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Cited by 153Healthcare Quality and ManagementHealth Policy Implementation SciencePatient Safety and Medication Errors

What are the most effective strategies for improving quality and safety of health care?

Scott, I.·2009·Internal Medicine Journal
DOI 10.1111/j.1445-5994.2008.01798.x
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Abstract

There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy‐maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS‐related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta‐review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy‐maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician‐directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small‐group case discussions, and patient‐mediated clinician reminders. Pay‐for‐performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy‐maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy‐maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.

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  • This rush to implementation often results in improvement interventions that are not clear about the specifics of desired behaviours, the social and technical processes they seek to alter, the means by which the proposed interventions might achieve their hoped-for effects in practice, and the methods by which their impact will be assessed.

    “This rush to implementation often results in improvement interventions that, while attractive in concept, are not clear about the specifics of the desired behaviours, the social and technical processes they seek to alter, the means by which the proposed interventions might achieve their hoped-for effects in practice, and the methods by which their impact will be assessed.37”

    From Demystifying theory and its use in improvement (2015) · cites this paper as [37]

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Authors
Scott, I.
Affiliations
Princess Alexandra Hospital (AU)
Corresponding author
Scott, I.
ORCID
Scott, I.
Venue
Internal Medicine Journal
Publisher
Wiley
Published
2009-06
Volume
39
Issue
6
Pages
389-400
ISSN
  • 1444-0903 (ISSN-L)
  • 1445-5994
DOI
10.1111/j.1445-5994.2008.01798.x
OpenAlex
W1966736499
Cited by
153
References
123
Citations by year
2026: 2 · 2025: 2 · 2024: 7 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 9 · 2019: 15 · 2018: 6 · 2017: 10 · 2016: 10 · 2015: 13 · 2014: 8 · 2013: 10 · 2012: 24
FWCI
2.54
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 31 d)
Locations
  • Internal Medicine Journal (publishedVersion)
  • PubMed (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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
quality improvement strategies, quality of care, patient safety, audit and feedback, clinical decision support systems, performance-based pay, continuous quality improvement, clinical governance, risk management, performance reporting, accreditation
MeSH terms
Humans, Quality of Health Care, Risk Factors, Safety, Safety Management

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