Planning and studying improvement in patient care: the use of theoretical perspectives

Milbank Q. 2007;85(1):93-138. doi: 10.1111/j.1468-0009.2007.00478.x.


A consistent finding in articles on quality improvement in health care is that change is difficult to achieve. According to the research literature, the majority of interventions are targeted at health care professionals. But success in achieving change may be influenced by factors other than those relating to individual professionals, and theories may help explain whether change is possible. This article argues for a more systematic use of theories in planning and evaluating quality-improvement interventions in clinical practice. It demonstrates how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality-improvement strategies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Decision Making, Organizational
  • Health Plan Implementation / organization & administration*
  • Humans
  • Interinstitutional Relations
  • Interprofessional Relations
  • Learning
  • Models, Organizational
  • Motivation
  • Organizational Culture
  • Organizational Innovation*
  • Systems Analysis*
  • Total Quality Management*