett, K.K., Batal, H.A., Maselli, J.H., et al. (2003). Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. Journal of General Internal Medicine, 18(5), 326-334.
Health Care Advisory Board. (1992). TQM: Directory of hospital projects. Washington, DC: Advisory Board Company.
Hoff, T., Jameson, L., Hannan, E., & Flink, E. (2004). A review of the literature examining linkages between organizational factors, medical errors, and patient safety. Medical Care Research and Review, 61(1), 3-37.
Horbar, J.D., Carpenter, J.H., Buzas, J., Soll, R.F., Suresh, G., Bracken, M.B., et al. (2004). Collaborative quality improvement to promote evidence based surfactant for preterm infants: A cluster randomised trial . British Medical Journal, 329(7473), 1004-1007.
Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Ishikawa, K. (1985). What is total quality control? The Japanese way. (D. Lu, Trans.). Englewood Cliffs, NJ: Prentice Hall.
James, B.C. (1989). Quality management for health care delivery. Chicago: Hospital Research and Educational Trust.
Joshi, M.S., Anderson, J.F., & Marwaha, S. (2002). A systems approach to improving error reporting . Journal of Healthcare Information Management, 16(1), 40-45.
Juran, J.M. (1989). Leadership for quality. New York: Free Press.
Leape, L.L. (1994). Error in medicine. Journal of the American Medical Association, 272(23), 35-43.
Marrie, T.J., Lau, C.Y., Wheeler, S.L., Wong, C.J., Vandervoort, M.K., Feagan, B.G., et al. (2000). A controlled trial of a critical pathway for treatment of community-acquired pneumonia. Journal of the American Medical Association, 283(6), 749-755.
McLaughlin, C.P., & Kaluzny, A.D. (2006). Continuous quality improvement in health care . Sudbury, MA: Jones & Bartlett .
Meyer, G.S., & Massagli, M.P. (2001). The forgotten component of the quality triad: Can we still learn something from "structure"? Joint Commission Journal on Quality and Patient Safety, 27(9), 484-493.
Moray, N. (1994). Error reduction as a systems problem. In M. S. Bogner (Ed.), Human error in medicine (pp. 67-91). Hillsdale, NJ: Lawrence Erlbaum.
Pandey, D., & Cursio, J. (2006). Data feedback for quality improvement of stroke care CAPTURE stroke experience. American Journal of Preventive Medicine, 31(6), S224-S229.
Schectman, J.M., Schroth, W.S., Verme, D., & Voss, J.D. (2003). Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain. Journal of General Internal Medicine, 18(10), 773-780.
Serisier, D.J., & Bowler, S.D. (2007). Effect of a simple educational intervention on the hospital management of community-acquired pneumonia. Respirology, 12, 389-393.
Shojania, K.G., Yokoe, D., Platt, R., Fiskio, J., Ma'luf, N., & Bates, D.W. (1998). Reducing vancomycin use utilizing a computer guideline: Results of a randomized controlled trial. Journal of the American Medical Informatics Association, 5(6), 554-562.
Shortell, S.M., Bennett, C.L., & Byck, G.R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76(4), 593-624.
Szpunar, S.M., Williams, P.D., Dagroso, D., Enberg, R.N., & Chesney, J.D. (2006). Effects of the tobacco use cessation automated clinical practice guidelines. American Journal of Managed Care, 12(11), 665-673.
Walton, M. (1990). Deming management at work. New York: G. P. Putnam.

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the SAGE Journals article sharing page.

Information, rights and permissions

Information

Published In

Article first published online: January 28, 2009
Issue published: June 2009

Keywords

  1. quality improvement effectiveness
  2. literature review
  3. health care organizations

Rights and permissions

Request permissions for this article.

History

Published online: January 28, 2009
Issue published: June 2009
PubMed: 19176833

Authors

Affiliations

Jeffrey A. Alexander
University of Michigan
Larry R. Hearld
University of Michigan

Metrics and citations

Metrics

Journals metrics

This article was published in Medical Care Research and Review.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 653

