Valuing Healthcare Improvement: Implicit Norms, Explicit Normativity, and Human Agency

Health Care Anal. 2018 Jun;26(2):189-205. doi: 10.1007/s10728-017-0350-x.


I argue that greater attention to human agency and normativity in both researching and practicing service improvement may be one strategy for enhancing improvement science, illustrating with examples from cancer screening. Improvement science tends to deliberately avoid explicit normativity, for paradigmatically coherent reasons. But there are good reasons to consider including explicit normativity in thinking about improvement. Values and moral judgements are central to social life, so an adequate account of social life must include these elements. And improvement itself is unavoidably normative: it assumes that things could and should be better than they are. I seek to show that normativity will always be implicated in the creation of evidence, the design of programs, the practice of healthcare, and in citizens' judgements about that care, and to make a case that engaging with this normativity is worthwhile.

Keywords: Cancer screening; Community participation; Early detection of cancer; Ethics; Evidence based medicine; Health policy; Implementation science; Improvement science; Knowledge translation; Social values.

MeSH terms

  • Community Participation
  • Delivery of Health Care*
  • Early Detection of Cancer
  • Evidence-Based Medicine*
  • Health Policy
  • Humans
  • Judgment
  • Quality Improvement*
  • Social Norms*