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Examples and reading list

Latest publications on Improvement Science from the ISL Team:


  • Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme.   Large scale improvement is hard work, particularly when carried out in the general practice sector. This paper describes a project undertaken by colleagues within UCLPartners which aimed to improve care for people with COPD registered with practices in North East London. We used an analytical framework developed by the Health Foundation which allowed us to explore how and why improvement in general practice is different from that in the hospital sector. There are some important lessons for clinicians, managers and policy makers interested in large scale improvement in General Practice.

Martin Marshall, James Mountford, Kirsten Gamet, Gulsen Gungor, Conor Burke, Robyn Hudson, Steve Morris, Nishma Patel, Phil Koczan, Rob Meaker, Cyril Chantler, Christopher Michael Roberts
DOI: 10.3399/bjgp14X682801Published 1 December 2014


             Marshall, M, Pagel, C, French, C, Utley, M, Allwood, D, Fulop, N, Pope, C, Banks, V
             and Goldman, A. 3rd June 2014
          Marshall, M, (2013). Bridging the ivory towers and the swampy lowlands; increasing
          the impact of health services research on quality improvement. Int J Qual Health Care (2013) 
          doi: 10.1093/intqhc/mzt076
         Marshall, M, Miani, C, Nolte, E and Gill, M. HSJ, 7the October 2013
  • More dialogue, more learning, more action. The authors discuss what is required for the growing jigsaw of empirical research and investigative reports into the UK’s health system in order to lead to change at scale for the lasting benefit of patients and the population..
          Mountford J and Marshall, M, (2013). More dialogue, more learning. BMJ Qual Saf 2013;0:1-3.
          Marshall M, Pronovost P, et al. (2013). Promotion of improvement as a science. The Lancet;
          2 February 2013 ( Vol. 381,Issue 9864,Pg 419-421 )

Additional reading

Below is a selection of publications which have helped to stimulate our thinking about the science of improvement

  • Recommendations for Evaluation of Health Care Improvement Initiatives. This paper challenges traditional approaches to the evaluation of improvement initiatives. It identifies 3 different stages in the life of improvement work – innovation, testing and scale up/spread – differentiated by what the authors call the ‘degree of belief’ of the stakeholders in the possible effectiveness of their work. Recognising the inherent uncertainty in improvement work shifts the evaluation question from ‘does it work’ to ‘How and in what contexts does a new model work or can be amended to work’. It’s a model that is work testing

             Parry,G.J; Carson-Stevens, A; Luff;D.F; McPherson, M.E; Goldmann, D.A (2013) Academic

            Pediatrics Vol13, Issue 6, Supplement , Pg. S23-S30

  • Reducing central line infections in intensive care units. A much quoted example of pragmatic science, rigorously evaluating a complex intervention to reduce central line infections in ICUs. This study initiated a number of similar large scale programmes around the world, including the UK’s ‘Matching Michigan’ programme.

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al., (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725-32.

Feder G, Davies RA, Baird K, Dunne D, Eldridge S, Griffiths C, et al. (2011). Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial. Lancet 2011. Nov 19;378(9805):1788-95.

Porter M, Mountford J, Ramdas K (2010). Reconfiguring Stroke Care in North Central London. Special Version, for UCLP Value in Health Care Delivery Programm June 2011, London

Porter ME, Mountford J, Ramdas K, and Takvorian S, (2011). Reconfiguring Stroke Care in North Central London. Harvard Business School Case 712-496.

  • Reducing emergency admissions: are we on the right track? A good example of how research evidence can be used to challenge commonly held beliefs – in this case, the approaches used to managing the rapid rise in emergency admissions. Surely targeting people at high risk of admission makes sense? Well, not really…

Roland M, Abel G. (2012). Reducing emergency admissions: are we on the right track? BMJ 2012;345:23-25

  • The Behaviour Change Wheel A review of behaviour change models which results in a sophisticated and multi-dimensional model designed primarily to influence changes in individual behaviour to improve public health but highly applicable to changes in organisational behaviour for service improvement.

Michie S, van Stralen M, et al. (2011). The Behaviour Change Wheel:  A new method for characterising and designing behaviour change interventions. Implement Science 6(42).

  • Collaborative Care for Patients with Depression and Chronic Disease. We are increasingly recognising that focusing on single disease improvement programmes in a world where a high proportion of patients have multi-morbidity is at best unhelpful. This ambitious study uses a single blind RCT to evaluate an intervention to improve outcomes for patients with both depression and diabetes and/or cardiovascular disease. The strategy to analyse outcomes across the three conditions is complex and ambitious but the bottom line is that coordinated care across all conditions is associated better outcomes than conventional single disease-focused care.

Katon WJ, Lin EHB, Von Korff M et al., Collaborative Care for Patient with Depression and Chronic Disease. N Eng J Med 2010;363:2611-20.

  • The Science of Improvement. A typically thoughtful paper from one of the fathers of the quality improvement movement in health care, challenging traditional approaches to evaluating improvement interventions.

Berwick DM. (2008). The Science of Improvement. JAMA. 2008;299(10):1182-1184.

  •  Evidence Based Quality Improvement. An entertaining paper which compares and contrasts Evidence Based Management with Evidence Based Medicine. You can imagine which comes of worst.

Shojania K. and Grimshaw J (2005). Evidence Based Quality Improvement:  The state of the science. Health Affairs 24(1).

Eccles M, Grimshaw J, Campbell M, Ramsay C, (2003). Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 2003;12:47-52

Walshe K, Rundall TG. (2001). Evidence-based management: From theory to practice in health care. The Milbank Quarterly 2001; 79:429-457

One Comment leave one →
  1. January 6, 2015 10:53 am

    It’s going to be ending of mine day, except before end Iam reading this wonderful piece
    of writing to increase my know-how.

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