*Article usage tracking started in December 2016

Articles citing this one

Web of Science: 62 view articles Opens in new tab

Crossref: 63

  1. Determining the skills needed by frontline NHS staff to deliver qualit...
    Go to citation Crossref Google Scholar
  2. Emergent barriers to the lean healthcare journey: baronies, tribalism ...
    Go to citation Crossref Google Scholar
  3. Quality improvement studies in nursing homes: a scoping review
    Go to citation Crossref Google Scholar
  4. Healthcare Quality Improvement Analytics: An Example Using Computerize...
    Go to citation Crossref Google Scholar
  5. Ensuring Implementation Fidelity Is Essential for Quality Improvement
    Go to citation Crossref Google Scholar
  6. Improving Care Experiences for Patients and Caregivers at End of Life:...
    Go to citation Crossref Google ScholarPub Med
  7. Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobi...
    Go to citation Crossref Google Scholar
  8. Increasing Operating Room Efficiency with Shop Floor Management: an Em...
    Go to citation Crossref Google Scholar
  9. Impact of quality improvement strategies on the quality of life of ind...
    Go to citation Crossref Google Scholar
  10. Beyond the ostensible: an exploration of barriers to lean implementati...
    Go to citation Crossref Google Scholar
  11. Understanding Determinants of Sustainability Through a Realist Investi...
    Go to citation Crossref Google Scholar
  12. Implementing Patient-Reported Outcome Measures in Clinical Breast Canc...
    Go to citation Crossref Google Scholar
  13. Sustaining Quality Improvement
    Go to citation Crossref Google Scholar
  14. Why is reporting quality improvement so hard? A qualitative study in p...
    Go to citation Crossref Google Scholar
  15. Identifying and resolving the frustrations of reviewing the improvemen...
    Go to citation Crossref Google Scholar
  16. Retrospective Analysis of Suspended Surgeries and Influencing Factors ...
    Go to citation Crossref Google Scholar
  17. Análisis retrospectivo de las suspensiones quirúrgicas y de los factor...
    Go to citation Crossref Google Scholar
  18. Care pathways are complex interventions in complex systems: New Europe...
    Go to citation Crossref Google Scholar
  19. Harveian Oration 2018: Improving quality and safety in healthcare 
    Go to citation Crossref Google Scholar
  20. Characteristics of Quality Improvement Champions in Nursing Homes: A S...
    Go to citation Crossref Google Scholar
  21. Understanding middle managers’ influence in implementing patient safet...
    Go to citation Crossref Google Scholar
  22. Assuring Sustainable Gains in Interdisciplinary Performance Improvemen...
    Go to citation Crossref Google Scholar
  23. Helping Hospitals Improve Patient Centeredness: Assessing the Impact o...
    Go to citation Crossref Google ScholarPub Med
  24. Long-Term Sustainability of Timely Emergency Department Analgesia for ...
    Go to citation Crossref Google Scholar
  25. A comparison of working in small-scale and large-scale nursing homes: ...
    Go to citation Crossref Google Scholar
  26. Optimal management of children on antiretroviral therapy (ART) in prim...
    Go to citation Crossref Google Scholar
  27. The potential for nurses to contribute to and lead improvement science...
    Go to citation Crossref Google Scholar
  28. How Quality Improvement Practice Evidence Can Advance the Knowledge Ba...
    Go to citation Crossref Google Scholar
  29. A PICU patient safety checklist: rate of utilization and impact on pat...
    Go to citation Crossref Google Scholar
  30. What methods are used to apply positive deviance within healthcare org...
    Go to citation Crossref Google Scholar
  31. Do quality improvement collaboratives’ educational components match th...
    Go to citation Crossref Google Scholar
  32. A cross-sectional survey to investigate the quality of care in Tuscan ...
    Go to citation Crossref Google Scholar
  33. Integration of non-communicable chronic diseases (NCDs) and HIV/AIDS a...
    Go to citation Crossref Google Scholar
  34. Barriers and supportive conditions to improve quality of care for crit...
    Go to citation Crossref Google Scholar
  35. Impact of a GRADE-based medical question answering system on physician...
    Go to citation Crossref Google Scholar
  36. Republished: How to study improvement interventions: a brief overview ...
    Go to citation Crossref Google Scholar
  37. Depicting the interplay between organisational tiers in the use of a n...
    Go to citation Crossref Google Scholar
  38. How to study improvement interventions: a brief overview of possible s...
    Go to citation Crossref Google Scholar
  39. Factors Associated With Poor Hospital Mortality Rates After the Nation...
    Go to citation Crossref Google ScholarPub Med
  40. Quality Improvement, Patient Safety, and Continuing Education
    Go to citation Crossref Google Scholar
  41. Local politico-administrative perspectives on quality improvement base...
    Go to citation Crossref Google Scholar
  42. Agency for Healthcare Research and Quality Evidence-based Practice Cen...
    Go to citation Crossref Google Scholar
  43. Engaging the Health Care Team through Operations Councils: Strategies ...
    Go to citation Crossref Google Scholar
  44. An exploration of management practices in hospitals
    Go to citation Crossref Google Scholar
  45. Short and long term improvements in quality of chronic care delivery p...
    Go to citation Crossref Google Scholar
  46. A systems-based partnership learning model for strengthening primary h...
    Go to citation Crossref Google Scholar
  47. Measuring team factors thought to influence the success of quality imp...
    Go to citation Crossref Google Scholar
  48. Regulated provider perceptions of feedback reports
    Go to citation Crossref Google Scholar
  49. Measurable outcomes of quality improvement using a daily quality round...
    Go to citation Crossref Google Scholar
  50. Deciding when quality and safety improvement interventions warrant wid...
    Go to citation Crossref Google Scholar
  51. Positioning continuing education: boundaries and intersections between...
    Go to citation Crossref Google Scholar
  52. (Mis)perceptions of Continuing Education: Insights From Knowledge Tran...
    Go to citation Crossref Google Scholar
  53. A new pathway for elective surgery to reduce cancellation rates
    Go to citation Crossref Google Scholar
  54. Sustainability of healthcare improvement: what can we learn from learn...
    Go to citation Crossref Google Scholar
  55. Measuring organizational and individual factors thought to influence t...
    Go to citation Crossref Google Scholar
  56. A Rasch model analysis of technology usage in Minnesota hospitals
    Go to citation Crossref Google Scholar
  57. Assessment of primary care in health surveys: a population perspective
    Go to citation Crossref Google Scholar
  58. Is the maturity of hospitals' quality improvement systems associated w...
    Go to citation Crossref Google Scholar
  59. Identifying quality improvement intervention publications - A comparis...
    Go to citation Crossref Google Scholar
  60. The Science of Quality Improvement Implementation
    Go to citation Crossref Google Scholar
  61. Does Quality Improvement Face a Legitimacy Crisis? Poor Quality Studie...
    Go to citation Crossref Google ScholarPub Med
  62. Moving the Science of Quality Improvement in Critical Care Medicine Fo...
    Go to citation Crossref Google Scholar
  63. Reliability of 95% confidence interval revealed by expected quality-of...
    Go to citation Crossref Google Scholar

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:


Alternatively, view purchase options below:

Purchase 24 hour online access to view and download content.

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub