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The role of theory in research to develop and evaluate the implementation of patient safety practices: Figure 1
Abstract
Theories provide a way of understanding and predicting the effects of patient safety practices (PSPs), interventions intended to prevent or mitigate harm caused by healthcare or risks of such harm. Yet most published evaluations make little or no explicit reference to theory, thereby hindering efforts to generalise findings from one context to another. Theories from a wide range of disciplines are potentially relevant to research on PSPs. Theory can be used in research to explain clinical and organisational behaviour, to guide the development and selection of PSPs, and in evaluating their implementation and mechanisms of action. One key recommendation from an expert consensus process is that researchers should describe the theoretical basis for chosen intervention components or provide an explicit logic model for ‘why this PSP should work.’ Future theory-driven evaluations would enhance generalisability and help build a cumulative understanding of the nature of change.
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“In this article, we join others in arguing that the explicit application of theory could shorten the time needed to develop improvement interventions, optimise their design, identify conditions of context necessary for their success, and enhance learning from those efforts.4–9”
From Demystifying theory and its use in improvement (2015) · cites this paper as [4]
In the citing paper
“In this article, we join others in arguing that the explicit application of theory could shorten the time needed to develop improvement interventions, optimise their design, identify conditions of context necessary for their success, and enhance learning from those efforts.4–9”
From Demystifying theory and its use in improvement (2015) · cites this paper as [4]
In the citing paper
“In this article, we join others in arguing that the explicit application of theory could shorten the time needed to develop improvement interventions, optimise their design, identify conditions of context necessary for their success, and enhance learning from those efforts.4–9”
From Demystifying theory and its use in improvement (2015) · cites this paper as [4]
In the citing paper
“In this article, we join others in arguing that the explicit application of theory could shorten the time needed to develop improvement interventions, optimise their design, identify conditions of context necessary for their success, and enhance learning from those efforts.4–9”
From Demystifying theory and its use in improvement (2015) · cites this paper as [4]
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“Certainly, having more theory-designed interventions that are reported clearly would make synthesis from a theoretical perspective more efficient[3,6] but without a comprehensive approach to understanding the theoretical basis for the effects of A&F, a hit and miss approach to designing A&F interventions will likely p…”
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“…performance beyond satisfaction and knowledge acquisition (Alper, Rosenberg, O’Brien, Fischer, & Durning, 2009; Bell, Moorman, & Delbanco, 2010; Foy et al., 2011; Gunderson, Smith, Mayer, McDonald, & Centomani, 2009; Halbach & Sullivan, 2005; Kane, Branne, & Kern, 2008; Lucian Leape…”
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Self-citationTell me about the context, and more
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“TMFs offer an efficient way of generalising findings across diverse settings by providing explicit explanations of implementation-related phenomena: they provide a common language and facilitate shared understanding across disciplines [32, 33].”
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“Theoretical models are valuable because they provide a mechanism for identifying the factors that influence behaviour, and form the basis of developing interventions which can be systematically evaluated to examine what works, for whom and how (6, 30).”
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Measuring implementation: development of the implementation process assessment tool (IPAT)
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“Further, this may have obstructed the translation of the results back to theory [37, 38].”
Self-citationTheorizing is for everybody: Advancing the process of theorizing in implementation science
Meza, R. D., Moreland, J. C., Pullmann, M. D., Klasnja, P., Lewis, C. C., & Weiner, B. J. (2023) · Frontiers in Health Services · doi:10.3389/frhs.2023.1134931 · Cited by 27
“As such, they support efficiency in generalizing knowledge across contexts (3).”
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“Shekelle and colleagues emphasize how important it is that researchers clarify why they believe the intervention should work—that is, a study should articulate a theory of action (3).”
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“This paper aims to provide an in depth analysis of the organisational context in which ED management of mTBI and implementation of new practices occurs, drawing upon organisational level theory [20].”
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Nnaji, C. A., Wiysonge, C. S., Lesosky, M., Mahomed, H., & Ndwandwe, D. E. (2021) · Vaccines · doi:10.3390/vaccines9070691 · Cited by 19
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“A wide range of methods exist for the identification of these factors [37,38], including the use of theories of behavioural change [39,40].”
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“Many of the articles published under its aegis draw on a social scientific framework within which the role of theory in evaluating interventions has an important place (Foy et al., 2011).”
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Mishoe, S. C., Tufts, K. A., Diggs, L. A., Blando, J. D., Claiborne, D. M., Hoch, J. M., & Walker, M. L. (2018) · Journal of Research in Interprofessional Practice and Education · doi:10.22230/jripe.2018v8n1a264 · Cited by 16
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Rebalancing risk management-Part 1: The Process for Active Risk Control (PARC)
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A nudge towards increased experimentation to more rapidly improve healthcare
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“20 24 Randomised trials of prescribing behaviour demonstrate the extent to which seemingly similar nudges can drastically differ in their effect.”
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Organising a manuscript reporting quality improvement or patient safety research
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Self-citationUse of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions
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Anticorruption practices in construction projects: looking through two theoretical lenses
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Teamwork and Teamwork Training in Health care: An Integration and a Path Forward
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“This study emphasizes the complexity of the implementation processes involved in improvement initiatives, which include implementation strategies for behavioral, system and context-related factors and requires interdisciplinary collaboration (Foy et al., 2011). Although not specifically highlighted by Salas and collea…”
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A Library of Logic Models to Explain How Interventions to Reduce Diagnostic Errors Work
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“1,6,14,15 For example, although an effective training program may have been developed, the intervention developers do not consider how to ensure that all clinicians attend the training and subsequently apply their new knowledge once they are back in practice.”
Background
Metadata
- Authors
- Foy, R., Ovretveit, J., Shekelle, P. G., Pronovost, P. J., Taylor, S. L., Dy, S., Hempel, S., McDonald, K. M., Rubenstein, L. V., & Wachter, R. M.
- Affiliations
- University of Leeds (GB)
- RAND Corporation (US)
- Johns Hopkins University (US)
- Stanford University (US)
- University of California, San Francisco (US)
- Corresponding author
- Foy, Robbie
- ORCID
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2011-02-11
- Volume
- 20
- Issue
- 5
- Pages
- 453-459
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- OpenAlex
- W2116131319
- Cited by
- 148
- References
- 49
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 8 · 2019: 16 · 2018: 14 · 2017: 13 · 2016: 8 · 2015: 11 · 2014: 7 · 2013: 11 · 2012: 8
- FWCI
- 20.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Keywords
- patient safety measures, theory-based evaluation, implementation evaluation, logic model, generalizability, intervention development, mechanism of action, expert consensus, organizational behavior
- MeSH terms
- Health Services Research, Humans, Models, Theoretical, Planning Techniques, Psychological Theory, Models, Organizational, Safety Management
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