Pseudoinnovation: the development and spread of healthcare quality improvement methodologies
Abstract
BACKGROUND: Over the last two decades, we have seen the successive rise and fall of a number of concepts, ideas or methods in healthcare quality improvement (QI). Paradoxically, the content of many of these QI methodologies is very similar, though their presentation often seeks to differentiate or distinguish them. METHODS: This paper sets out to explore the processes by which new QI methodologies are developed and disseminated and the impact this has on the effectiveness of QI programmes in healthcare organizations. It draws on both a bibliometric analysis of the QI literature over the period from 1988 to 2007 and a review of the literature on the effectiveness of QI programmes and their evaluation. RESULTS: The repeated presentation of an essentially similar set of QI ideas and methods under different names and terminologies is a process of 'pseudoinnovation', which may be driven by both the incentives for QI methodology developers and the demands and expectations of those responsible for QI in healthcare organizations. We argue that this process has important disbenefits because QI programmes need sustained and long-term investment and support in order to bring about significant improvements. The repeated redesign of QI programmes may have damaged or limited their effectiveness in many healthcare organizations. CONCLUSIONS: A more sceptical and scientifically rigorous approach to the development, evaluation and dissemination of QI methodologies is needed, in which a combination of theoretical, empirical and experiential evidence is used to guide and plan their uptake. Our expectations of the evidence base for QI methodologies should be on a par with our expectations in relation to other forms of healthcare interventions.
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A wide range of diverse and inconsistent terminology exists in the field of knowledge translation.
“A wide range of diverse and inconsistent terminology exists in the field of knowledge translation.”
From Towards a common terminology: a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies (2014) · cites this paper as [2]
In an analysis of titles and abstracts of over 20,000 quality improvement publications, Walshe found that authors used numerous different terms to present an essentially similar set of approaches, with terms changing in frequency of use over time.
“in an analysis of the titles and abstracts of over 20,000 quality improvement publications, Walshe found that authors used numerous different terms to present an essentially similar set of approaches, with terms changing in frequency of use over time [2].”
From Towards a common terminology: a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies (2014) · cites this paper as [2]
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- Authors
- Walshe, K.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Walshe, Kieran
- ORCID
- Walshe, Kieran
- Venue
- International Journal for Quality in Health Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-04-21
- Volume
- 21
- Issue
- 3
- Pages
- 153-159
- ISSN
- 1353-4505 (ISSN-L)
- 1464-3677
- OpenAlex
- W2131777996
- Cited by
- 208
- References
- 36
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 8 · 2021: 12 · 2020: 16 · 2019: 29 · 2018: 10 · 2017: 15 · 2016: 18 · 2015: 19 · 2014: 17 · 2013: 12 · 2012: 11
- FWCI
- 18.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal for Quality in Health Care (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- healthcare quality improvement, quality improvement methods, healthcare organizations
- MeSH terms
- Delivery of Health Care, Diffusion of Innovation, Quality Assurance, Health Care, Review Literature as Topic, Bibliometrics
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